Interesting news article

[Elisa]

Interesting article though. Still, at about $150K for scoliosis surgery for an average stay of 5 days in the hospital compared to: $150K for scoliosis surgery + posterior release surgery with halo application + 5 weeks stay in hospital (with parent) + 24 hr. nursing care + physio care + school teachers + transportation to and from hometown to Portland + hotels & meals + some other stuff I probably don't even know about. WOW, I can only imagine what the grand total of all this is going to be. I think I need to buy a LOT of Shriners raffle tickets when I get back home.

Edit: Ballet Mom, I typed out my response before I read your last one and agree with everything you said. If my son had been seen in a timely manner in BC then we would not have been forced into this extremely expensive route. Don't agree with your statement about the other surgeon though as he should NEVER answer anyone by saying: "Why do you care?" Just wrong. All around wrong, tasteless and rude. No excuse. It wasn't about me "refusing" a certain type of metal, I was just curious what they were planning on using.

[Elisa]

Your son is receiving donated care that most kids with those size curves do not receive. The girl water polo player that I mentioned that had a 112+ degree curve after waiting to play in her state finals had just a regular scoliosis surgery, with no halo treatment, etc. The surgeon recalls the surgery as "very difficult" as he had to move that large curve in one big session. Kids from this country do not receive insurance payments to stay for weeks at the hospital with a halo on. That seems to be a Shriners feature.

I'm not familiar with the 'water polo girl' that you're referring to but according to Dr. K surgeons rarely see kids with massive curves b/c they are corrected much sooner. I'm sure regular medical insurance allows kids in the US who have been diagnosed with scoliosis to see a specialist relatively quickly if they have been referred? That's the feedback I'm getting while down here. Let's just look at this hospital we're in right now, there's 3 spinal surgeons who practice here. There are 2 spinal surgeons who deal with kids in the entire province of BC which has 1 million kids. The kids with the big curves they see here and mainly from Canada. Sad but true. I am just thankful that the BC Shriners are still active in our community otherwise... I can't even go there b/c it's too scary and gives me nightmares and anxiety attacks. That's why I recently joined a 'cause' on facebook to fix this particular mess and I hope it does make a difference soon for other kids and their parents who are going through this very thing.

[Elisa]

While I'm on my BC rant, check out this article. Looks like they're spending a boatload of money to build a new kids hospital. Is this really going to cut down the wait times for kids' surgeries? Why aren't they spending money to bring in surgeons to help out with the workload burdened on those TWO they already have? Yeah, we'll have a brand new gorgeous kids hospital to awe at but you'll still have to wait until your kid turns into a pretzel and can't breathe... and you still don't get an appointment. I left a comment but I doubt very much it will ever get posted.

these donations will ensure that BC’s one million children will have access to the finest medical care our hospital can provide.

^^ This is such an oxymoron. Yes, the kids will get the finest medical care the hospital can provide... with those 2 surgeons available for 1 million kids, LOL

http://www.bcchf.ca/blog/?p=1438

[Ballet Mom]

Edit: Ballet Mom, I typed out my response before I read your last one and agree with everything you said. If my son had been seen in a timely manner in BC then we would not have been forced into this extremely expensive route. Don't agree with your statement about the other surgeon though as he should NEVER answer anyone by saying: "Why do you care?" Just wrong. All around wrong, tasteless and rude. No excuse. It wasn't about me "refusing" a certain type of metal, I was just curious what they were planning on using.

Surgeons are known for their surgical skills, not necessarily known for their bedside manner. All doctors get tired of answering questions from patients with a little dangerous knowledge learned off of the internet. My sister even complains about it (a doctor). Doctors and surgeons have very limited time to spend with the patient to answer questions, I'm sure he doesn't want to start a conversation about the metallurgical properties of different implant systems with you.

I personally find it "wrong, tasteless and rude" to be trashing a well-regarded surgeon on the internet for the world to see, when your son is receiving outstanding care. Just my opinion.

[Elisa]

I asked what kind of rods they were planning to use. All he had to say was: cobalt-chromium-molybdenum. I had a pen in hand to write it down and Google it. He is not caring for my son, Dr. Krajbich is. You are entitled to your opinion which you express freely and often. I am entitled to mine. End of story.

[Ballet Mom]

I've been trying to figure out the role of insurance companies recently. It would seem as if it would be to their advantage to vigorously investigate medical fraud and overcharges, but that doesn't seem to be the case. I've wondered if maybe they're afraid of having an antagonistic relationship with doctors for fear that doctors will no longer accept their insurance.

The insurance companies have started to clamp down on some spine surgeries:


"A collection of nine medical associations is arguing against new restrictions on spinal-fusion surgery set by a health insurer in North Carolina amid concerns such restrictions could limit patient care and spread to other states.

Whether the groups can alter the new rules from Blue Cross and Blue Shield of North Carolina, which go into effect Jan. 1, remains to be seen. But the response is evidence doctors are joining forces to battle ongoing insurance pressure on the spinal-fusion market. Several spinal device-makers, most recently NuVasive Inc. (NUVA), have cited signs insurers are raising barriers to such procedures amid concerns they're over-utilized.

Doctors worry the new policy in North Carolina, which is seen as particularly restrictive, could further dampen an already slowed market if it spreads elsewhere.

"We certainly see that once even a local area starts coming up with these policies, others may start adopting it," said Joseph Cheng, who directs the neurosurgery spine program at Vanderbilt University Medical Center in Nashville, Tenn. He also serves on the coding and reimbursement team for the American Association of Neurological Surgeons, which co-signed the letter.

The letter was sent last week and also signed by the American Association of Orthopaedic Surgeons, the Scoliosis Research Society and the North American Spine Society, among other groups. They said they "have concerns regarding the criteria and guidelines" in the new coverage policy, and they proposed less restrictive language.

That policy includes detailed descriptions of conditions for which fusion surgery in the lower back should and shouldn't be covered. In one case, the new policy denies coverage for patients with degenerative disc disease. There is also new requirement for prior authorization before patients get surgery.

http://online.wsj.com/article/BT-CO-...22-712475.html

[LindaRacine]

I got my insurance company explanation of benefits for my January surgery today. The cost of the implants was $45,213 (of which BC allowed $22,607, exactly half). My implants included 3 cages, 2 SS rods (L2-S1), 10 SS pedicle screws, one iliac bolt, and 2 connectors (connecting the new implants to the old). I didn't receive any detailed invoice from the hospital, so I don't know how much each screw was, but obviously, they were pretty expensive.

The overall hospital bill for the OR, implants, and 5 days in the hospital was $261,125, which does not include the professional fees.

--Linda

[jrnyc]

i agree, Elisa, that the reply was snotty! i don't know if the guy meant it to be snotty, but it was! and...no doctor of any kind should ever ask a parent why they care about something concerning their child!! he could have said a lot of other things...like "there is only one form of instrumentation we can use" or "there is only one appropriate to his needs, and the name of it is_____" or whatever....what he said was so obnoxious, i would have been yelling at him as soon as i closed my mouth from being open in shock!

something appropriate to say a thank you that is almost impossible to put into words...saving Elias' life....is hard to think of....
perhaps a really beautiful letter to the President of the hospital...praising Elias' surgeon, and also naming and praising whomever on the staff have been sweet to him....most all people in all kinds of work like to be praised by name....i found that to be true in department stores and in medical offices, so i bet it is true in hospitals as well....plus of course you could include a big thank you to Shriners itself...

thinking of Elias, and you, for the surgery and after...
jess

[LindaRacine]

Recent publication quoting implant cost. Note that 1) this is from Europe (which could make a huge difference), and it's hard to know whether "cost" refers to the cost to the patient/insurance, the cost approved by insurance companies/Medicare, etc., or whatever.

Eur Spine J. 2011 Apr 26. [Epub ahead of print]
Right adolescent idiopathic thoracic curve (Lenke 1 A and B): does cost of instrumentation and implant density improve radiographic and cosmetic parameters?
Yang S, Jones-Quaidoo SM, Eager M, Griffin JW, Reddi V, Novicoff W, Shilt J, Bersusky E, Defino H, Ouellet J, Arlet V.
Source

Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive Suite 330, Charlottesville, VA, 22903, USA.
Abstract

In adolescent idiopathic scoliosis (AIS) there has been a shift towards increasing the number of implants and pedicle screws, which has not been proven to improve cosmetic correction. To evaluate if increasing cost of instrumentation correlates with cosmetic correction using clinical photographs. 58 Lenke 1A and B cases from a multicenter AIS database with at least 3 months follow-up of clinical photographs were used for analysis. Cosmetic parameters on PA and forward bending photographs included angular measurements of trunk shift, shoulder balance, rib hump, and ratio measurements of waist line asymmetry. Pre-op and follow-up X-rays were measured for coronal and sagittal deformity parameters. Cost density was calculated by dividing the total cost of instrumentation by the number of vertebrae being fused. Linear regression and spearman's correlation were used to correlate cost density to X-ray and photo outcomes. Three independent observers verified radiographic and cosmetic parameters for inter/interobserver variability analysis. Average pre-op Cobb angle and instrumented correction were 54° (SD 12.5) and 59% (SD 25) respectively. The average number of vertebrae fused was 10 (SD 1.9). The total cost of spinal instrumentation ranged from $6,769 to $21,274 (Mean $12,662, SD $3,858). There was a weak positive and statistically significant correlation between Cobb angle correction and cost density (r = 0.33, p = 0.01), and no correlation between Cobb angle correction of the uninstrumented lumbar spine and cost density (r = 0.15, p = 0.26). There was no significant correlation between all sagittal X-ray measurements or any of the photo parameters and cost density. There was good to excellent inter/intraobserver variability of all photographic parameters based on the intraclass correlation coefficient (ICC 0.74-0.98). Our method used to measure cosmesis had good to excellent inter/intraobserver variability, and may be an effective tool to objectively assess cosmesis from photographs. Since increasing cost density only improves mildly the Cobb angle correction of the main thoracic curve and not the correction of the uninstrumented spine or any of the cosmetic parameters, one should consider the cost of increasing implant density in Lenke 1A and B curves. In the area of rationalization of health care expenses, this study demonstrates that increasing the number of implants does not improve any relevant cosmetic or radiographic outcomes.