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The Cost of an ACL Injury

calv.info

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Re: The Cost of an ACL Injury

#81

Post by larrys »

dr_ wrote: 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…

"with insurance only for real medical emergencies"

You then have people putting off preventive care, tests etc and then you have to cover a bigger problem down the line.

I'll give you an example. You are a landlord with a tenant and you tell the tenant "you have to take care of minor repairs I will cover anything major". As a result they don't do normal maintenance either because they forget, don't care, who knows. Then because of lack of that maintenance the compressor fails on the HVAC and you end up having to replace a unit. Good luck with trying to tie that to the lack of maintenance. Or saying you won't cover it.

Re: The Cost of an ACL Injury

#82

Post by rayiner »

dbuxton wrote: 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…

Medical liability costs are about $55 billion in the U.S., or about 2.4% of overall costs: http://www.hsph.harvard.edu/news/press-releases/medical-liab....

There are debates about how much "defensive medicine" adds to the cost, but those aren't all that relevant here since the costs presented are exclusive of additional tests, etc.

Re: The Cost of an ACL Injury

#83

Post by Zigurd »

kenrikm wrote: post #62
calvinfo wrote: post #48

Earlier quoted context omitted.

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.

Somewhere within the regulatory frameworks in which health insurance and hospitals operate, there's got to be the leverage to make pricing and other metrics like infection rate, readmission rate, etc., transparent.

Otherwise you can hide some serious price gouging in that fog of bogus prices.

Re: The Cost of an ACL Injury

#84

Post by rayiner »

goronbjorn wrote: post #70
dionidium wrote: post #36

Earlier quoted context omitted.

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.

Possibly, but look at the picture of the sliced out tendon. ACL replacement is an inherently complicated operation, from a highly skilled practitioner. The take-away from that is: you can't afford to play a dangerous sport like rugby if $5-7k is financially crippling.

Re: The Cost of an ACL Injury

#85

Post by ohazi »

ry0ohki wrote: post #76
old-gregg wrote: post #27

Earlier quoted context omitted.

Similar to my experiences as well. I once compared the price of a knee MRI scan across several countries by calling folks I knew. This is why I was dumbfounded by the call for "innovation" in medical industry at the end of the post. There's plenty of innovation is going on, it's the corruption and extortion we're looking at here: $60K were simply extorted from a person in pain. It's a legislation+law enforcement issu…

>$60K were simply extorted from a person in pain. Or more specifically from all of us. The author only paid $2400. The whole system is designed to be opaque and non-competitive so they can just bill insurance companies for whatever. I wonder what it would have cost if he said he was paying in cash (hint: a lot less).

You'd think that it should be "a lot less" for someone paying cash, but this is almost never the case (in the U.S., anyway). Insurers can threaten to remove a hospital from their network if the prices get too high. The hospital doesn't want to risk losing the large stream of sick/injured patients from the insurer, and usually couldn't care less about one person deciding to have surgery else for reasons of cost (edit: see last paragraph).

Individuals paying cash (and individuals without insurance) are generally stuck with the "sticker" price for care (higher than what private insurers pay, and significantly higher than what medicare pays (medicare basically gets to "declare" what they're willing to pay for a given procedure and hospitals generally have to go along with it or they'll lose some/all federal funding)).

It's usually very difficult to renegotiate the sticker price without an insurance provider or the government working on your behalf. If it's a time sensitive or life threatening procedure, you'll often have other more pressing action items than haggling over the price. It's even harder to negotiate after the fact, since hospitals make you sign away whatever bargaining rights you may have had before they'll agree to treat you.

[edit]

Finally, hospitals generate the bulk of their revenue from insured patients. They can and do quote higher prices to uninsured patients, but the fact remains that this is a fairly risky patient pool for the hospital, since many of these patients will sign whatever they need to sign in order to get treatment, despite being completely unable to pay the (relatively huge) prices quoted.

Hospitals have incentives to keep this pool as small as possible, and occasionally resort to extreme measures (legal or otherwise) to get rid of these patients [1]. Though the hospitals often aren't able to collect the full price from many of these patients, you would be naive to believe that they won't send collections agencies after you and utterly ruin your credit rating if you find yourself unable to pay.

[1] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1646410/

Re: The Cost of an ACL Injury

#86

Post by dragonwriter »

angersock wrote: post #47
ISL wrote: post #8

Excellent read. One point on disposing of fancy, potentially reusable, tools: We do more than a little precision machining in our lab. When a job matters, the shop buys new tooling. It's lower in cost, especially time, than verifying that a tool is sharp and correct. At first, it seems wasteful to throw away a once-used tool, but if all you do is critical work, you must be certain that your tools are reliable and cor…

To be fair, you're doing exceedingly delicate machine and test equipment manufacture. The machine shops I know will buy new tools as needed, but reuse them on large job runs--and throw them out once they lose tolerance. Something like the $900 knife in the article is/could be a mass-produced stamped piece of metal, perhaps sharpened on-site or at the factory; unit cost for that should be easily less than $10.

> The machine shops I know will buy new tools as needed, but reuse them on large job runs--and throw them out once they lose tolerance.

Hospitals aren't machine shops, though, so it would be a significant additional cost to equip and staff them to evaluate tools for reuse.

There's also particular costs around requiring additional handling of used surgical tools rather than disposing of them that may not exist to the same extent with used machine tools.

And its quite possible that even breaing all those additional costs, a large percentage of tools would be out of tolerance or otherwise unusable after being used once, so you'd be paying the additional cost and still disposing of them.

Re: The Cost of an ACL Injury

#87

Post by djulius »

gregcrv wrote: post #50

here a link to compare the cost of the same injury in France: http://blogs.wefrag.com/Naudec/2011/11/05/rupture-du-ligamen... basically it's about 7559 euros all inclusive (MRI, etc..)

In fact, in the link you provide, the 7559 euros also cover 75 sessions of physical therapy, a nurse coming at home every working day during a month and various drugs.

It would be interesting to have a global comparison (operation+therapy).

Here, the operation including all appointments before is about 5274 euros.

Re: The Cost of an ACL Injury

#88

Post by jonknee »

knifeySpooney wrote: post #63
jonknee wrote: post #25

Earlier quoted context omitted.

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.…

Why are they $900 in the first place? Seems like about an order of magnitude more than any reasonable cost. It's not like it's that rare of an item, there are ~100k of these surgeries performed annually just in the US.

Re: The Cost of an ACL Injury

#89

Post by ricree »

larrys wrote: post #77
angersock wrote: post #47

Earlier quoted context omitted.

To be fair, you're doing exceedingly delicate machine and test equipment manufacture. The machine shops I know will buy new tools as needed, but reuse them on large job runs--and throw them out once they lose tolerance. Something like the $900 knife in the article is/could be a mass-produced stamped piece of metal, perhaps sharpened on-site or at the factory; unit cost for that should be easily less than $10.

"Something like the $900 knife in the article is/could be a mass-produced stamped piece of metal" Very well could be some liability potential wrapped into reuse of a device. After all part of the cost does go toward covering things that go wrong for whatever reason. If you take the device fresh and something isn't right you can claim it was defective. If it was used for another operation who is to say when something…

>If you take the device fresh and something isn't right you can claim it was defective. If it was used for another operation who is to say when something happened to it?

There's something on the order of 100,000 ACL tears per year. Even with no reuse, it seems odd that economies of scale can't get that well below $900.

Re: The Cost of an ACL Injury

#90

Post by jonknee »

larrys wrote: post #77
angersock wrote: post #47

Earlier quoted context omitted.

To be fair, you're doing exceedingly delicate machine and test equipment manufacture. The machine shops I know will buy new tools as needed, but reuse them on large job runs--and throw them out once they lose tolerance. Something like the $900 knife in the article is/could be a mass-produced stamped piece of metal, perhaps sharpened on-site or at the factory; unit cost for that should be easily less than $10.

"Something like the $900 knife in the article is/could be a mass-produced stamped piece of metal" Very well could be some liability potential wrapped into reuse of a device. After all part of the cost does go toward covering things that go wrong for whatever reason. If you take the device fresh and something isn't right you can claim it was defective. If it was used for another operation who is to say when something…

What do you want to bet that the US is the only place in the world that this product is sold for anywhere near $900? It's a plainly ridiculous price (and I'm sure the insurance company didn't actually pay it, but that's another debate).
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