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The Cost of an ACL Injury

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61–70 of 179 posts

Re: The Cost of an ACL Injury

#61
post #59

Earlier quoted context omitted.

So, it sounds like we need to stop coddling the doctors and standardize on a particular set of tools.

The issue with that is that no hospital is willing to be the first. Hospital: We're going to lower costs by not letting doctors choose their equipment. Talented surgeons: Welp, don't want to work there. Patients: Why would I go to the hospital that doesn't have any of the good surgeons?

So, have a deal that says "Hey, if you want to be able to receive Medicare/Medicaid payments, you have to standardize tools."

All the hospitals will say "Wow, holy shit, alright", and the surgeons will have to play ball--because a surgeon without a proper OR is basically just a butcher or barber.

EDIT: Please explain why this is a bad idea instead of just downvoting.

Re: The Cost of an ACL Injury

#62
post #37

Interesting read, and a valid criticism of the costs associated with ACL repair in the US. It would be nice to know, however, how much your insurance company actually paid for the procedure. There's probably a large discrepancy there. My own thoughts are that if there were a true free market for healthcare, with insurance only for real medical emergencies, the costs of a lot of these services would drop, including ph…

You're right, there is a discrepancy and I didn't think to put it in the article. I couldn't find the doctor's charges on-hand, but the total cost for the facilities/drugs/equipment was $48,851.82. The insurance ended up paying $14,742.88 of that post-adjustments.

$14,742.88 is the real cost since hospital are running off of the income from what insurance actually pays. if average people were able to pay the "insurance adjusted price" for most things they would not need insurance for most things.

Re: The Cost of an ACL Injury

#63
post #25
post #18

Earlier quoted context omitted.

I've heard from someone who was involved in this that sterilizing medical equipment that you can't autoclave is seriously non-trivial. And certainly not free, nor is autoclaving, including the inevitable human errors that will result in incompletely sterilized equipment, plus there are all sorts of tradeoffs made here. I'm just old enough to have had glass syringes used on me, they're thick, heavy and obviously much…

Metal tools seem quite simple to autoclave. That said, they should also be pretty cheap to make (unlike the $900 knife in the article).

Okay, but for various sharps, blades and other cutting tools, keep in mind that repeatedly heating and cooling innately dulls them. Taking metal through temperature ranges that result in expansion and contraction mess with the honed edge. Think about metal as if it were a malleable wax candle.

Not to mention that mere pressure against skin on a cutting edge effectively bends and dents the edge until it becomes dull. That's what happens to IV needles, just the pressure to pierce skin alone ruins the point. How many times do you get to re-use a safety razor after shaving your beard or legs/armpits? Was the activity really very stressful on the blade?

And yet, maybe you'll get 5 passes (with a multi-blade razor on a thick beard) before it's pulling at the hair and skin, and you notice it's painful to shave with.

So too with surgical tools. After so many cycles of cutting, then heating and cleaning, you're pressing a dull butter knife against skin and whatever else you're cutting, relying more on cutting by sheer pressure than using the sharp edge to separate the tissue.

And then you can't stop the bleeding because the cut was wrong, the patient dies, you get sued (you DO get sued), and maybe you lose your license, reputation, time and money. So balance it against, just buying a $900 object brand-new.

But, yeah, how about sharpening them again? But with what? An angle grinder plugged into an extension cord? A stone wheel down in the metal shop? Not quite... I really don't know all that much about cutlery, but getting a blade perfectly sterile after sharpening it is probably something that is best done by automated factory machines, at which point the blade may as well be new anyway.

Re: The Cost of an ACL Injury

#64
post #39
post #9

This is absolutely shocking to me. Had my ACL replaced in the UK privately about 8 years ago (no health insurance, paid out of pocket). Total cost was £3000 (+ £600 for initial scan). I could have got it done for free on the NHS but it would have messed up my term time at university. Like the OP I had meniscal tearing too so more or less directly comparable. (Although obviously 8 years is probably a long time in medi…

I got my ACL replaced in Argentina and the cost including rehab was about U$S 3000 having one of the best insurance companies (about 120 U$S a month). If I wanted to use the public care, it could probably cost almost nothing. It always amazed me that in the US the health of a person is not a right and if you get hurt doing anything you have to pay huge fees.

That's because in Libertarian Utopia everyone of importance will be independently wealthy, and those who aren't, deserve to be trampled by the others. /sarcasm

Re: The Cost of an ACL Injury

#65
post #54
post #49

The most useful aspect of this article is the pie charts and line-item comparisons. Ignore the dollar amounts themselves. Why? Because almost no one pays that. Why? - In California, MediCal (state-wide health insurance safety net) pays about 20% of the cost (not price) of treatment for those without insurance. So if a surgery costs $10k, MediCal says "Here's your $2k. That's all you get." - Nationwide, Medicare pays…

This is true, but often the discounts aren't as steep as you'd think. I had a mitral valve replacement a couple years back (at age 29, due to a one in a million condition), and the insurance company was billed ~350k for the surgery + recovery in hospital. Even after their discounts, the total still came to $~250k (this is not the normal price - I had a complicated recovery, and spent an abnormal amount of time in the…

Yup, and if course it varies. Complications are a huge driver of costs, so making marginal improvements to the complication rate (either by improving the standard of care OR by insisting that you go to a place with a low complication rate) can have an outsize impact on the cost of care in the aggregate.

Companies like ConsultingMD (horrible name, http://consultingmd.com) are taking this approach to reducing costs.

Re: The Cost of an ACL Injury

#67
post #30

So, I have a few questions. > Going in, I had anticipated that doctors would take the lion’s share of the costs. I was surprised when the facilities ended up being the dominant cost; over 40% of the total. Is that because you're paying for the cost of nurses here, rather than breaking that cost out elsewhere? > This centimeter-wide cutting machine cost $900 according to the price sheet. That seems to be a bit much. I…

> So why don't insurance companies seem to be driving the costs down?

They are driving down costs -- as the OP mentions elsewhere in this thread, while he was billed nearly $49k for facilities/equipment, the insurance company only paid $15k.

There certainly are a lot of rich doctors and hospital executives who are being paid ludicrous amounts of money (especially considering the hospitals themselves are billed as not-for-profit), but the insurance companies are making money hand-over-fist in the current regime.

Re: The Cost of an ACL Injury

#68
Achilles tendon harvested from a cadaver

Yeah, I wouldn't recommend this route, either. I read an article in The New Yorker about body parts harvested from cadavers that were used in transplants. The parts were way past their harvest-by date. This was discovered, at least partially, by someone having an ACL transplant from one of this bad parts, and the recipient of the bad part died from bad infection due to a mold on the tendon.

The lack of controls on that business forever made me wary of using cadaver parts for transplants.

Re: The Cost of an ACL Injury

#69

It was $1,600 have ACL surgery on our dog. Think about that one for a while.

Crazy, but dog lifespan is considerably less. How long does the repair really have to last for?

I doubt that has a significant impact on the cost of the procedure, though, right? I mean, sort of like replacing the clutch on a car -- the cost isn't (necessarily) based on the lifetime/quality of the new clutch, but rather the labor required to pull the engine, install the clutch, button everything back up.

Re: The Cost of an ACL Injury

#70

When I was in college, I couldn't afford health insurance (no parents + financial aid does not cover it). I played rugby (generally not the safest sport) for two years, in addition to playing pickup basketball all four years. I very fortunately did not sustain any major injuries. Six months after graduating (and getting a job with health insurance), I tore my ACL while playing pickup basketball. The costs were as ins…

You wouldn't have paid anything like $68k. As mentioned in the article, those prices are inflated for charging the insurance company, who in turn negotiates a much better actual price. Similarly, the hospital would have likely worked out a better deal with you. Or, if you qualified (and it sounds like you would have), then Medicaid would have initially picked up the tab and they would have negotiated a better deal fo…

That's true, though even 10% of that number (more than twice the out-of-pocket cost with insurance) would've been financially crippling.
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