Geographic arbitrage

[nimbus]

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Is this a win win win for the patient, surgeon and employer? Cost to the payor is 12k vs 30k and the patient gets 5k cash back. Surgeon gets more up front and apparently doesn’t need to provide follow up care. Implant cost is lower.

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[urge]

Is this a win win win for the patient, surgeon and employer? Cost to the payor is 12k vs 30k and the patient gets 5k cash back. Surgeon gets more. Implant cost is lower.

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Too bad the anesthesiologist is not American trained.


Sounds like they need some tariffs.

 

[Mikkel]

Basically, less regulation and less administrative overhead results in lower costs?

 

[NICMAN]

Where does a patient turn when there are complications as there will certainly be at least a small percentage of complications. Could turn into a nightmare for some.

 

[deleted126335]

The implication was that the ortho pod flew down just for her surgery only. More likely he spent a week there with a PA or two and did quite a few total joints.

 

[nimbus]

The implication was that the ortho pod flew down just for her surgery only. More likely he spent a week there with a PA or two and did quite a few total joints.

That didn’t make sense to me either. Maybe they are ramping up in the early stages of this program.

 

[deleted171991]

Is this a win win win for the patient, surgeon and employer? Cost to the payor is 12k vs 30k and the patient gets 5k cash back. Surgeon gets more up front and apparently doesn’t need to provide follow up care. Implant cost is lower.

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Excellent. Hope more surgeons/patients will do this. The corrupt American insurance/hospital system needs to be fixed. Too many middlemen; a big racket built on the doctors' good names.

 

[pgg]

It's all fun and games until the hospital doesn't sterilize an instrument properly and 20% of the patients in a given week get infected prosthetics.

 

[okayplayer]

It's all fun and games until the hospital doesn't sterilize an instrument properly and 20% of the patients in a given week get infected prosthetics.

Exactly. It’s a third world country.

I practice in a “center of excellence” for total joints and we are insanely paranoid about infections (no personnel turnover mid case, etc etc). What is the practice in Mexico?

 

[anonperson]

Also, having an American doctor meant that if something went wrong, she could file a malpractice suit in the United States, she added

Straight from the article.

In a nut shell, one of the many reasons American health care is completely insane.

Bad outcome does not equal malpractice but scumbag lawyers have effectively trained the American public to think this way.

Sounds like a bad idea overall. Who deals with the potential complications immediately post op? How about delayed ones a few weeks out?

I have no desire to get my medical care in a third world country.

 

[deleted171991]

I can completely understand why the public would be reassured by the ability to file a malpractice lawsuit. One of the reasons American doctors have much better ethics than non-physicians is exactly that. As a doctor watching suboptimal care happen to my patients, I sometimes regret that not everybody in the hospital can be sued.

Also, just because a hospital is in a developing country it doesn't mean that they can't adhere to first-world safety standards. Especially if private. Nobody wants to kill the goose with the golden eggs. There are few, if any, bigger moneymakers than first-world medical tourism, for a second-world hospital.

It's more likely to get better care in the States, but it's not a given. Your money goes much further in a poorer country.

 

[narcusprince]

I smell bs..... One hour surgical op time for a total knee? Those op times seem a little manufactured. Too much risk involved in care. The first “complication” that occurs and the costs for this system will be driven astronomically higher. Im skeptical.

 

[nimbus]

I have no doubt that the Mexican hospital is capable of providing similar outcomes for these procedures compared to a US hospital. My problem with this model is that when the same patient has a stroke, STEMI, or gets run over by a bus, the Mexican hospital does not have to take care of them. They are taking the easy elective high paying work and leaving the expensive, resource intensive emergency work to the local American hospital. When that local hospital shuts down and there’s no place to go, the patients will have no one to blame but themselves.

 

[nimbus]

I smell bs..... One hour surgical op time for a total knee? Those op times seem a little manufactured. Too much risk involved in care. The first “complication” that occurs and the costs for this system will be driven astronomically higher. Im skeptical.

I’ve worked with a couple of surgeons who do 50min total knees. It’s not that uncommon.

 

[deleted171991]

I have no doubt that the Mexican hospital is capable of providing similar outcomes for these procedures compared to a US hospital. My problem with this model is that when the same patient has a stroke, STEMI, or gets run over by a bus, the Mexican hospital does not have to take care of them. They are taking the easy elective high paying work and leaving the expensive, resource intensive emergency work to the local American hospital. When that local hospital shuts down and there’s no place to go, the patients will have no one to blame but themselves.

On the other hand, if more local hospitals shut down, people would start paying attention to the reason, i.e. Medicare/Medicaid/insurance reimbursements, instead of wishing for Medicare For All (only for my enemies).

 

[mdan]

I’ve worked with a couple of surgeons who do 50min total knees. It’s not that uncommon.

Yep. 35 min tourniquet time. 60 min doable if turnover is good.

 

[Hoya11]

Is this a win win win for the patient, surgeon and employer? Cost to the payor is 12k vs 30k and the patient gets 5k cash back. Surgeon gets more up front and apparently doesn’t need to provide follow up care. Implant cost is lower.

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isnt this another orthopod endangering a patient in the name of money?

he would have made some money if he did this case in the US. he made more money doing it in mexico and putting the patient in a dangerous spot if there were any complications.. arrogant surgeon, dumb patient

 

[Mman]

I’ve worked with a couple of surgeons who do 50min total knees. It’s not that uncommon.

I get sad if our total knee patients are in the OR for an hour. The surgical time should be something like 35-45 minutes for a straightforward case.


Also I'm no lawyer but am curious how a malpractice suit would get brought in such a situation. Which state's court system has jurisdiction over something done in a foreign country?

 

[Ronin786]

It's all fun and games until the hospital doesn't sterilize an instrument properly and 20% of the patients in a given week get infected prosthetics.

They set up their own autoclave.

 

[deleted480308]

I have no doubt that the Mexican hospital is capable of providing similar outcomes for these procedures compared to a US hospital. My problem with this model is that when the same patient has a stroke, STEMI, or gets run over by a bus, the Mexican hospital does not have to take care of them. They are taking the easy elective high paying work and leaving the expensive, resource intensive emergency work to the local American hospital. When that local hospital shuts down and there’s no place to go, the patients will have no one to blame but themselves.

No hospital should be required to lose money on a procedure, then there is no reason for govt to trap high profit procedures in certain locations to cover losses

 

[Planktonmd]

I get sad if our total knee patients are in the OR for an hour. The surgical time should be something like 35-45 minutes for a straightforward case.


Also I'm no lawyer but am curious how a malpractice suit would get brought in such a situation. Which state's court system has jurisdiction over something done in a foreign country?

It seems that the company is U.S. based so that company would be targeted in whatever state they do business, and the physician would be sued as an agent of that company in that state.

 

[deleted59964]

how’s the air con system ? filtration rate,? positive pressure?

how’s the sterilisation quality control?
what about the sterility of consumables?

who’s giving the anaesthetic?

what if there is a complication?
infection
dvt / pe / ami

medical tourism is rolling the dice in my opinion.

 

[deleted171991]

isnt this another orthopod endangering a patient in the name of money?

he would have made some money if he did this case in the US. he made more money doing it in mexico and putting the patient in a dangerous spot if there were any complications.. arrogant surgeon, dumb patient

Why do you assume Mexico always equals bad care? Ask yourself that.

I have met people who had a ketamine coma in Mexico, for a week or so, and got off opiates, back when America was not even admitting to our opiate problem.

I do agree about rolling the dice. But that applies to the US, too, just in a smaller measure. Let's just admit that first-world countries don't have a monopoly on good medical care. For example, I don't think 1:4 supervision is good anesthetic care, regardless of the anesthesiologist, if you know what I mean. 😉

 

[deleted162650]

I have long held the belief that there are a few things in life you do not want to bargain shop for. Surgery and airplanes are at the top of that list

 

[deleted171991]

I have long held the belief that there are a few things in life you do not want to bargain shop for. Surgery and airplanes are at the top of that list

And still we compromise on our anesthetics in the name of Profit. Every single ACT group. Most of us would refuse non-physician care, and yet we push it on our patients.

The most disappointing thing I encountered recently was when the specialist whom I had been seeing for years tried to convince me (with an APRN present) that I could just see one of his APRNs next time (instead of waiting 4-6 months to see him). And he's a well-respected full tenured professor, not just a cog. So please stop drinking the American corporate medicine kool-aid. There is a reason the concierge medicine model is flourishing, whether here or abroad.

 

[dannyboy1]

how’s the air con system ? filtration rate,? positive pressure?

how’s the sterilisation quality control?
what about the sterility of consumables?

who’s giving the anaesthetic?

what if there is a complication?
infection
dvt / pe / ami

medical tourism is rolling the dice in my opinion.

This is a routine case on carefully selected healthy patients. Do you really think that the medical device company can’t figure out how to keep their $hit clean ? Of course we all feel threatened by competition but overall this seems reasonably safe ....

 

[VA Hopeful Dr]

So this is interesting. You can fly to Mexico to get a knee replacement for 12k.

Or, you can go to Oklahoma and get it done for 16k: Total Knee Arthroplasty (Knee Replacement) | Surgery Prices | Surgery Center of Oklahoma

I'd pay 4k more to stay in the US, personally.

 

[deleted171991]

So this is interesting. You can fly to Mexico to get a knee replacement for 12k.

Or, you can go to Oklahoma and get it done for 16k: Total Knee Arthroplasty (Knee Replacement) | Surgery Prices | Surgery Center of Oklahoma

I'd pay 4k more to stay in the US, personally.

At least in Oklahoma and Mexico you know ahead what your bill will show in 95+% of the cases (the rest being the unforeseen complications).

We wouldn't get into a taxi that can't predict the fare with reasonable error. Why do we get into a facility like that, especially for elective procedures? Just because it has a good brand (usually built on the inflated facility fees and marketing expenses, not on true quality and word of mouth), and negotiated rates with co-conspirator insurance companies, it's still a racket.

 

[deleted59964]

This is a routine case on carefully selected healthy patients. Do you really think that the medical device company can’t figure out how to keep their $hit clean ? Of course we all feel threatened by competition but overall this seems reasonably safe ....

Every suture, every drape, they are all potential sources of implant infection.
I’m sure they’re sterile when leaving the factory, not so confident by the time they’re opened.

We get people going to Thailand, Indonesia, and the Philippines - mostly for stupid cosmetic surgery that we don’t do in the public system. No way would I get a joint replacement in a developing country.

By the way, 90% of my practice is as a government employee - i’m Immune to competition (for the foreseeable future). I lose nothing if joe blow wants to get his knee done in Manila, or barbie wants her boobs done in bali.

 

[VA Hopeful Dr]

At least in Oklahoma and Mexico you know ahead what your bill will show in 95+% of the cases (the rest being the unforeseen complications).

We wouldn't get into a taxi that can't predict the fare with reasonable error. Why do we get into a facility like that, especially for elective procedures? Just because it has a good brand (usually built on the inflated facility fees and marketing expenses, not on true quality and word of mouth), and negotiated rates with co-conspirator insurance companies, it's still a racket.

Preaching to the choir, I owned a cash-only office for a number of years so I've seen just how insane a lot of medical billing is.

My favorite story from those days: I had a patient who made decent money but no insurance. He had enlarged tonsils - not huge, but enough that they caused trouble and he wanted them out. The hospital employed ENT he was seeing said that he could do the surgery for $500 but the hospital-owned OR for that procedure (including anesthesia) was going to be $15,000.

I called up an ENT who was part of a private group that owned their own ASC. Procedure fee cash price: $250. OR fee including anesthesia? $1,200.

Now I get that hospitals have lots of overheard since they are open 24/7 and do a lot of uncompensated care. But over an order of magnitude difference? That's just ridiculous.

 

[Ronin786]

So this is interesting. You can fly to Mexico to get a knee replacement for 12k.

Or, you can go to Oklahoma and get it done for 16k: Total Knee Arthroplasty (Knee Replacement) | Surgery Prices | Surgery Center of Oklahoma

I'd pay 4k more to stay in the US, personally.

The patient also got a $5k check in the mail. Obviously going abroad for surgery is rolling the dice, but this is a situation where a US-based company is going and ensuring that things are up to par. Done correctly, this is a very feasible model that includes significant cost savings and gets around a lot of the bloat in our health care system. If anything, it might push our hospitals to fix their game.

 

[VA Hopeful Dr]

The patient also got a $5k check in the mail. Obviously going abroad for surgery is rolling the dice, but this is a situation where a US-based company is going and ensuring that things are up to par. Done correctly, this is a very feasible model that includes significant cost savings and gets around a lot of the bloat in our health care system. If anything, it might push our hospitals to fix their game.

That's part of the company benefits, has nothing to do with the surgery itself. I've seen stories of companies doing the same thing with the place in Oklahoma as a way to incentivize patients to be willing to travel outside of their home location to have surgery.

 

[Hoya11]

Why do you assume Mexico always equals bad care? Ask yourself that.

I have met people who had a ketamine coma in Mexico, for a week or so, and got off opiates, back when America was not even admitting to our opiate problem.

I do agree about rolling the dice. But that applies to the US, too, just in a smaller measure. Let's just admit that first-world countries don't have a monopoly on good medical care. For example, I don't think 1:4 supervision is good anesthetic care, regardless of the anesthesiologist, if you know what I mean. 😉

while your right that i dont have any evidence for it, i do indeed feel scared to be cared for for something serious in mexico vs a major US city

 

[urge]

Basically, less regulation and less administrative overhead results in lower costs?

Yes, but it is not only that.

Salaries are way lower there. You are saving on all the salaries of the nurses, the anesthesiologist, the orderly, the cleaning staff, the knee rep., the kitchen people, and all the way to the truck drivers that supply the hospital.

This system basically says everyone is over paid except the surgeon.

In the end it is a recipe for economic disaster if we end up exporting all the manufacturing plus the services too. The first people to tap this scheme will benefit but in the end everyone ends up screwed.

 

[dhb]

I've seen better private clinics in third world countries than in first world countries.
Which doesn't mean i'd travel yhere for medical care.

 

[pgg]

This is a routine case on carefully selected healthy patients. Do you really think that the medical device company can’t figure out how to keep their $hit clean ? Of course we all feel threatened by competition but overall this seems reasonably safe ....

Last summer I worked overseas for a few months in something of a visiting professor sort of role.

The infection and explant rate for their total joint program that they admitted to was over 20%. The joint-receiving patient population was all cash pay. If they got infected, they paid cash for the explant and then later they paid cash to try again. It was just normal and expected.

As much as I cringe when I see anyone from JCAHO turn the corner at my hospital, after that trip I had to admit that some kind of clipboard commando from some accrediting agency is needed for enforcing basic standards.

There is some dodgy **** going on out there. Buyer beware.

 

[Mikkel]

Last summer I worked overseas for a few months in something of a visiting professor sort of role.

The infection and explant rate for their total joint program that they admitted to was over 20%. The joint-receiving patient population was all cash pay. If they got infected, they paid cash for the explant and then later they paid cash to try again. It was just normal and expected.

As much as I cringe when I see anyone from JCAHO turn the corner at my hospital, after that trip I had to admit that some kind of clipboard commando from some accrediting agency is needed for enforcing basic standards.

There is some dodgy **** going on out there. Buyer beware.

Open up a competing hospital, institute high standards, get your explant rate under 5%.

Once you become the best hospital in town, increase price for the original surgery because you can point to fewer infections.

 

[deleted171991]

@pgg, a state hospital in THAT developing country cannot be compared to some private hospitals elsewhere. It's apples and oranges.

Regardless, I do agree with buyer beware. I personally don't go to Mexico even for tourism.

 

[pgg]

@pgg, a state hospital in THAT developing country cannot be compared to some private hospitals elsewhere. It's apples and oranges.

That's a fair point, but there were some medical tourists from nearby countries present ...

 

[deleted171991]

That's a fair point, but there were some medical tourists from nearby countries present ...

I guess there is always worse.

 

[deleted171991]

So this is interesting. You can fly to Mexico to get a knee replacement for 12k.

Or, you can go to Oklahoma and get it done for 16k: Total Knee Arthroplasty (Knee Replacement) | Surgery Prices | Surgery Center of Oklahoma

I'd pay 4k more to stay in the US, personally.

Just FYI: the reason SCO can put their prices online is because they don't take any federal money. Let me repeat that: if one takes Medicare/Medicaid money, one is not allowed to publish one's prices online. How corrupt is that?

What is direct primary care? An alternative form of health care avoids insurance altogether

As Americans grapple with a health care system that costs $10,000 per person annually, a form of health care that avoids the insurance system is starting to become an alternative option.

finance.yahoo.com

 

[VA Hopeful Dr]

Just FYI: the reason SCO can put their prices online is because they don't take any federal money. Let me repeat that: if one takes Medicare/Medicaid money, one is not allowed to publish one's prices online. How corrupt is that?

What is direct primary care? An alternative form of health care avoids insurance altogether

As Americans grapple with a health care system that costs $10,000 per person annually, a form of health care that avoids the insurance system is starting to become an alternative option.

finance.yahoo.com

I did direct primary care for 3 years, FYI.

But yeah the secrecy of healthcare pricing is quite shady.