Neurosurgeon collects $117,000 for ONE operation

Discussion in 'Anesthesiology' started by BLADEMDA, 09.24.14.

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  1. BLADEMDA

    BLADEMDA ASA Member 7+ Year Member

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  3. BLADEMDA

    BLADEMDA ASA Member 7+ Year Member

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    The biggest surprise was the bill from Dr. Mu, the assistant surgeon. Fusions generally require a second trained pair of hands, but those can be provided by a resident or a neurosurgical nurse or physician assistant employed by the hospital, for whom there is no additional charge. The operative record for Mr. Drier’s surgery states that no qualified resident was available.


    Mr. Drier tried to negotiate with the surgeons to divvy up the $117,000 payment in a way he believed was more fair; he liked Dr. Tindel and felt he was being underpaid. Mr. Drier’s idea, he wrote in an email, was to settle on “a reasonable fee for both the surgeon and assistant and return the rest of the check to the insurance company/employees” of his company.

    But in July, he received a threatening letter from Dr. Mu’s lawyer noting that he had failed to forward the $117,000 check. So he sent it along, with regret.
     
  4. Arch Guillotti

    Arch Guillotti Senior Member Lifetime Donor SDN Administrator 10+ Year Member

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    This was all over sermo for the last week.
     
  5. BLADEMDA

    BLADEMDA ASA Member 7+ Year Member

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  6. soorg

    soorg ASA Member 7+ Year Member

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    Jail time indeed-NO human skill is worth $117K for three hours of work.

    With all the regulatory bs we all have to endure, it's hard to believe this stuff goes on. This morning alone I've had to sign, date, and time my signature sixteen times before noon, for taking care of FOUR patients. If they can regulate my friggin' signature, why can't they control something as egregious as this?!
     
  7. jwk

    jwk CAA, ASA-PAC Contributor 10+ Year Member

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    This game with friggin' surgical "assistants", whether they be physicians, NP's, PA's, surgical assistants, or surgical techs, is one that really pisses me off. Some procedures need an assistant - no doubt. But some are there strictly so they can bill for something whether needed or not. Many times, an assistant is totally unnecessary. Lap appy? No. Port placement? Hell no. Yet I see assistants with these cases all the time. Why? Because surgeons are spoiled. In my early career, assistants were almost unheard of. Nearly every procedure was done with the surgeon and the scrub tech. That was it.

    Among other games that are played...

    When a patient signs their mountain of paperwork for surgery, very few actually look at what they are signing. Physician offices will slip in a "consent" for a surgical assistant - that consent includes a clause that the assistant may or may not be in network, but that the patient agrees to pay the bill regardless. It borders on fraud - it's rarely mentioned by the surgeon ahead of time.

    Many areas, including mine, use "certified surgical assistants". Some of them are very talented, including some who are actually IMG's that can't get jobs as physicians in the US. These assistants, at least in my state, are unlicensed. In some cases, they have an agreement with the hospital. Medicare won't pay for them, but since it's admittedly difficult to do some procedures without an assistant, the hospital sometimes pays a flat fee for the assistant as an enticement for the surgeon to work there.

    In other cases, the assistant, or their office, send in a bill to insurance companies for their services. Some insurance companies will pay, some won't. They don't ever appeal with the insurance companies (unless they have a network agreement, which most don't). However, if they have that little "consent" from the physician office, they then turn around and balance bill the patient.

    My wife had a lap chole several years back. The surgeon got his usual discounted fee. Really not that bad for less than a 45 minute procedure and one post-op office visit that took five minutes. The unlicensed surgical assistant received more in payment than the anesthesia team (anesthesiologist and anesthetist). Absolutely absurd.
     
  8. BuzzPhreed

    BuzzPhreed

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    What you bill and what you collect are two entirely different things. This guy is not going to have to pay $117k for a second assist. You, me, and everyone else knows that. This is just fodder for the Marxist anti-physician rhetoric of this communist newspaper.
     
  9. jwk

    jwk CAA, ASA-PAC Contributor 10+ Year Member

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    Regardless of the amount collected, it's unconscionable to see bills this large that are simply not based in reality.

    It's not just neurosurgeons or orthopods that play this game. We have employees that have chosen to have some procedures done at an in-network outpatient center. Unfortunately, the anesthesia group with that center is out-of-network. The anesthesia fee for a colonoscopy was about $2900. Ridiculous.
     
  10. nimbus

    nimbus Member 10+ Year Member

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    The surgeon was 1st assistant and he did indeed collect $117k. The check was sent to the patient who reluctantly forwarded it to the assistant surgeon.
     
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  11. Mad Jack

    Mad Jack Critically Caring Gold Donor 2+ Year Member

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  12. Mad Jack

    Mad Jack Critically Caring Gold Donor 2+ Year Member

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    He did pay up if you read the article.
     
  13. BuzzPhreed

    BuzzPhreed

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    He (the patient) didn't pay! And this will probably get reduced/rebated in the end anyway.
     
  14. pgg

    pgg Laugh at me, will they? SDN Moderator 10+ Year Member

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    The ins co did, which blows my mind. I wonder which claim-approving flunky there is looking for work today?


    Many professional athletes get paid far more.
     
  15. Baller MD

    Baller MD 7+ Year Member

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  16. soorg

    soorg ASA Member 7+ Year Member

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    Ah-doesn't mean they deserve it.
     
  17. Baller MD

    Baller MD 7+ Year Member

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    It doesn't matter whether they deserve it or not. People are willing to pay that much for them.
     
  18. Spinach Dip

    Spinach Dip Delicious with nachos 2+ Year Member

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    They can fill stadiums with 40,ooo+ screaming, obsessive fans who want nothing more than to see them throw or catch a ball.

    As far as I know, no surgeon has yet managed to obtain that sort of attention (although plenty act like it).
     
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  19. pgg

    pgg Laugh at me, will they? SDN Moderator 10+ Year Member

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    Sure they do. They're entertainers. The NFL earns $billions every year. I'd be happy to see everyone involved get rich off it, players, owners, coaches, referees (if only), TV networks, advertisers.
     
  20. bronx43

    bronx43 Word. 10+ Year Member

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    I'm totally fine with someone getting that much in a free market, but we sure as hell all know that medicine isn't a free market.
     
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  21. BLADEMDA

    BLADEMDA ASA Member 7+ Year Member

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    And the patient never met Dr. Mu, never agreed to Dr. Mu's fee and would have OBJECTED to Dr. Mu's services had he known there would be a $117,000 charge.

    There was nothing "free market" about this case and please note the patient did look into the costs of his operation: Surgeon fee, Anesthesia fee, Facility fee, etc. He negotiated these fees in advance of the procedure only to be hit with a ridiculous $117,000 bill from an assistant surgeon he never met.
     
  22. EMDO2018

    EMDO2018 Banned Banned

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    Charlie Sheen made 2 million dollars per episode with two and a half men, a crap show with a crap cast.
     
  23. BLADEMDA

    BLADEMDA ASA Member 7+ Year Member

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    Charlie Sheen disclosed to the network he wanted $2 million per eposide and the network agreed to pay it.

    This Neurosurgeon never met the patient, never discussed his fee and the patient never agreed to pay $117,000 for his assisting the primary surgeon during the procedure.

    This case is exactly the reason the liberals are successful with passing new laws reigning in rogue physicians like Dr Mu. While I rarely agree with liberals on anything Especially health care I feel strongly all patients deserve full disclosure of all fees, bills, services etc prior to any elective procedure.

    I am certain the patient would have declined Dr Mu's services if he knew the bill was $117,000. Would anyone agree to pay such a sum? Why does Dr Mu get to charge 50 times his medicaid fee to the patient without disclosing it in advance?
     
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  24. Spinach Dip

    Spinach Dip Delicious with nachos 2+ Year Member

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    BA-DING!!



    I'm sure that if the patient was fully informed of his options ahead of time, he would have chosen to have this surgery when a qualified resident WAS available.
     
  25. Random Resident

    Random Resident Random Resident 7+ Year Member

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    I'm a libertarian. They probably defended the idea of someone being able to set their own price for providing a skill set. This is different from it being ethical, or that the market would even allow a particular price point like that. I haven't read through those libertarian posts you mention, but I doubt they are praising the character of this guy.

    You and I should also be free to name a fee amount for a service. Whether anyone would hire you and pay it or laugh at it is another thing.

    Aside from politics, it was a very unethical move.
     
  26. Random Resident

    Random Resident Random Resident 7+ Year Member

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    This is another problem I had with it too. Unethical.
     
  27. Ipassgas

    Ipassgas ASA Member 2+ Year Member

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    This should be criminal.

    He never gave truly informed consent.

    A man he never met, whose specific appearance he was never warned about (an assistant at a teaching hospital could reasonably assumed to be a resident or other faculty member - also presumably on the patents insurance plan) performed a procedure without the patients full understanding.

    If they were coordinated enough to schedule the assistant, knowing there was no resident available, they should have been coordinated enough to talk to the patient about billing. had the billing been discussed, he would have waited for a resident.

    If I take my car to Bobs auto body shop, and Bob says sure, I take your insurance, Bob can't just say to me when I pick it up - "Hey, I needed help from an expert. He doesn't take your insurance. What I did was covered. You owe him $45,000 or you don't get your car back."

    Bob would go to jail rather quickly I suspect.
     
  28. chocomorsel

    chocomorsel Senior Member 10+ Year Member

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    The primary surgeon needs to be held accountable. And what in the heck did the insurance company have that morning to write that kind of check.

    No wonder the public sees us as greedy docs. This is truly criminal.

    OTOH, our department staffs the GI suite. Although the patients sign paperwork saying they agree their insurance company be billed, no one (including me) tells them that this is a separate fee. I feel like I should, however none of the senior partners do it, so I don't. Kinda feel guilty.
     
  29. jwk

    jwk CAA, ASA-PAC Contributor 10+ Year Member

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    It's part of our anesthesia consent, and, there are signs posted in the admissions/registrations areas of the hospital that the physicians and/or NP's, CRNA's, and PA's used in the ER, radiology, pathology, and anesthesiology departments are not hospital employees and the patient will receive a second bill.
     

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