08 Nov Is More Expensive Surgery “Better” Surgery?
Surgery is exceptionally expensive in this country. Healthcare cost overruns need to be ruled in, and surgery must become a more affordable option for patients when needed. Affordable surgery does not mean “lesser” quality procedures. In fact, the best outcomes in surgery naturally lead to lower costs. Better surgical techniques decrease the time required to perform surgery, avoid the use of unnecessary very expensive “tools” such as robots, and lower complications dramatically. Complications in surgery are the greatest single factor increasing costs. Complications increase the direct costs with prolonged hospital stay, the need for more surgery, more post surgical care, and increased costs to society with patient disability, loss of work, and loss of income.
A faster, more efficient surgical procedure using exceptional techniques with the lowest complications possible LOWERS the cost of surgery and maximizes the BEST outcomes for patients.
So how can surgeons DECREASE the cost of surgery and provide BETTER outcomes? By 1. using the best techniques available, 2. avoiding expensive tools, 3. choosing the right surgical facility, and 3. avoiding “cash based” endometriosis surgeons.
1. The Right Techniques
Techniques in surgery determine the success of the surgical procedure. Period. Surgery is a technical exercise. To put this in more basic terms, if you have a carpenter build a house for you that has exceptional carpentry techniques, your house will be built correctly, will look great, and will be done on time at the lowest possible cost. Why the lowest cost? Because that carpenter will not have to come back and fix complications that he or she caused with poor carpentry skills, and you will not have to repair what he did wrong with a second opinion to another carpenter. The same is exactly true with surgery. If the best techniques are used, the surgery will be done right and the complications will be close to none. Experience is helpful, such as knowing the number of surgeries performed by the surgeon. But realize that there are many surgeons out there that have performed hundreds or thousands of procedures with average or below average techniques. The number of procedures performed does not always equate to the best possible care.
In GYN surgery, standard techniques are used by almost all GYN surgeons. GYN surgery is like no other surgical specialty. What makes it different than lets say General Surgery for a hernia repair, or Orthopedic Surgery for a knee replacement? GYN surgeons are mostly OBGYN’s. OBGYN’s are concentrating mostly on Obstetrics, not surgery. There is NO OTHER SURGICAL SPECIALTY like OBGYN in which surgery is a part time endeavor. General Surgeons and Orthopedic Surgeons are surgeons 100% of the time. OBGYN’s are surgeons 25% of the time. Specialists such as Dr. MacKoul do NOT use standard techniques. Instead they employ highly advanced techniques and procedures based on Retroperitoneal Dissection (RPD). RPD is learned in GYN Oncology training – not in OBGYN training or even fellowship training in Minimally Invasive GYN surgery. The RPD approach is extremely powerful, allowing almost any surgery to be performed laparoscopically with a high degree of safety, the lowest complications, and exceptional outcomes. All at lower cost in the surgery center setting, thereby avoiding the higher cost and complications and low patient satisfaction of the hospital. For more information on results with RPD procedures, please go to Number 5 in this series: Superior Techniques, Proven Results, and Publications
2. The Wrong Tools
The Robot – is this the best way to perform GYN surgery? Absolutely not. For more information on why the robot is NOT your best option, refer to Number 2 in this series Tools or Techniques – Which is More Important?.
Robots are also extremely expensive. The purchase price of the robot is $2 million dollars. The robot uses disposable equipment which is very expensive, and those costs are always passed on to the patient in co-insurance costs. Compared to Dualport and LAAM procedures performed by Dr. MacKoul, robots require more time to perform the surgery, often two to three times as long, which increases operating room time and costs. Robots are based in hospitals. Hospitals increase the cost of surgery dramatically. (see facility below), and once again those costs are passed directly to the patient through your co-insurance. Robots have a longer recovery which increases personal costs to the patient by increasing time away from work and loss of income. Most importantly robotic surgery is associated with higher complication rates than Dualport and LAAM procedures. The greatest factor in increasing healthcare costs in surgery is complications. Whether it is a prolonged hospital stay, a blood transfusion, a reoperation, need for additional antibiotics or pain medication – whatever – those complications are higher. For more information on published information on this, see specific articles presented in Number 5 in this series: Superior Techniques, Proven Results, and Publications.
3. Choosing the Right Surgical Facility
Free standing surgery centers – which means a surgical center that is NOT associated with a hospital – will dramatically decrease costs when compared to a hospital or HOPD – Hospital Outpatient Department. HOPD’s charge the same as the hospital, so they are NOT less expensive. The HOPD is not a free-standing surgery center. It is usually on the hospital campus, and the billing is done through the hospital system. Since the pricing for an HOPD is the same as a hospital, patients will pay the same, even though the patient may think that the HOPD is a surgery center.
Free standing surgery centers are not on the hospital campus, and the costs associated with surgery in free standing surgery centers can be 60% less than the hospital. That cost savings is passed directly on to the patient, since the “co-insurance” of your insurance – the amount that you have to pay as a patient – is directly related to the cost of the surgery. As an example, a typical hysterectomy procedure in a hospital in Maryland costs between $15 and $20,000. The same surgery in the free-standing surgery center may cost $5,000. The co-insurance you would have to pay at the hospital for a 20% co-insurance rate would be between 20% of $15,000 ($3,000) or 20% of $20,000 ($4,000). At the free-standing surgery center, you would have to pay 20% of $5,000 ($1,000). That is a saving of between $2,000 to $3,000, solely because you had your surgery at a free standing surgery center.
Continuing to use the robot as an example of a higher cost option, robotic procedures usually always require a hospital visit since 99.9% of all robots are purchased by hospitals. Hospitals operating rooms increase infection rates, as well as other problems, and are associated with lower patient satisfaction than the free standing surgery center. Free standing surgery have much lower infection rates and higher satisfaction than hospitals. They are also easier to access, much more streamlined and efficient, and provide an exceptional option for surgery.
4. Cash Based Endometriosis Surgeons
For any patient entertaining the option of a cash based endometriosis surgeon, realize there is a better option for a lower cost, higher quality procedure with a better outcome. Cash based surgeons typically require a payment upfront, usually between $15 – 50,000, for the surgery. They market themselves as providing the best quality endometriosis care and complain that they are not compensated properly by insurance companies. Realize that any surgeon can charge cash for any procedure. However, the marketing used by cash-based endometriosis surgeons depicts them as providing the best surgical care possible. This is simply not the case. Any patient who needs endometriosis surgery should always seek out a specialist. A true specialist will be able to do what the cash-based endometriosis surgeon can do, often in network with the patient’s insurance so that the cost of the procedure does not require paying cash upfront.
Dr. MacKoul for example uses GYN Oncology techniques to perform endometriosis surgery, including retroperitoneal dissection, that results in a better outcome than cash based non GYN oncology surgeons. Further, GYN Oncologists such as Dr. MacKoul are trained to repair bowel, bladder, ureters, and other structures. This means that if endometriosis is involving these organs the GYN Oncologist can remove disease to these structures safely and effectively since they are trained to do these types of procedures. Cash based Non GYN Oncologists cannot do these types of surgery and need to call in a General Surgeon or Urologist to assist.
GYN Oncology trained surgeons are the best option for endometriosis patients. Cash based surgeons only increase the direct cost to the patient. Realize as well that cash-based surgeons will take patients to hospitals more than surgery centers, further increasing the costs to patients. Many cash-based surgeons will tell the patient that they can bill their insurance company for the procedures performed. If a patient pays $25,000 dollars for surgery, and then bills the insurance company, the amount paid to the patient is usually less than $1,500.
Please keep this in mind when choosing an endometriosis surgeon. Cash based options for care should not be considered since there are better options available.