These outpatient procedure “Surgery Center” clinics allow the physician to collect both the procedure and hospital fees. The hospital fees are MUCH larger, e.g. a rough estimate for gallbladder removal is a procedure fee of $1,000 and a hospital fee of $20,000.
The public for the most part is unaware of the difference between having a major operation done in a private Surgery Center where the temptation for the operator is about 20 fold increase in reimbursement.
But the most frightening aspect of these “Surgery Centers” is that they are grossly under equipped to handle complications and critically ill patients. THEY ARE NOT A HOSPITAL and should not receive the same hospital fee because they do not provide the same service.
As a physician on the receiving end of these complications (a tertiary academic medical center) this is not an issue of competition. It’s an issue of patient safety.
Jul 23, 2023·edited Jul 23, 2023Liked by Anish Koka MD (Cardiology)
Given the difficulty in obtaining revascularization of stenotic arteries under the most favorable of circumstances, increasing the supply side of the medical economics equation with outpatient centers is understandable.
It seems to me that the problem would be with carefully evaluating risk factors that should properly result in referral to a hospital-based vascular surgeon. To allegations of "overtreatment," I remain highly skeptical. Yes, it occurs with dreary regularity in some quarters, but what no one seems willing to discuss, is the influence of "stealth rationing" on the potential overuse of "conservative" treatment modalities that result from demand far exceeding supply.
One of the examples used above was that of an auto mechanic. If he was treated and released to resume his occupation, the very same conditions contributing to his stenosis were also resumed. Mechanics stand in one place for the majority of their workday, older mechanics are usually exhausted by shift's end and the daily shop-floor-to-couch routine continues. Time and time again, we see patients such as chefs and mechanics return to work as soon as they're physically able to stand again. Without lifestyle and occupational changes, their prognosis is less than stellar.
This opens an entirely new discussion; the consequences of recommending long-term disability payments for those whose sole occupational skill is killing them. This discussion requires its own set of interviews and articles. Given what I have observed over the last four decades, I suspect that finding practitioners willing to speak frankly and openly may be rather challenging.
Consider writing a counter article to the NYT article. One that is based on facts / investigational/ truth. A significant interest and support to SHINE the light onto the reality instead of the mIsconception. The hidden reality/ truth& facts barried deep into many rabbit holes within the darkness of the NYT.
These outpatient procedure “Surgery Center” clinics allow the physician to collect both the procedure and hospital fees. The hospital fees are MUCH larger, e.g. a rough estimate for gallbladder removal is a procedure fee of $1,000 and a hospital fee of $20,000.
The public for the most part is unaware of the difference between having a major operation done in a private Surgery Center where the temptation for the operator is about 20 fold increase in reimbursement.
But the most frightening aspect of these “Surgery Centers” is that they are grossly under equipped to handle complications and critically ill patients. THEY ARE NOT A HOSPITAL and should not receive the same hospital fee because they do not provide the same service.
As a physician on the receiving end of these complications (a tertiary academic medical center) this is not an issue of competition. It’s an issue of patient safety.
Given the difficulty in obtaining revascularization of stenotic arteries under the most favorable of circumstances, increasing the supply side of the medical economics equation with outpatient centers is understandable.
It seems to me that the problem would be with carefully evaluating risk factors that should properly result in referral to a hospital-based vascular surgeon. To allegations of "overtreatment," I remain highly skeptical. Yes, it occurs with dreary regularity in some quarters, but what no one seems willing to discuss, is the influence of "stealth rationing" on the potential overuse of "conservative" treatment modalities that result from demand far exceeding supply.
One of the examples used above was that of an auto mechanic. If he was treated and released to resume his occupation, the very same conditions contributing to his stenosis were also resumed. Mechanics stand in one place for the majority of their workday, older mechanics are usually exhausted by shift's end and the daily shop-floor-to-couch routine continues. Time and time again, we see patients such as chefs and mechanics return to work as soon as they're physically able to stand again. Without lifestyle and occupational changes, their prognosis is less than stellar.
This opens an entirely new discussion; the consequences of recommending long-term disability payments for those whose sole occupational skill is killing them. This discussion requires its own set of interviews and articles. Given what I have observed over the last four decades, I suspect that finding practitioners willing to speak frankly and openly may be rather challenging.
Outstanding article!! Very insightful and balanced.
Consider writing a counter article to the NYT article. One that is based on facts / investigational/ truth. A significant interest and support to SHINE the light onto the reality instead of the mIsconception. The hidden reality/ truth& facts barried deep into many rabbit holes within the darkness of the NYT.