The Cost of an ACL Injury • Hacker News Board

Re: The Cost of an ACL Injury

#91

Post by dragonwriter » Mon, Jun 03, 2013, 10:49 PM UTC

pkulak wrote: post #46

It seems to me that the balance of power has shifted far over to the providers and away from the insurance companies. Would allowing more mergers give them more bargaining power and bring these costs down? Or is that just too simple?

> It seems to me that the balance of power has shifted far over to the providers and away from the insurance companies.

That's because you are looking at an accounting of the nominal charges, and not what the insurance actually paid. If you look at what the insurance actually paid based on those nominal charges, you'll see that the balance of power isn't where you think it is.

Re: The Cost of an ACL Injury

#92

Post by jonknee » Mon, Jun 03, 2013, 10:51 PM UTC

ricree wrote: post #89

larrys wrote: post #77

Earlier quoted context omitted.

"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.

Economies of scale have nothing to do with medical billing in the US. For example, IV bags of saline don't cost $100 in the real world (more like $1).

Re: The Cost of an ACL Injury

#93

Post by dragonwriter » Mon, Jun 03, 2013, 10:59 PM UTC

ianstormtaylor wrote: post #6

skaevola wrote: post #4

Why don't the medical tools get reused? That seems absolutely insane to me.

Yeah I also don't get that. Would they not be able to just be disinfected and resealed?

> Would they not be able to just be disinfected and resealed?

Blades that need to be very sharp and of very particular dimension are going to need sharpened, which is going to change their dimensions. So there is limited, if any, reusability in any case.

And the keeping, transporting to a cleaning facility, cleaning, sharpening, etc., is going to come with an additional cost cost and risk of accident that you don't have with immediate disposal.

Re: The Cost of an ACL Injury

#94

Post by Fomite » Mon, Jun 03, 2013, 11:04 PM UTC

ianstormtaylor wrote: post #6

skaevola wrote: post #4

Why don't the medical tools get reused? That seems absolutely insane to me.

Yeah I also don't get that. Would they not be able to just be disinfected and resealed?

Some can be, some can't be. Many simple, common-place tools are remarkably hard to clean.

In a battle between "Lets save money" and the risk of a healthcare-associated infection, both economics and clinical ethics sides on tossing the tool.

Re: The Cost of an ACL Injury

#95

Post by r00fus » Mon, Jun 03, 2013, 11:11 PM UTC

bluedino wrote: post #11

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

Pet insurance. Some companies provide this benefit. One of the reasons we never got a pet, though my kids would absolutely love one.

Re: The Cost of an ACL Injury

#96

Post by drdoc » Mon, Jun 03, 2013, 11:11 PM UTC

angersock wrote: post #61

epmatsw wrote: post #59

Earlier quoted context omitted.

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.

As an anesthesiologist, this is a bad idea for various different reasons. There are a numerous reasons why a physician needs the tools that he needs. The type of procedure, the type of patient and the familiarity of the equipment. I routinely intubate patients with a particular type of tool because that is what I feel most comfortable with and I have trained with. Yes, I can intubate with the myriad of other devices but there is that 1 out of a 1000 chance (slim but not unrealistically slim because I do >1000 intubations a year) that I cannot intubate you and you need to have a tracheostomy or worse, you die.

Some may argue that we should all train with the same equipment, but even then, what about inherent differences in the physician or the patients. Maybe where I trained, all my patients had large tongues and I need a particular blade more often so I became better skilled with that or maybe my hands are just better with a particular blade.

Re: The Cost of an ACL Injury

#97

Post by jacoblyles » Mon, Jun 03, 2013, 11:17 PM UTC

pyre wrote: post #64

chudi wrote: post #39

Earlier quoted context omitted.

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

Libertarians have been complaining about the USA's complicated health bureaucracy for decades. Hell, they've written dozens of books about it. It doesn't take a genius to find perverse incentives in US medical pricing schemes.

But don't let me get in the way of your 30 seconds of hate...

Re: The Cost of an ACL Injury

#98

Post by drdoc » Mon, Jun 03, 2013, 11:19 PM UTC

I would like to pose a question to the Hacker News community. If you had to, where would you cut costs? Do you think doctors are paid too much? Or nursing staff? Obviously, we think these services are overbilled but the reality of it is that most of these bills are not paid at all or paid for a fraction of what is billed.

Re: The Cost of an ACL Injury

#99

Post by bayton » Mon, Jun 03, 2013, 11:22 PM UTC

Great read. Very well researched and written.

As a side note, medical insurance much like construction is a 'cost-plus' industry. The insurance companies actually have incentive to make prices go up.

For example, insurance companies are required to spend 80% on medical expenses. So if cost of an ACL surgery skyrocketed $100,000 then, they would make $20,000 off of it. Instead, they only made about $14k off of Calvin's surgery.

Re: The Cost of an ACL Injury

#100

Post by angersock » Mon, Jun 03, 2013, 11:32 PM UTC

drdoc wrote: post #96

angersock wrote: post #61

Earlier quoted context omitted.

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.

As an anesthesiologist, this is a bad idea for various different reasons. There are a numerous reasons why a physician needs the tools that he needs. The type of procedure, the type of patient and the familiarity of the equipment. I routinely intubate patients with a particular type of tool because that is what I feel most comfortable with and I have trained with. Yes, I can intubate with the myriad of other devices…

If I dropped a Linux admin off at a shop which didn't have emacs on their boxen and he refused to work because he might accidentally screw up a config file, he'd be laughed out of the joint.

If I dropped a plumber off at a job site and she didn't have a particular type of ergonomic monkey wrench she'd grown accustomed to and said she couldn't do the job, she'd be mocked endlessly.

If I dropped a line chef off at a kitchen and they didn't have their favorite knife available and they held up orders for a whole night, their boss would fire them.

~

This custom bespoke medicine nonsense is increasingly seeming to be just that: nonsense.

Sure, there's this .1% chance that you might screw up an intubation, but that seems to be more of an issue of bad training than bad equipment.

As far as your point about differences in patients or physicians: that's a cop-out. Part of being good at what you do (as a dev, as a maker, as a person) is being flexible enough to make do and succeed.

In a system which costs as much as ours does to people who simply can't afford it, we (as a society) cannot afford to cater to the whims of overspecialized professionals.