What does a lap chole pay?

[diesel]

I was wondering since this is one of the major bread & butter procedures for gen. surgery, what is medicare reimbursing for it these days? Also while on the subject, whats the going rate for yanking out a uterus?

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[apma77]

around 300 bucks depending on insurance
no wonder gen surgeons are such unahppy SOBs!

 

[diesel]

That sucks, I know anesthesiologists get 300-600 for administering the general depending on the procedure plus another 300 if they do a spinal. In reality a gp could make just as much seeing 6 patients at 50 bucks a pop for an office visit with less sweat.

 

[apma77]

Well..there are those who will argue that money isnt everything and ones interest in surgery should outweigh the measly salaries gen surgeons make...pretty naive outlook if you ask me

for 300 bucks why the heck would I want to operate on some1 and take their lif ein my hands when I can burn off warts for a $1000 in 15 min or read an MRI for 800 bucks in 10 min.

Med students these days want lifestyle and money in future for their hardwork...that is very reasonable and thats why the trend towards lifestyle and money earning subspecilaties get the best applicants and NOT FP or Gen Surg!

 

[powermd]

Supply and demand will help sort out the low compensation of general surgeons. Fewer and fewer students will enter general surgery, either not doing it all together, or subspecializing. In a few years it will be harder to find general surgeons, so commercial insurance plans will have to pay more in contracts to surgical groups to get the procedures done. Unfortunately, for those >65 on Medicare, when you have the government setting reimbursement rates, there is no guarantee they will respond to the decreased supply of surgeons. Fortunately the AARP is a pretty strong lobby, so this may not be such a big problem after all.

 

[Celiac Plexus]

Where I'm from the gs gets about 500 bucks for a lap choly.

Sidebar: The senior residents at my university do lap choles (uncomplicated) from cut to close in about 30 minutes. The record is supposedly 16 minutes.

 

[apma77]

Celiac plexus,,,,,,,, are you smoking crack? Lap chole in 16 minutes!
and a resident one is 30 min. Dude even the quickest and best technical surgeons take about 45 min and thats not including the prep which is another 30-45 min (total 2-3 hrs in OR).

Dude,,just think,,in 16 min?? would u want urs out that quick knowing the dude is rushing everything not to say its unsafe probably

 

[Foxxy Cleopatra]

Med students these days want lifestyle and money in future for their hardwork...that is very reasonable and thats why the trend towards lifestyle and money earning subspecilaties get the best applicants and NOT FP or Gen Surg!

Hey man, I have to ask, what's up with the hostility towards general surgery? The folks on this board have actually been pretty decent towards your comments- I'm surprised at the low level of flaming. I understand that not everyone likes or wants to do surgery, but if it is that repulsive, filled with people other than "the best applicants", why bother frequenting this board?

If the interest in surgery is so low, why is it there were only 11 unfilled G. surg categorical spots in this year's match, and that the only things other than the surgical subspecialties with less available spots were rads and derm?

I guess I'm not a typical med student because I realize that I'll probably not be as rich as a radiologist, but I really don't care. I like what I do and surgery will provide more than enough money to make me happy.

Peace!

 

[apma77]

I have a right to say what I want regardless of who agrees with it- if you (clepatra) dont like my input dont read it!


Freedom of speech!!

 

[Foxxy Cleopatra]

LOL- you're right, I was just wondering why the hate for surgeons? We're a pretty good gang on this board.

 

[Celiac Plexus]

Originally posted by apma77
Celiac plexus,,,,,,,, are you smoking crack? Lap chole in 16 minutes!
and a resident one is 30 min. Dude even the quickest and best technical surgeons take about 45 min and thats not including the prep which is another 30-45 min (total 2-3 hrs in OR).

Dude,,just think,,in 16 min?? would u want urs out that quick knowing the dude is rushing everything not to say its unsafe probably

I said "cut to close"... Most attendings do not come in to the OR until the patient is prepped and ready to go. As for a 30 minute lap chole... That's the standard here. Not EVERY lap chole goes in 30 minutes, but I have scrubbed on a number of them that have been roughly 30 minutes. The chiefs here can do a lap choly in 30 minutes or less from cut to close. It's sort of an unwritten requirement. Including prep time the whole thing takes less than an hour. 30-45 minute prep? The ORs are just too busy for everyone to take 30-45 minutes to prep a patient (though there are some services that take this long).

And the record is "supposedly" 16 minutes by one of the chiefs who left 2 years ago. To answer your question though... I tend to agree with you that IF the record is 16 minutes that is just too fast. The guy had to be rushing, and no I wouldn't want my surgeon to be using me as a tool to set some dumb record. Then again, I have no proof that the record is 16 minutes. It could be just an urban surgery legend...

 

[droliver]

16 minutes is pretty brisque, but by no means is it shocking. I know I've done some in less time then that. So much of that depends on anatomy. The quickest ones are usually kids, thin older ladies with acalculous dz., or patients on steroids (little inflamation). On patients with quick trocar placement & an unimflamed gallbladder with sparse peritoneal attachments you can really have the operation over very,very quickly. I would say that most "easy" gallbladders go in the 30-45 minute range depending upon 1) how much futzing around you do with the ports 2) how much disection you have to do (this is very attending dependent, some skeletonize everything while others do minimal disection) 3) whether you get bleeding or bile spillage requiring irrigation & 4) whether or not you do a cholangiogram.

I asked one of the surgeons I was operating with today about reimbursement for the procedure. He said insurance was paying about $800 with medicaid paying $650 & that a cholangiogram added about $100. These #'s have stayed pretty steady for a while for insurance, but no increase for inflation has been adjusted in over a decade. Medicaid has been cutting 4-5% per year the last few years

 

[Winged Scapula]

I'd agree with CP's time statements above.

Even I'VE done a lap chole in 25 minutes and have seen others do it around 20 mins. Most take 30-45 mins as droliver states - although I recently spent 3.5 hours watching the attending (after he took the instruments away from me, feeling it was too difficult) struggle with one (whilst I silently plead, "open, open, open...").

Our guys here get around $700-$800 for the procedure which seems to be the going rate and is frankly better pay if you can run several rooms and do 2 an hour, than a "GP seeing 6 patients".

BTW, don't be alarmed at apma's statements - he's been debasing surgery and its practitioners for a long time around these parts.

 

[womansurg]

Oh sure, we've done them in as little as 16 minutes on a noninflamed, straightforward lap chole without grams. Thirty minutes is pretty typical with grams; certainly longer if acute inflammation is present or the anatomy is difficult. Being a community hospital in the pork capitol of the world we just see so darned much gallbladder pathology. I've done five gallbladders in a row before - no joshin'. I did two laparoscopic common bile duct explorations in a row one time.

An acutely inflamed, phlegmon of a gangrenous gallbladder is amazingly difficult and is advanced laparoscopy by anyone's standards. And certainly you can run into trouble quickly if things are not straightforward, but simple lap chole's are often a chip shot. We're proud of the fact that, despite the fact that we do in excess of 300 gallbladders per year (or more likely, BECAUSE of it), we've never had a single common bile duct injury at our institution, and our conversion rate is less than 1%.

Our surgeons collect $700 to $800 per gallbladder also.

 

[Skylizard]

Originally posted by Kimberli Cox
I'd agree with CP's time statements above.

Most take 30-45 mins as droliver states...Our guys here get around $700-$800 for the procedure which seems to be the going rate and is frankly better pay if you can run several rooms and do 2 an hour, than a "GP seeing 6 patients".

Coming from the perspective of somebody completing a year in FP and eagerly salivating at the prospect of being back in the OR once again (even as an intern), I can tell you I would much rather do an EIGHT HOUR cholecystectomy (lap or open...your choice) for only $800 reimbursement than spend another hour in FP clinic seeing 6 patients and trying to convince them why their cholesterol, or diabetis, or hypertension medication is so important...or trying to deal with irritable bowel or fibromyalgia!!!

Further, my past dealings in the OR and present dealings with consulting surgeons is that a straightforward GB comes out in under 30 minutes. Remember, the OR costs about $300-$400.00 per minute to run so you had better be efficient.

Also, I would take any comments from someone "escaping " surgery with a grain of salt. They might not be the best reference to have in choosing your career.

my nickel

 

[Tenesma]

300-400 per minute for OR time? you kidding me? average is 50-80$ per minute...

as far as i know surgeons here bill 600-800 but often only get 140 to 240 from insurance (that is for straightfoward GB)... My record for lap. chole is 6 hrs for lap then 4hrs after conversion to open... i have to give surgeons credit though: it looked disgustingly tough and included GB-duct exploration, etc..