Medicare Facility Fees

[heybrother]

I hadn't seen this before but found it fascinating.

Procedure Price Lookup for Outpatient Services | Medicare.gov

Use official Procedure Price Lookup tool to compare national average to Medicare costs in ambulatory surgical centers, hosptial outpatient departments

www.medicare.gov

Essentially, Medicare gives an "average" doctor fee and facility fee for ASCs vs hospital outpatient. Value is only for 1 procedure so some of the utility is limited, but its still interesting. I obviously don't care about the average doctor fee since I can look it up for my area. Does anyone have anything interesting or different to add? Smattering of procedures below. I don't know if there's a more efficient place to get this information or a way to get for my specific locality.

My thoughts - hopefully reorganized/straightened out by wiser people:

-I figured the centers would get paid more for the boring generic forefoot stuff ie. Austin's and toes and such.

-If you perform an Austin and you are doing anything besides a single screw or a k-wire ie. I saw a thing where people were plating Austin's - it seems like you are costing the ASC money

-Add the word fusion and things seem to jump. I figured the ASC would like the Austin surgeon better than the 1st MPJ fusion surgeon, but if your hardware is cheap they actually come out ahead on you...


Procedure - ASC - Outpatient
PIPJ fusion 28285 - $1286 - $2737
Austin - 28296 - $1286 - $2737
Cheilectomy - $1286 - $2737
Lapidus -28297 - $4020 - $5981
1st MPJ fusion - 28750 - $4068 - $5981
Midtarsal multi - 28730 - $8734 - $11900
Triple - 28715 - $8838 - $11900
Ankle fusion - 27870 - $8448 - $11900
Subtalar joint fusion - 28725 - $8118 - $11900
Gastrocnemius Recession - 27687 - $1286 - $2737
2ndary Achilles repair - 27654 - $2803 - $5981

Now I know how they pay for you fancy hospital podiatrists...?

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[air bud]

I hadn't seen this before but found it fascinating.

Procedure Price Lookup for Outpatient Services | Medicare.gov

Use official Procedure Price Lookup tool to compare national average to Medicare costs in ambulatory surgical centers, hosptial outpatient departments

www.medicare.gov

Essentially, Medicare gives an "average" doctor fee and facility fee for ASCs vs hospital outpatient. Value is only for 1 procedure so some of the utility is limited, but its still interesting. I obviously don't care about the average doctor fee since I can look it up for my area. Does anyone have anything interesting or different to add? Smattering of procedures below. I don't know if there's a more efficient place to get this information or a way to get for my specific locality.

My thoughts - hopefully reorganized/straightened out by wiser people:

-I figured the centers would get paid more for the boring generic forefoot stuff ie. Austin's and toes and such.

-If you perform an Austin and you are doing anything besides a single screw or a k-wire ie. I saw a thing where people were plating Austin's - it seems like you are costing the ASC money

-Add the word fusion and things seem to jump. I figured the ASC would like the Austin surgeon better than the 1st MPJ fusion surgeon, but if your hardware is cheap they actually come out ahead on you...


Procedure - ASC - Outpatient
PIPJ fusion 28285 - $1286 - $2737
Austin - 28296 - $1286 - $2737
Cheilectomy - $1286 - $2737
Lapidus -28297 - $4020 - $5981
1st MPJ fusion - 28750 - $4068 - $5981
Midtarsal multi - 28730 - $8734 - $11900
Triple - 28715 - $8838 - $11900
Ankle fusion - 27870 - $8448 - $11900
Subtalar joint fusion - 28725 - $8118 - $11900
Gastrocnemius Recession - 27687 - $1286 - $2737
2ndary Achilles repair - 27654 - $2803 - $5981

Now I know how they pay for you fancy hospital podiatrists...?

How do you think I remain employed at my salary seeing 30 patients a week and doing 50 cases a year...?

 

[dtrack22]

I hadn't seen this before but found it fascinating.

Procedure Price Lookup for Outpatient Services | Medicare.gov

Use official Procedure Price Lookup tool to compare national average to Medicare costs in ambulatory surgical centers, hosptial outpatient departments

www.medicare.gov

Essentially, Medicare gives an "average" doctor fee and facility fee for ASCs vs hospital outpatient. Value is only for 1 procedure so some of the utility is limited, but its still interesting. I obviously don't care about the average doctor fee since I can look it up for my area. Does anyone have anything interesting or different to add? Smattering of procedures below. I don't know if there's a more efficient place to get this information or a way to get for my specific locality.

My thoughts - hopefully reorganized/straightened out by wiser people:

-I figured the centers would get paid more for the boring generic forefoot stuff ie. Austin's and toes and such.

-If you perform an Austin and you are doing anything besides a single screw or a k-wire ie. I saw a thing where people were plating Austin's - it seems like you are costing the ASC money

-Add the word fusion and things seem to jump. I figured the ASC would like the Austin surgeon better than the 1st MPJ fusion surgeon, but if your hardware is cheap they actually come out ahead on you...


Procedure - ASC - Outpatient
PIPJ fusion 28285 - $1286 - $2737
Austin - 28296 - $1286 - $2737
Cheilectomy - $1286 - $2737
Lapidus -28297 - $4020 - $5981
1st MPJ fusion - 28750 - $4068 - $5981
Midtarsal multi - 28730 - $8734 - $11900
Triple - 28715 - $8838 - $11900
Ankle fusion - 27870 - $8448 - $11900
Subtalar joint fusion - 28725 - $8118 - $11900
Gastrocnemius Recession - 27687 - $1286 - $2737
2ndary Achilles repair - 27654 - $2803 - $5981

Now I know how they pay for you fancy hospital podiatrists...?

this is a good illustration of why some ASCs won’t even let you book cases on medicare patients who require any type of hardware.

Also an illustration of why the people who think a meaningful shift to surgical care in true Ambulatory Centers is the future, are completely wrong. Medicine is going to shift towards the model with a significantly lower reimbursement...lol...good one

 

[heybrother]

I'm curious about 1st MPJ fusions. I'll never get the love of a 2 screw person yet in general I think most people do some variation of plating over a screw. I'm under the impression the hardware (plate/screws) I use for this is $1000-1100. No reamer. No grafts. Just rongeur and round burr. No additional fancy products. Anyone know their hardware cost on this procedure if they are plating?

 

[air bud]

I'm curious about 1st MPJ fusions. I'll never get the love of a 2 screw person yet in general I think most people do some variation of plating over a screw. I'm under the impression the hardware (plate/screws) I use for this is $1000-1100. No reamer. No grafts. Just rongeur and round burr. No additional fancy products. Anyone know their hardware cost on this procedure if they are plating?

No, but I think disposable stuff and peel packed brings cost down fairly significantly. I do crossroads for almost all forefoot fusions. Plate/staple all peel packed. Reamers also that way.

 

[G0dFather]

Procedure - ASC - Outpatient
PIPJ fusion 28285 - $1286 - $2737
Austin - 28296 - $1286 - $2737
Cheilectomy - $1286 - $2737
Lapidus -28297 - $4020 - $5981
1st MPJ fusion - 28750 - $4068 - $5981
Midtarsal multi - 28730 - $8734 - $11900
Triple - 28715 - $8838 - $11900
Ankle fusion - 27870 - $8448 - $11900
Subtalar joint fusion - 28725 - $8118 - $11900
Gastrocnemius Recession - 27687 - $1286 - $2737
2ndary Achilles repair - 27654 - $2803 - $5981

Now I know how they pay for you fancy hospital podiatrists...?

Facility Wealth ..... Pod Labor....

 

[heybrother]

No, but I think disposable stuff and peel packed brings cost down fairly significantly. I do crossroads for almost all forefoot fusions. Plate/staple all peel packed. Reamers also that way.

Right before I got to my residency they had a weird episode I think with ...Trilliant (I think...feel bad naming them but I think it was them). They did a 1st MPJ with plates and screws which were "nearly free" and then got billed for like ...a $2000 reamer. Total cost stuff is interesting. Our OR hardware manager approached one time because we did 2 Jones fractures in a week. One was done with a synthes screw over a k-wire and it was $100 bucks. The other was done with a Stryker screw, but there was some sort of fancy guide and reamer and such that kept the price cranking up to like $1700-2000. The manager wanted to know if there was something inherently better about the screw.

 

[heybrother]

Facility Wealth ..... Pod Labor....

Yeah, I didn't include the doctor reimbursement cause it would make you scream.

I know some of these procedures can often be difficult, revisions, require more hardware etc, but looking at those prices I recall scrubbing an ankle fusion that was done in under an hour and with 3 screws. It was just another foot procedure in the mind of the people who did it... and theoretically a win for the facility as the patient went home same day. At first I typed big win, but I deleted big because...

My dad had a spinal fusion done last year. Discharged the morning after. Had some sort of Federal Blue Cross. He says to me - yeah, I got bills for about $150K - surgeon, anesthesia, hospital combined. I said - yeah, but you didn't pay that. He says - I paid like $5K and BC paid a bit over $95K.

I thought ...damn. Ortho spine. Holy crap.

 

[Feli]

...Lapidus -28297 ...

...whaaaaa? I always thought Lapidus was xx740 and xx292... with maybe xx900. Nevermind, you're right. I looked it up. 28297 it is.

...you can use steel plate (lock or non) and solid lag screw to do 1st MPJ, and I use steel lock plate with one cann steel screw for Lapidus. The steel ones are a lot cheaper (and stronger) than titanium plate and titanium cannulated screws sets. The only downside is they are a bit thicker, but most patients would sure rather have HWR than nonunion or malunion or something.

Screws alone works (heck, you should be able to do these procedures with any fixation option), but just think about what you'd want if it was your foot -esp on the Lapidus. The plates give you a LOT more wiggle room to WB earlier and protect the pt if they have a stumble or just decide to take the boot off early at 2-3wk mark "just to see if it might be ok and see how it felt walking barefoot around the house... it got kinda swollen after a couple days, though, so I put the boot back on." (literally had one of those today!)

As for fusions, yeah, they generally pay better. They also generally work better in any long term analysis, so win-win. Maybe the Cartiva captains and Cadence cavaliers and HyProCure hot shots and ArthroSurface admirals will quit accidentally sending me and other docs revision pts one day? Then again, I bet their patients are all "doing great" as far as they know since they never saw them after a year or so. Dunno.

 

[Utvolsdpm]

...whaaaaa? I always thought Lapidus was xx740 and xx292... with maybe xx900. Nevermind, you're right. I looked it up. 28297 it is.

...you can use steel plate (lock or non) and solid lag screw to do 1st MPJ, and I use steel lock plate with one cann steel screw for Lapidus. The steel ones are a lot cheaper (and stronger) than titanium plate and titanium cannulated screws sets. The only downside is they are a bit thicker, but most patients would sure rather have HWR than nonunion or malunion or something.

Screws alone works (heck, you should be able to do these procedures with any fixation option), but just think about what you'd want if it was your foot -esp on the Lapidus. The plates give you a LOT more wiggle room to WB earlier and protect the pt if they have a stumble or just decide to take the boot off early at 2-3wk mark "just to see if it might be ok and see how it felt walking barefoot around the house... it got kinda swollen after a couple days, though, so I put the boot back on." (literally had one of those today!)

As for fusions, yeah, they generally pay better. They also generally work better in any long term analysis, so win-win. Maybe the Cartiva captains and Cadence cavaliers and HyProCure hot shots and ArthroSurface admirals will quit accidentally sending me and other docs revision pts one day? Then again, I bet their patients are all "doing great" as far as they know since they never saw them after a year or so. Dunno.

Uh oh don’t let PMNews see this thread. They’re on a big anti fusion kick right now.

 

[G0dFather]

He says to me - yeah, I got bills for about $150K - surgeon, anesthesia, hospital combined. I said - yeah, but you didn't pay that. He says - I paid like $5K and BC paid a bit over $95K.

I thought ...damn. Ortho spine. Holy crap.

SAVAGE, they are the ones making millions and rightfully so ... hope dad is doing well now !

 

[heybrother]

Uh oh don’t let PMNews see this thread. They’re on a big anti fusion kick right now.

Anti-fuse is a lie. Many of these old surgeons are simply "Austin only" - when all you have is a hammer. Austins have plenty of indications but if its all you see and the only thing you can do I think it will cloud your judgement when it comes to addressing other pathology like 2nd MPJ and medial column issues.

When I get someone's else's unhappy Austin patient - most of the time everyone is sad, confused, etc I explain how its a perfectly common procedure that doesn't always go as desired. If the surgeon treated the patient like crap I simply show them their x-ray. They have almost never seen it. Why wouldn't you want to show a patient a beautiful x-ray

SAVAGE, they are the ones making millions and rightfully so ... hope dad is doing well now !

Thanks. Complete relief of radicular pain/symptoms. Woke up the morning after 99% improved. Saw him a month before - he had debilitating nerve pain in his leg and was losing muscle strength and reflexes. The foot was slapping the ground because he couldn't control it anymore. Couldn't walk up stairs. Saw him and thought - wow, I didn't think he'd deteriorate/die so quickly. The day he had it done there was a 30 year old guy having a revision back fusion done because he'd "started lifting weights again too quickly". That's a tough road to walk.

 

[heybrother]

...whaaaaa? I always thought Lapidus was xx740 and xx292... with maybe xx900. Nevermind, you're right. I looked it up. 28297 it is.

...you can use steel plate (lock or non) and solid lag screw to do 1st MPJ, and I use steel lock plate with one cann steel screw for Lapidus. The steel ones are a lot cheaper (and stronger) than titanium plate and titanium cannulated screws sets. The only downside is they are a bit thicker, but most patients would sure rather have HWR than nonunion or malunion or something.

Screws alone works (heck, you should be able to do these procedures with any fixation option), but just think about what you'd want if it was your foot -esp on the Lapidus. The plates give you a LOT more wiggle room to WB earlier and protect the pt if they have a stumble or just decide to take the boot off early at 2-3wk mark "just to see if it might be ok and see how it felt walking barefoot around the house... it got kinda swollen after a couple days, though, so I put the boot back on." (literally had one of those today!)

As for fusions, yeah, they generally pay better. They also generally work better in any long term analysis, so win-win. Maybe the Cartiva captains and Cadence cavaliers and HyProCure hot shots and ArthroSurface admirals will quit accidentally sending me and other docs revision pts one day? Then again, I bet their patients are all "doing great" as far as they know since they never saw them after a year or so. Dunno.

Had a lapidus walk in 1 week in a normal shoe earlier this year. Revised a 1st MPJ fusion by breaking it, realigning and plating. Walked into their 1st visit in a sandal. I thought - will I ever be able to write a short post-op note again.

I saw a guy for nail surgery the other day who had bilateral 1st MPJ fusions done. He told me (maybe he's misremembering) that the orthopedist (who is supposedly the best F&A in town) made him non-weight bearing for 3 months and in a boot for 4 months. I could definitely feel a prominent plate. I thought - who is the patient who could adhere to that regimen. Or more appropriately - who is the patient who WOULD adhere to that regimen. All my peeps just wanna walk.

Which brings me to the best moment of this past year.

Me: Now if you think you are going to fall down and you can put your foot down in the boot to save yourself you should ...
Patient interrupting me excitedly: FALL DOWN.
Me: No.