Bill set fee per procedure. Great for fast surgeons. Slow surgeons... not so much
Like many things, the minute we're not paid for it is when we stop doing it. Our total joint operation is a well-oiled machine - pt in OR 1, pt rolling into OR 2 to get prepped and draped, next pt for OR 1 getting their spinal in pre-op. Surgeon has his PAs close in OR 1 and goes straight to OR 2 where the pt is ready. Pt in OR1 goes to PACU, and the nurse goes straight to pre-op to pick up the next pt who has just finished getting their SAB +/- blocks. It helps that the surgeon's average time on a joint is about 15-20 minutes and has zero interest in downtime.
Your colleague must be a man of principle. I probably would not bother for 90$.
Half his patients for the day are in pre-op by 5am. He sees all of those and marks them before he does his first case. Sometime after the first few cases he will drop by pre-op and mark any others that have come in. Don't know when or if he sees the family post-op. He frequently goes straight out of one OR, scrubs, and right into the next OR where the patient is draped and ready to go. He's all business and wants to get in and get his work done. He'll do 12-14 total joints by 3pm and patients walk out of the hospital or outpatient center 3-4 hours post-op.
With self-pay patients, especially things like in vitro and cosmetic work, you can basically charge any way you want and as much or as little as you want. Not being able to charge for pre-op time and many other billing practices only apply for private insurance / CMS patients. He would have gained nothing reporting them to the medical board unless some state law or regulation was broken, which I doubt is the case. Now, if they're getting insured coverage for in vitro procedures, that's totally different.
It is a violation if he walked away from the patient, which he probably did (and the patient's husband knew).
