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I was actually surprised how close things were. Based on all we hear about “overpaying procduralists” I was expecting a big discrepancy. Instead we got that they maybe overpaid urologists and orthopedic surgeons by a couple hundred bucks each (divide the amount of overpayment by the number of docs) and underpaid neurosurgeons.
In reality the bigger question is turnover. Especially for quick procedures, reimbursement needs to include not just the procedure itself but the unreimbursed time between procedures that limits productivity.
In reality the bigger question is turnover. Especially for quick procedures, reimbursement needs to include not just the procedure itself but the unreimbursed time between procedures that limits productivity.
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Personally I think tying procedural reimbursement exclusively (or even in large proportion) to time is a crappy approach. If (for example) one surgeon can do a leg bypass in half the time it takes a different surgeon to do a bypass of both equal quality and equal complexity, basing reimbursement off of time actually favors the slower surgeon. Even working on an average, there are too many other competing factors in surgery to make time the predominant factor in consideration.
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The more I think about it the sillier it seems to tie reimbursement to time. A cystectomy doesn’t take much longer then a prostatectomy, but the latter goes home on POD1 while the former is day 3-7 with a much higher readmission and complication rate. Operative time and operative risk/Perioperative care (within the global) often don’t correlate well.
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How about the value proposition to the patient? Patients don't fund these articles, so I can see how their perspective might be missing.
What an idea- get paid based on how much the patient benefits. Even better if you factor in the value of the resources required to produce that benefit (your training and expertise, the facility investment in staff, property, plant, equipment, admin, etc).
What an idea- get paid based on how much the patient benefits. Even better if you factor in the value of the resources required to produce that benefit (your training and expertise, the facility investment in staff, property, plant, equipment, admin, etc).
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Yeah but how do you compare cosmetic vs. cancer vs. functional benefit to the patient? Resection of a T1 breast cancer vs. the longterm health benefits of a gastric sleeve? No easy answers here.
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So basically you’re saying penile prosthesis should be the highest reimbursing procedure?
I’m all for this.
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Cosmetic is easy- it's whatever the cash market will bear.
In a third-party reimbursement environment you get the value to the third party.
Asking what the value is to a second party (the patient) without his participation is a mostly a round peg square hole problem.
But just for example, what does a CABG pay to the surgeon now, $1000? Ridiculous. For that level of training, skill, experience, malpractice risk- and the extraordinary value to the patient, the surgeon surely deserves a lot more.
I had sciatica last year and recall thinking I would easily trade $5000 to make it go away. Then I learned how to stretch my piriformis on Youtube.
