Follow-up - Forum

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Lady Surgeon

Re: Follow-up - Ärzteforum

Post#11 »

Be careful what you share. The federal anti-trust lawyers like to look for charging conspiracies.


forceps

Re: Follow-up - Ärzteforum

Post#12 »

I definitely would like to know how my patient is coping after the surgery. I am sure it is a great moral boost for the patient to get along with his/her life seeing the operating surgeon afterwards. In my practice (which is typical of this subcontinent), my old patients sometime come with their pregnant wife to ask me which gynaecologist to consult! It may be quite silly to most of you but I take it as a measure of confidence om my patients on me. In my opinion, (no level evidence)no other branch of medical science can instill this much bonding between the healer and the healed. I think sparing a few minutes even just to talk to your postop patient is time well spent.

सर्जन

Re: Follow-up - Ärzteforum

Post#13 »

canadian wrote:In Canada, although we have free trade with the US of A, Canadian surgical
fees are almost exactly 1/6 th of those you quote. I am totally shocked
that an American insurance payor wouldn't be happy to have me do their lap
choles for $270 US or even a colonoscopy for less than $100 US. I don't
think our results are any better or worse. If you want the Full Monty, a
REPEAT liver transplant pays the surgeon less than $2000US. This is the
highest fee, and a moot point, because these guys are all on salary anyway.


Indian surgeons are paid about 1/4th (one-fourth) the Canadian fees!
Talk of being underpaid!

User avatar
Old surgeon

Re: Follow-up - Ärzteforum

Post#14 »

I thouroughly agree that we seem to be in a different world from
those who think it is appropriate to abandon a patient after an
operative procedure--and abandonment it is , not to personally
followup a patient postop--this is not just my view, but that of the
American College of Surgeons. This constitutes itinerant surgery,
and is considered dangerous for the patient, as can be confirmed by
anyone who has seen a nonsurgeon flailing ignorantly with
incomprehension at dealing with any postop occurrence--the surgeon is
the most appropriate individual to properly interpret and follow
patient complaints and the course of convalescence following surgery.
This is why itinerant surgery is one of the few transgressions
specifically mentioned (along with fee-splitting) as grounds for
dismissal from fellowship in the American College of
Surgeons--now--perhaps we all need some remedial education from the
ACS on the proper practice of surgery? Think to yourselves, those
who disagree with this stance, why the founders of the ACS would have
been so emphatic on this point to put it in their charter back at its
founding in 1912! Franklin Martin would be turning over in his grave
were he to be seeing this debate.

Arizona

Re: Follow-up - Ärzteforum

Post#15 »

Surrgeon wrote:
Doctor Green wrote: how much does cost to pay


Inguinal hernia $1,012 cpt 49505
incisional hernia 1,525 cpt 49560
gastric cancer (partial gastrectomy with gastroduodenostomy- 2,696 cpt
43631)
lap cholecystectomy 2,099 cpt 56340
classic cholecystectomy 2,099 cpt 47600

These are the charges submitted. The reimbursement is at the mercy of the third party payors. For non US surgeons, cpt codes are the uniform method of coding the type of surgery in the US. I'd be interested in the geographical variation of charges within and outside the US. For me, all post op visits (one in uncomplicated or as many as necessary in complicated) are included.


Forgive a financial question from the land of socialised
medicine! What are these sums? Surgeons fees? Surgeons plus
anaesthetists fees? Hospital charges included? Investigations?

User avatar
Alalo

Re: Follow-up - Ärzteforum

Post#16 »

canadian wrote:In Canada, although we have free trade with the US of A, Canadian surgical
fees are almost exactly 1/6 th of those you quote. I am totally shocked
that an American insurance payor wouldn't be happy to have me do their lap
choles for $270 US or even a colonoscopy for less than $100 US. I don't
think our results are any better or worse. If you want the Full Monty, a
REPEAT liver transplant pays the surgeon less than $2000US. This is the
highest fee, and a moot point, because these guys are all on salary anyway.


That is indeed shocking. How can you afford to pay your office staff,
the rent on your office, and your malpractice insurance premiums and
still be able to buy shoes for your kids?

Surrgeon

Re: Follow-up - Ärzteforum

Post#17 »

These are the surgical fees. Do not include hospital, anesthesia, and
any
other fees tacked on by others (Pathologists, consultants, pre op labs,
x-rays).


I too am amazed at the Canadian fees. No wonder we frequently recruit
Canadian surgeons to relocate in the US (our new orthopod is coming from
Quebec). There also seem to be a thriving trade along the border towns
(i.e. Duluth, MN) for Canadians coming down to get their elective
surgery
done in the US rather than going on a long waiting list. Americans are
usually quite impatient and I often add people to the schedule within a
week
of when I see them.
I am under the impression that the fees charged in the Midwest are lower
than those charged in the East and West coast. I will
take all the lap choles and colons that want to come here from New York.

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Doctor Green

Re: Follow-up - Ärzteforum

Post#18 »

This is a "feature" of the Canadian health care system! When people start to
talk about a two-tier system as part of health-care reform, I tell them that
we already have it. Those who can't pay wait, and those who can go to
upstate New York.

I have often heard that there are proportionally more specialists in the US
and that Canadian specialists do more procedures each (ie fewer people to
spread the cases between) as a result. I have a hard time believing this
based on the amount of OR time I see my attendings getting. I am curious to
know how much time a typical American surgeon has.

Noro

Re: Follow-up - Ärzteforum

Post#19 »

There is a Turkish folkstale about the cook's apprentice who prepared
Shashlik (skewered marinated lamb) for the Sultan, the sultan enjoyed the
Shashlik and told the grand vazier to tell the cook that the Shashlik was
outstanding. The grand vazier told the vazier to tell the cook that the
Shashlik was very good. The vazier told the house master to tell the cook
that the Shashlik was quite good, and so the compliment went down the
chain of command, so by the time it got to the apprentice, he was arrested
for trying to poison the Sultan.

This thread is a bit as bizzare. It started out with a question about
follow up, which I took to be something along the lines of inviting
patients a year or two after an inguinal hernia repair to see if it
returned. Someone argued that the practice is expensive and is only
justified in the setting of academic research. To it well, you have to
spend a lot of money. About 10 years ago, Lichtenstein told me he spends
200K U$ a year on the followup, and I bet it is more so now.


What has this got to do with our need to furnish postop care?

User avatar
A Doctor

Re: Follow-up - Ärzteforum

Post#20 »

Postop follow-up is a mixed bag, and it was great to hear of the different
aspects. Unfortunately everyone talked about one of the aspects and jumped
at a conclusion that the others are immoral.

I hope we are not disagreeing that the immediate postop follow-up for any
surgery is a must. It is our College's law. And needless to say a surgeon
would like to see the outcome of his own handicraft.

Long term follow-ups to see if complications (eg, hernia in the incision,
etc.) are also required. If a surgeon has an auditing system that allows
analysing that follow-up to learn from his/her experience, that's ideal.
Academic institutions have that on a regular basis. This is better than
witing for the primary care physician (PCP) to tell us of a late
complication. Needless to say, the PCP may send the patient to another
surgeon and you'll never know.

Finally follow-up for certain cancers (eg, lung and colon) with protocols to
detect early recurrence are debatable these days. It seems that our ability
at this time to diagnose early recurrences outpaced our technology to treat
them effectively. So there is no survival benefit from that knowledge of
early recurrence, till our ability to treat them improves.

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