Medicine is nearing its end of life cycle. Midlevel surgeons submitting independent claims backed by private equity: NPR

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The Knee Surgeon Was In-Network. The Surgical Assistant Wasn't, And Billed $1,167

Izzy Benasso was playing a casual game of tennis with her father on a summer Saturday when she felt her knee pop. She had torn a meniscus, one of the friction-reducing pads in the knee, locking it in place at a 45-degree angle. Although she suspected she had torn something, the 21-year-old...
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Enjoy. Midlevel surgeons
 
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linkin06 said:
PE are scums.
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coffeebythelake said:
Wow. Scum.
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Not disagreeing with you guys, but before we throw stones —

“Chhabra and his colleagues at the University of Michigan recently found that 1 in 5 privately insured patients undergoing surgery by in-network doctors at in-network facilities still receive a surprise out-of-network bill.
Of those, 37% are from surgical assistants — tied with anesthesiologists as the most frequent offenders.”

Our colleagues aren’t any better
 
Urzuz said:
Not disagreeing with you guys, but before we throw stones —

“Chhabra and his colleagues at the University of Michigan recently found that 1 in 5 privately insured patients undergoing surgery by in-network doctors at in-network facilities still receive a surprise out-of-network bill.
Of those, 37% are from surgical assistants — tied with anesthesiologists as the most frequent offenders.”

Our colleagues aren’t any better
Click to expand...
I think a surgical assistant is a bit different than an anesthesiologist. And let's be real, if insurances wanted to pay reasonable rates, I bet most of those anesthesiologists would be happy to go in-network.
 
DocVapor said:
I think a surgical assistant is a bit different than an anesthesiologist. And let's be real, if insurances wanted to pay reasonable rates, I bet most of those anesthesiologists would be happy to go in-network.
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Completely agree. I just feel like getting a surprise bill from ANYONE after an elective surgery is scummy, regardless if they are essential like the anesthesiologist, or just “nice to have” like a PA...especially in a case like this where it says they did their due diligence beforehand.

And to be fair, I don’t even blame the PA in this case. If anyone is to blame, it’s the surgeon. Why didn’t he tell the patient beforehand that he needed help from a PA that may not be in network (I’m sure this isn’t the first time it’s come up, most patients probably just pay the bill and move on). Furthermore, what orthopedic surgeon needs an extra pair of hands for a meniscus?!?
 
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DocVapor said:
And let's be real, if insurances wanted to pay reasonable rates, I bet most of those anesthesiologists would be happy to go in-network.
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This is the real problem. Lots of spin though.

Also how smaller groups without “clout” get manhandled by certain insurers. Patients complain to the hospital and causes a headache for the group.
 
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Arch Guillotti said:
This is the real problem. Lots of spin though.
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Yeah, it should be called ‘Surprise Lack of Insurance Coverage’. This is actually a huge problem that would destroy medicine if insurers get their bills passed forcing docs to take median rates (or worse Medicare rates :dead:) if docs are out of network. There goes our ability to negotiate rates with insurers...
 
The real REAL problem as I see it is as follows:

1) hospital charges 100k for a knee scope. 30 min surgery
2) hospital ACCEPTS $3200 from insurer as payment in full

Hospitals and insurance companies have all the power. All of it. It’s a screwed up system not setup to benefit patients. Hospitals are allowed to charge unreasonable amounts making patients fully insurance dependent. If that poor girl has no insurance she’s financially screwed for life. Over a knee scope. That’s just not fair.
 
Southpaw said:
The real REAL problem as I see it is as follows:

1) hospital charges 100k for a knee scope. 30 min surgery
2) hospital ACCEPTS $3200 from insurer as payment in full

Hospitals and insurance companies have all the power. All of it. It’s a screwed up system not setup to benefit patients. Hospitals are allowed to charge unreasonable amounts making patients fully insurance dependent. If that poor girl has no insurance she’s financially screwed for life. Over a knee scope. That’s just not fair.
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As much as I hate the idea of single payer system, this is the one huge problem that it would solve. Seeing the power of insurance companies and hospitals evaporate overnight would be amazingly gratifying. Whether this gratification eases the pain of my bank account getting ****ed in the process...that remains to be seen.
 
Surgical assistants are not new, at least not in my state (Georgia), and neither are the games they play with charging. It's quite a racket.

SAs (CSAs, CFAs, even CSTs) are used quite frequently for any number of surgical procedures, and they generally are very competent at what they do and deserve compensation for it. I'm good friends with a number of them and have worked with them for years. However - their charges are outrageous, and most patients, including me, only find out after the fact what kind of games are played.

A number of our SAs work for a large national healthcare corporation whose name most of you would know. Others work for smaller groups or solo. Their "non-discounted" fee is often as much as, or even higher than the surgeon. Fortunately, a non-licensed healthcare provider in Georgia cannot collect on a balance bill for their services, so they take whatever insurance will pay them. If they know up front they won't get paid by insurance, they generally have an agreement with the hospital or surgeon for some sort of payment from them. That doesn't stop them from sending a statement to the patient, hoping they'll get paid more than the insurance allows. Fortunately patients will frequently question these outrageous bills. When the surgeon charges $5k for a lap chole, and accepts $1500 from the insurance company as full payment, and then the assistant comes along and tries to bill the same $5k, patients know something isn't right.

Also unfortunate is the fact that surgeons are frequently in on this racket as well. Often hidden in the mountain of pre-op forms a patient is asked to sign (and rarely reads) will be an acknowledgement or "consent" that the surgeon requires an assistant and that this assistant charges a separate fee that "may or may not be covered" by the patient's insurance, and that the patient agrees to pay the unpaid balance. Most of the time the patients never notice this - it's "just another form to sign". It's really shady for surgeons to participate in this racket - but I'm hardly surprised. At least I know better than to pay. Many patients have no idea.
 
Urzuz said:
Not disagreeing with you guys, but before we throw stones —

“Chhabra and his colleagues at the University of Michigan recently found that 1 in 5 privately insured patients undergoing surgery by in-network doctors at in-network facilities still receive a surprise out-of-network bill.
Of those, 37% are from surgical assistants — tied with anesthesiologists as the most frequent offenders.”

Our colleagues aren’t any better
Click to expand...

Many of those anesthesiologists are working for PE and have no idea how much is being billed and collected under their name.
 
Urzuz said:
Not disagreeing with you guys, but before we throw stones —

“Chhabra and his colleagues at the University of Michigan recently found that 1 in 5 privately insured patients undergoing surgery by in-network doctors at in-network facilities still receive a surprise out-of-network bill.
Of those, 37% are from surgical assistants — tied with anesthesiologists as the most frequent offenders.”

Our colleagues aren’t any better
Click to expand...
Exactly. Anesthesiologists are notorious for this.
 
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Arch Guillotti said:
private equity.
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I thought so. Except this article was talking about a private surgical assistant. Where did PE come in?

And I would like to know what people's opinion of a "fair" rate from insurance companies is. I hate the idea of the larger groups getting more than the small groups for sure, but what is fair? We know medicare sucks.

I would also like to add that there's a guy on here @aneftp, I believe, whose friend bills out of network in Dallas and makes $1M a year doing that. Is that fair? I mean when he sends patients these "surprise" bills should we be defending this behaviour? Or is it all part of scummy behavior? Plenty of anesthesiologists doing that all over. And Dallas is a decently reimbursed market lets be honest. Plenty of well to do people.

The whole system is a sick money grubbing game. Everyone is trying to as large a piece of a pie as they can and it's complete BS. I personally refuse to pay bills that I consider outrageous. I don't care if I have the money. Send it to collections. I don't care. A damn knee scope should not "cost" 97K.
 
chocomorsel said:
I thought so. Except this article was talking about a private surgical assistant. Where did PE come in?

And I would like to know what people's opinion of a "fair" rate from insurance companies is. I hate the idea of the larger groups getting more than the small groups for sure, but what is fair? We know medicare sucks.

I would also like to add that there's a guy on here @aneftp, I believe, whose friend bills out of network in Dallas and makes $1M a year doing that. Is that fair? I mean when he sends patients these "surprise" bills should we be defending this behaviour? Or is it all part of scummy behavior? Plenty of anesthesiologists doing that all over. And Dallas is a decently reimbursed market lets be honest. Plenty of well to do people.

The whole system is a sick money grubbing game. Everyone is trying to as large a piece of a pie as they can and it's complete BS. I personally refuse to pay bills that I consider outrageous. I don't care if I have the money. Send it to collections. I don't care. A damn knee scope should not "cost" 97K.
Click to expand...
Nah man. If they refuse to pay the out of network fee. They will usual negotiate a fee. It’s a starting point if they refuse.

So what’s worst. Being a small player and accepting $60-70 a unit in Dallas in network? While usap Dallas is getting $120/unit from same private insurance in network? So u Bill out of network. They come to the table eventually. It’s better than accepting low ball in network being a small company.

Yes. It’s all greed. But the docs working for usap are actually costing the system more money than a small player.

it’s just not just usap as we all know. It’s the whole system. Like the article mention. A knee scope at most should cost $5000-8000 cash rate including facility fee, anesthesia fee, surgeon fee.

look at Oklahoma surgery center that been in the news published its cash rate.

Surgery Frequently Asked Questons | Surgery FAQs | The Surgery Center of Oklahoma
 
secretasianman said:
Everything is a smoke and mirrors racket. Hospital bills for $97000 and accepts over $3000. What a joke.
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You know why? Because they in turn get to go to the federal government and chart the difference as unreimbursed expenses. It starts from the very top.

www.econtalk.org

Keith Smith on Free Market Health Care - Econlib

Entrepreneur and Anesthesiologist Keith Smith of the Surgery Center of Oklahoma talks with host Russ Roberts about what it’s like to run a surgery center that posts prices on the internet and that does not take insurance. Along the way, he discusses the distortions in the market for health care...
www.econtalk.org www.econtalk.org

This is an eye opening listen.
 
chocomorsel said:
I thought so. Except this article was talking about a private surgical assistant. Where did PE come in?

And I would like to know what people's opinion of a "fair" rate from insurance companies is. I hate the idea of the larger groups getting more than the small groups for sure, but what is fair? We know medicare sucks.

I would also like to add that there's a guy on here @aneftp, I believe, whose friend bills out of network in Dallas and makes $1M a year doing that. Is that fair? I mean when he sends patients these "surprise" bills should we be defending this behaviour? Or is it all part of scummy behavior? Plenty of anesthesiologists doing that all over. And Dallas is a decently reimbursed market lets be honest. Plenty of well to do people.

The whole system is a sick money grubbing game. Everyone is trying to as large a piece of a pie as they can and it's complete BS. I personally refuse to pay bills that I consider outrageous. I don't care if I have the money. Send it to collections. I don't care. A damn knee scope should not "cost" 97K.
Click to expand...

honestly, looking at careers as a whole, if i had to pick one career that should be making 1m each as a whole, id pick physicians. can you pick any other career to make the 1m/yr? should lawyers, police, ibankers, accountants, computer programmers, engineers, make the 1m / yr instead? you can argue no one should make it, but if i had to pick, id pick physicians. literally the longest training by far. and if you ask 1000 people whats the most important to them, most people i believe would pick health.
 
Ronin786 said:
You know why? Because they in turn get to go to the federal government and chart the difference as unreimbursed expenses. It starts from the very top.

www.econtalk.org

Keith Smith on Free Market Health Care - Econlib

Entrepreneur and Anesthesiologist Keith Smith of the Surgery Center of Oklahoma talks with host Russ Roberts about what it’s like to run a surgery center that posts prices on the internet and that does not take insurance. Along the way, he discusses the distortions in the market for health care...
www.econtalk.org www.econtalk.org

This is an eye opening listen.
Click to expand...
great podcast
 
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anbuitachi said:
honestly, looking at careers as a whole, if i had to pick one career that should be making 1m each as a whole, id pick physicians. can you pick any other career to make the 1m/yr? should lawyers, police, ibankers, accountants, computer programmers, engineers, make the 1m / yr instead? you can argue no one should make it, but if i had to pick, id pick physicians. literally the longest training by far. and if you ask 1000 people whats the most important to them, most people i believe would pick health.
Click to expand...
Nah. Most people would pick MONEY! It’s what this country is about. It’s what this discussion is about.

For sure not the lawyers unless we are talking public defenders. Those people get paid peanuts to help the most unfortunate members of society.

I went into medicine thinking I would-be making $250k and that was a nice chunk of change in my head. It still is to me.
 
chocomorsel said:
Nah. Most people would pick MONEY! It’s what this country is about. It’s what this discussion is about.

For sure not the lawyers unless we are talking public defenders. Those people get paid peanuts to help the most unfortunate members of society.

I went into medicine thinking I would-be making $250k and that was a nice chunk of change in my head. It still is to me.
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lol, possibly.

funny thing is as a premed, i was expecting around 300k doing medicine. that was many many years ago though so adjusting for inflation, im actually pretty close
 
Ronin786 said:
You know why? Because they in turn get to go to the federal government and chart the difference as unreimbursed expenses. It starts from the very top.

www.econtalk.org

Keith Smith on Free Market Health Care - Econlib

Entrepreneur and Anesthesiologist Keith Smith of the Surgery Center of Oklahoma talks with host Russ Roberts about what it’s like to run a surgery center that posts prices on the internet and that does not take insurance. Along the way, he discusses the distortions in the market for health care...
www.econtalk.org www.econtalk.org

This is an eye opening listen.
Click to expand...

i checked out his website. definitely cheaper than hospital charges, but still more expensive than what i was expecting
circumcision for 2000$ !
 
anbuitachi said:
i checked out his website. definitely cheaper than hospital charges, but still more expensive than what i was expecting
circumcision for 2000$ !
Click to expand...
I think the model works for outpatient procedures and most elective surgery. My personal opinion is that a free market elective option with a backup nationalized healthcare system for emergencies is the way forward.

Also more so than the absolute costs, the way he breaks down the costs that hospitals come up with is fascinating. Every piece of the pie is except for the actual people doing work are incentivized to inflate charges and collect less. It becomes a vicious positive feedback cycle.
 
I’m with you. First, we have health insurance that is historically tied to employment. Then, we make it cover anything and everything, when it should be just catastrophic. The system is anything but a free market and too much of robbing Peter to pay Paul.


Ronin786 said:
I think the model works for outpatient procedures and most elective surgery. My personal opinion is that a free market elective option with a backup nationalized healthcare system for emergencies is the way forward.

Also more so than the absolute costs, the way he breaks down the costs that hospitals come up with is fascinating. Every piece of the pie is except for the actual people doing work are incentivized to inflate charges and collect less. It becomes a vicious positive feedback cycle.
Click to expand...
 
secretasianman said:
I’m with you. First, we have health insurance that is historically tied to employment. Then, we make it cover anything and everything, when it should be just catastrophic. The system is anything but a free market and too much of robbing Peter to pay Paul.
Click to expand...

agree but when they make healthcare a right, combined with our spending culture where 70% of americans have less than 1000$ saved, i cant see other methods working. most americans wont even be able to afford a couple of medical appointments, let alone any elective surgery. its a 3rd world country here
 
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secretasianman said:
I would support a dual govt/public healthcare system. As it is now the amount we all pay for health insurance is so high it might as well be called a tax..
Click to expand...

mostly single payer can work if done correctly. i have zero faith it will be done correctly if we do implement it though. at some point people will abuse the system.

it should be something along the lines of all doctors should be employees with national benchmarked base salary. OT starts after 40 hrs at 1.5x like in other essential services. Med school should either be free or paid. residency should be same as attending, but with lower base, but still OT after 40 hrs. Fee for service should be removed, which should decrease corruption.

therefore under this universal insurance, its not about submitting claims and collecting, the 'insurance' is more like another branch of government that is publically funded. Out of this fund this fund will pay the healthcare workers salaries.

base salaries can be determined by length of training, and whether need to cover emergencies or not, with a percentage bonus. example being 240k for IM doctors (3 yrs residency, minimal emergencies), 300k for anesthesiologist with no emergencies. 560k for neurosurgeons.


etc

but dont see it every happening and if it does, will be terribly managed and abused
 
Urzuz said:
Completely agree. I just feel like getting a surprise bill from ANYONE after an elective surgery is scummy, regardless if they are essential like the anesthesiologist, or just “nice to have” like a PA...especially in a case like this where it says they did their due diligence beforehand.

And to be fair, I don’t even blame the PA in this case. If anyone is to blame, it’s the surgeon. Why didn’t he tell the patient beforehand that he needed help from a PA that may not be in network (I’m sure this isn’t the first time it’s come up, most patients probably just pay the bill and move on). Furthermore, what orthopedic surgeon needs an extra pair of hands for a meniscus?!?
Click to expand...

I used to be a surgical assistant. I worked for the hospital and so didn’t bill anyone, but we did have one that was an IC who would bill independently. A lot of times the surgeon didn’t specifically need her help specifically, she would just ask them if she could scrub in and they would say sure (cause an extra set of hands can be nice, though not sure why they’d need it on a meniscus), assuming she was billing insurance. I don’t want to assume, but it is possible the surgeons don’t really know this douche is billing patients thousands of dollars if the insurance doesn’t pay.
 
anbuitachi said:
i checked out his website. definitely cheaper than hospital charges, but still more expensive than what i was expecting
circumcision for 2000$ !
Click to expand...
And I was quoted 1500 dollars for my 2008 volvo muffler system. Or 900 dollars for my med school ‘97 civic slave cylinder replacement. Everyone in any industry can charge whatever the heck they want, and no one bats an eye. But if you’re a pcp or a dentist charging 200 bucks for an exam or dental work, patients get into a tizzy etc (as they surf on their 100/month cell phone plan)
 
Lecithin5 said:
And I was quoted 1500 dollars for my 2008 volvo muffler system. Or 900 dollars for my med school ‘97 civic slave cylinder replacement. Everyone in any industry can charge whatever the heck they want, and no one bats an eye. But if you’re a pcp or a dentist charging 200 bucks for an exam or dental work, patients get into a tizzy etc (as they surf on their 100/month cell phone plan)
Click to expand...

i definitely bat my eye for everything
 
Matthew9Thirtyfive said:
I used to be a surgical assistant. I worked for the hospital and so didn’t bill anyone, but we did have one that was an IC who would bill independently. A lot of times the surgeon didn’t specifically need her help specifically, she would just ask them if she could scrub in and they would say sure (cause an extra set of hands can be nice, though not sure why they’d need it on a meniscus), assuming she was billing insurance. I don’t want to assume, but it is possible the surgeons don’t really know this douche is billing patients thousands of dollars if the insurance doesn’t pay.
Click to expand...

i wonder if this can be a lawsuit (not that i support lawsuits), but just curious. do patients consent to this particular surgical assistant helping with the case..
 
anbuitachi said:
i wonder if this can be a lawsuit (not that i support lawsuits), but just curious. do patients consent to this particular surgical assistant helping with the case..
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Yeah I dunno. It was like 10 years ago but I’m pretty sure the consent included something about assistants. Sometimes it would be another surgeon, sometimes an assistant, sometimes both. I sure as **** wouldn’t be paying a grand for that.
 
secretasianman said:
The current system has to die before any change can happen. Not going to with all these bailouts...
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Die die die!!!! There basically needs to be an expose of what is happening with the finances in medicine.
From greedy docs and nurses and scrub techs and especially the insurance companies and hospitals. It all needs to implode in order to start over.
The amount of money people pay in insurance is insane and then they say they don’t want higher taxes. Makes absolutely no damn sense.
 
Lecithin5 said:
And I was quoted 1500 dollars for my 2008 volvo muffler system. Or 900 dollars for my med school ‘97 civic slave cylinder replacement. Everyone in any industry can charge whatever the heck they want, and no one bats an eye. But if you’re a pcp or a dentist charging 200 bucks for an exam or dental work, patients get into a tizzy etc (as they surf on their 100/month cell phone plan)
Click to expand...

I was quoted $5k by a board certified doggie dentist to pull some teeth on this guy. He’s a 2008.

7F123353-59E2-435E-9A7C-92455B08DA2C.jpeg
 
Urzuz said:
As much as I hate the idea of single payer system, this is the one huge problem that it would solve. Seeing the power of insurance companies and hospitals evaporate overnight would be amazingly gratifying. Whether this gratification eases the pain of my bank account getting ****ed in the process...that remains to be seen.
Click to expand...

Thanks, i feel a bit sour now and will head on over to the political thread to vent
 
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Lawpy said:
Something has gone wrong if PE buyouts are appearing to be even more common lately!
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They’re not more common. There was a huge slowdown with acquisitions in the past 2-3 years. It probably reflects that most desirable groups have either sold or true equal partnership style where PE wasn’t willing to put up the bucks. Now what you are seeing is contracts being shuffled Between AMCs.

I can’t blame someone for taking a $2 M buyout when they are in their 60s. I would absolutely do the same. Dont try to say you wouldn’t either. The best defense against this is to set your practice up to avoid a PE buyout by making sure EVERYONE in the practice is an equal partner (after buy in and even then make it a percentage, AND no tiered partnerships). No one is coming in an offering $80 million to a 40 physician group to sell. Groups that do all that are super rare, even my own you’d get none during buyout if it happened probably.
 
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The US healthcare system has gotten to be such a dumpster fire that I’m at the point of saying we should just roll the dice on single payer.

Then again, I’m far enough into my career that I’ve made most of my money and won’t be affected (much) if my salary is cut in half. Feel bad for younger doctors.

My fear is that nationalized healthcare will become some sort of monster that still includes leeching insurance companies taking part of the pie, while screwing doctors.
 
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