Ent sergery, average hourly pay?

[mike liz]

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Hi,

I have an 8 year old that needs a "Tympanoplasty with radical mastoidectomy" done this month. It should take 3 1/2 hours, to do the the surgery.Our (private practice) doctor sent us an estimate for the surgery, it would be $1200.00 per hour. That's just for his fee.

That's seems way to much!!! We need to see him in a few weeks for a pre opt visit. We need to find any info. on the what it cost per hour on average. Maybe he will change the estimate for us.

The doctor's billing supervisor said they can't take our goverment insurance because it only pays $364.00 an hour, for the Dr's fee.


Thank you for any help, we can't find any hourly fees for private practice Ent doctors.


All the Ent Doc's work at the same place in the city, which is 1 hour away. The next town is 2 hours away.

Mike

 

[BOOURNS]

I'll paint your car for $199.99!

Seriously though, surgeons usually don't charge by the hour. Unless they went to Hollywood Upstairs Medical College.

 

[tkim]

surgeons charge by the operation, not by the hour.

 

[Leforte]

As already pointed out. Surgeons are paid by the operation, not by the hour. $1200 for a tympanomastoidectomy would be approximately what medicare would pay depending on location. Medicaid is less (sometimes substantially less) and private insurance is sometimes a little more.

Your surgeon may be quoting what he/she bills for the operation. What they collect is often ~35% from the insurance companies (can be higher or lower dependent upon a TON of factors, which is a whole other issue). If they are quoting you a fee, you are likely being quoted the fee that they would bill an insurance company, and not necessarily what they would collect.

If they do not take your insurance, you have several options. 1) You can pay their fee, 2) You can find another surgeon who does accept your insurance plan, 3) You can negotiate with your original surgeon for a reduced fee, 4) You can elect to not have the operation.

You'll also need to ensure that the anesthesiologist either takes your insurance, or you'll need to find their fee, too, for payment of the operation. Anesthesiologist often are paid for their services by the amount of time that they are involved in the patients care, unlike surgeons.

Then there is the hospital/surgical center fee.

If there is any pathology, there will be their fee, too, for processing and reading the pathology.

While $1200 sounds like a lot of money for a tympanomastoidectomy - remember that while the surgeon is operating, they are still paying for the clinic nurses, front desk staff, billers, coders, medical assistants, practice rent, overhead, malpractice, medical insurance for their employees, disability insurance, social security and benefits for employees, etc, etc, etc. Moreover, with a 90 day global, most postoperative care is included in the reimbursement for the surgery. If I do a neck dissection for a cancer and the patient ends up in the hospital for a week or two for whatever reason, I would not get paid for all subsequent care (rounding, discharge planning, etc, etc) while they are admitted and several months postoperatively.

You also have to consider the risk and skill required for the operation. Taking a drill to someones skull and removing infected bone and tissue around 1) the nerve that controls your face, 2) canals that control your balance and equilibrium, 3) microscopic bones that are involved in hearing, 4) the brain, 5) sigmoid sinus, etc, etc carries a substantial risk. A set of tubes may pay $100-$150. There is considerably less risk in performing eight sets of tubes for $1200 than a tympanomastoidectomy for the same amount of money. Both of theses (eight sets of tubes in eight patients or a single tympanomastoidecomy) would take a similar amount of time to perform. Far more risk with the tympanomastoidectomy, however. The global period is less for tubes, too.

Many otolaryngologists actually make less money in the operating room than they do in the clinic -

 

[resxn]

Mike,

I understand your concern, but agree with LeForte. I would be very surprised if your surgeon quoted you an hourly rate. We're not lawyers, we don't do that. If it is a tympanomastoidectomy (CPT 69635), Medicare will pay on avg $1257.97 for that 3.5 hour procedure. If you're only being charged $1200, you're getting a deal. If you're being charged $3600 or more, find another surgeon.

You'll still have charges for the OR, anesthesiologist, pathologist, and in an 8yo, sometimes an overnight stay in the hospital--you should know that ahead of time.

Personally, I think that $1200 is a total steal for that type of surgery and you should do what you can to take it if you are paying out of pocket. Depending on your gov insurance (Tricare, Medicare, or Medicaid), many doctors don't take these because they end up losing money in the care of these patients. What you think is expensive is not. If you're doc is anything like me, he'll end up taking home around $300 profit on your son's surgery. The rest covers all of his overhead expenses. You might think $100/hr is a lot, but that's misleading. Because of the 90-day global and your f/u visits including not only his face-to-face time with your son, but the time it takes to document the visit, clean his ears out, sterilize the equipment used to clean the ear, document that the sterilizer is working appropriate (req by your gov insurance), etc, he's probably making about $45/hr overall on that surgery.

No chump change for sure, but given the risk that's involved that LeForte described so well, it's sometimes not worth the stress we go through.

Also, as far as publishing fees, your US gov has decided that physicians cannot post their fees publicly because it violates antitrust laws, so the only way you can find out what a physician will charge is to ask them. Most aren't going to tell you unless they can evaluate your son first and, of course, this costs money as well.

It's not a good system in terms of cost containment, but believe me, your local ENT doctor feels the same way you do.