Had appointment with Dr. Neuwirth yesterday

[debbei]

My husband and I were very impressed by the office, the staff, and the doctor himself. I'm not in terrible pain, but we have documented evidence that I progressed significantly in 20 years, and it's a good idea to have the surgery. They seem to think that I'm a 'simple' case because I'm pretty flexible, and that he could get a pretty good correction. THey re-took full set of Xrays because the ones from Dr. Dumbell's office here in NJ were fuzzy and terrible.

Turns out Dr. Dumbell and his colleague 'teacher' were both fellows in Doctor Neuwirth's office, and Dr. Dumbell only graduated a year ago. The Nurse Practitioner couldn't believe that he told me that no one would touch me and did I want pain meds, come back in one year please? WhatEVER. Looks like I made a good call in my thoughts that he will not touch me no matter what.

Dr. N. said that He would fuse T3 to L3 or L4. I would only be in the hospital 5-6 days, and have a 3-4 month recovery. He wants to avoid going to the sacrum to leave me some mobility.

After Dr. N left us, we spoke more with the NP and we asked about taking the Xrays for our appointment with Dr. Boachie on 6/5. She said that we were absolutly right to see these 2 doctors, and we made arrangements to go pick up the Xrays the same morning of the other appointment.

What is worrying me again is the financial aspect of this whole thing. Dr. Neuwirth and the hospital are IN our insurance netowrk, and Dr. B and the Hospital for Special Surgeries are OUT. We do have out of network coverage, but we would have to pay above the 'reasonable & customary'. I called HSS this afternoon to ask, and there is no 'forgiveness' for any of the debt, they have payment plans and charge 9% interest. I was a little surprised at the interest part. I can't even begin to think how much this will cost us. Do you mind explaining how any of you who had Dr. B and HSS handled the financial part?

This past week I found an article http://health.usnews.com/usnews/heal...?spec=ihqorth&
saying that for orthopedics, HSS is #1 in the country. How could I possibly go anywhere else? But how on earth will I pay?

Sigh.......I wish this were an easier decision. I know I want the surgery, the question is who should I pick?

Thanks for listening to me ramble.

[Carmell]

This past week I found an article http://health.usnews.com/usnews/heal...?spec=ihqorth&
saying that for orthopedics, HSS is #1 in the country. How could I possibly go anywhere else? But how on earth will I pay?

Hi Debbe,

HSS is #1 for orthopedics - what does that mean? Being #1 is subjective. There are so many variables to consider. Being #1 to one person doesn't mean its #1 for all. I've learned this especially with pediatric orthopedics - what #1 means to someone may be totally inappropriate treatment for someone else. Orthopedics includes many things - fracture, joint replacements, etc. You want to choose the #1 choice for YOUR situation - adult scoliosis surgery. Is HSS #1 in that arena? Maybe. Is Dr. Neuwirth #2? Maybe. Maybe not. Regardless, he may be #1 for you. It's your job to do the research, talk to current/former patients, etc. Look at the whole picture - the staff, facility he operates in, the pre- and post-op care plan, etc. This is a huge PROCESS, not just a simple surgery.

You will do great. Good luck and best wishes in finding out the right solution for your problem.

[loves to skate]

loves to skate

Dear Debbei,
I agree with Carmell. Number 1 can mean any number of things. Just remember that many of us have had successful scoliosis surgery at many other hospitals than #1 on that list. My hospital was #17 on that list, but for scoliosis surgery, it was #1 in my book for Boston. I think any hospital in the top 20 would be a good bet. I believe you have to trust in God and then trust in your Dr. of choice. I don't understand why a Dr. or a hospital won't accept insurance of any kind. I guess only the rich need apply.
Sally

[Pooka1]

That list is for (the entire universe of) orthopedics. It would be very useful (ETA: for first time patients) to see a list for scoliosis surgeons, broken out into adult and pediatric.

I had one kid who was fused with a certain doctor at a hospital not on that list.

I don't think I could be convinced to go to another doctor for the other kid for the same surgery at this point after seeing the results.

[txmarinemom]

Carmell and Sally are both right: "#1 in orthopedics" is subjective, and #1 covers a LOT of ground.

Aside from my fusion surgery, I've had 3 knee surgeries ... and an ankle reconstruction in May 2006. All orthopedic surgeries.

I would not have considered even ONE of my doctors for all surgeries. Each one had their area of expertise, and that's where I chose to utilize their talents.

Although Boachie *does* first-time surgeries (Singer, he was your first, correct?), isn't he best known for his talents in revision/complex surgery (like Bridwell, I think)?

Don't get me started on the "doesn't accept insurance" issue, but there are a TON of talented surgeons all OVER the U.S. who *do*.

(... and 9% interest on a $250K+ (at least) surgery by Boachie - who uses his funds gained here to do free surgery in the country he calls home, while he butters his bread HERE - seriously burns my a**. I'd not heard *that* one yet. Maybe this is his "kindler, gentler office" vs. telling people to take out loans on their homes ...)

If your case is as uncomplicated as you say, I'd counter Boachie and his OON fees are unwarranted as a choice for your first surgery.

But that's just my opinion.

Regards,
Pam

[debbei]

Carmell and Sally are both right: "#1 in orthopedics" is subjective, and #1 covers a LOT of ground.

Aside from my fusion surgery, I've had 3 knee surgeries ... and an ankle reconstruction in May 2006. All orthopedic surgeries.

I would not have considered even ONE of my doctors for all surgeries. Each one had their area of expertise, and that's where I chose to utilize their talents.

Although Boachie *does* first-time surgeries (Singer, he was your first, correct?), isn't he best known for his talents in revision/complex surgery (like Bridwell, I think)?

Don't get me started on the "doesn't accept insurance" issue, but there are a TON of talented surgeons all OVER the U.S. who *do*.

(... and 9% interest on a $250K+ (at least) surgery by Boachie - who uses his funds gained here to do free surgery in the country he calls home, while he butters his bread HERE - seriously burns my a**. I'd not heard *that* one yet. Maybe this is his "kindler, gentler office" vs. telling people to take out loans on their homes ...)

If your case is as uncomplicated as you say, I'd counter Boachie and his OON fees are unwarranted as a choice for your first surgery.

But that's just my opinion.

Regards,
Pam

Hi Pam,

Let me clarify--it is the HOSPITAL that told me you have to pay in full and there is 9% interest. I don't know anything yet about the Dr's office yet as I have that appointment June 5th.

[debbei]

That list is for (the entire universe of) orthopedics. It would be very useful (ETA: for first time patients) to see a list for scoliosis surgeons, broken out into adult and pediatric.

I had one kid who was fused with a certain doctor at a hospital not on that list.

I don't think I could be convinced to go to another doctor for the other kid for the same surgery at this point after seeing the results.

You're right--I wish there was a similar list for scoliosis doctors.

[debbei]

Dear Debbei,
I agree with Carmell. Number 1 can mean any number of things. Just remember that many of us have had successful scoliosis surgery at many other hospitals than #1 on that list. My hospital was #17 on that list, but for scoliosis surgery, it was #1 in my book for Boston. I think any hospital in the top 20 would be a good bet. I believe you have to trust in God and then trust in your Dr. of choice. I don't understand why a Dr. or a hospital won't accept insurance of any kind. I guess only the rich need apply.
Sally

I guess my main objection is that Beth Israel, where Dr. Neuwirth does surgery, is not even on the list at all.

[bsprings]

Debbe,
Maybe you could plan on talking to the girl who does the billing for Dr. B when you have your appointment. She could probably give you alot of information that will help you decide-
Cathie

[Pooka1]

I guess my main objection is that Beth Israel, where Dr. Neuwirth does surgery, is not even on the list at all.

Sometimes you have to work with a hospital just to get the surgeon.

There were issues at the hospital when my one kid was fused. Those, however, would not stop me from going back to the same hospital, same floor, same nurses, etc. for the other kid although I now have my own protocols for certain things that I WILL insist upon getting even if I have to physically stand on the desk of the hospital administrator.

And I'll have a fist full of peer-reviewed literature while I'm standing up there.

[MaryF]

Healthcare is not free

In March I went to Dr. B's office in NYC. Using United Healthcare High Deductible, the x-ray charge from the hospital in Dr. Boachie's office was in network. His visit was $450 cash out of network. Dr. Shelekov was $357 for the office visit out of network. Difference is Manhattan vs Plano, TX. I have an appointment with Lenke next Wednesday. He is in network. I'll see what his allowable is from UHC. I also saw Dr. Geck in Austin, he is out of network, his bill was appr. $290. He traveled to South America last summer on a medical mission trip.

Doctors have a choice to be participating in network or non-participating.

This can be due to many reasons:

Basic supply vs demand=economics. Time vs money. Example below. 11 surgeries to generate $25,000. Or 1 surgery = $25,000.

The amount of money the insurance companies believe the procedure is worth maybe too low for the doctor. Such as in Manhattan a doctor will charge $25,000 for Spinal Fusion (CPT code 22802). If non- participating with a plan, they would collect that from the patient. That same procedure based on Medicare allowable in Manhattan is $2,311.50. Medicare pays 80% and patient or secondary insurance pays the 20%.

Many commercial insurances base their allowables as a percentage of Medicare or Relative Value Unit.

Location and the need for patient volume to be successful in a business. The more popular, the more they can charge.

Why do Celine Dion tickets cost more than the lady down the street? Who decided she was that good?

What we choose to do with the money we make from our jobs, with the exception of taxes, we a decide what we do with it. Spend, save, pay for the doctor we believe is the best for us or give it away anywhere in the world where we believe it is needed is everyone's choice. (support ex wives, buy luxury cars) We all make these choices.

Dr. Boachie chooses to help the less fortunate who do not have a choice.

Also the hassles of getting paid and that if not billed to the satisfaction of the insurance company, it can be denied and you can't bill the patient. That's what the HMO agreements read.

Ask for a predetermination letter and see if Dr. Boachie and your insurance come to agreement. LOA "Letter of Agreement" You still have a maximum out of pocket expense with your insurance if PPO. Not sure if with anHMO, check the plan. HMO plans recently have very high premiums and many people switch to PPO and High Deductible Health Plans. It won't be free, but it is a major expense in your life and the decision to have surgery is a life decision.

Finding the right surgeon for each us is an individual decision. Hopefully in talking to a few, one will stand out that we want. Some times it is the first one we meet, some times we seek a few opinions. We all are constrained at some level in all things due to the resources we choose to spend.

It is not an easy journey. Good Luck to us all.
Mary

[Singer]

In my case, most of my hospital costs were covered. By a happy fluke, my husband has New York-based insurance (B/C B/S), so we really lucked out there. Also, our insurance covered 80% of Boachie's total surgical bill and Boachie wrote off the difference after I placed a very polite call to Theresa, the HSS billing lady. That being said, Yes, we did pay $400 cash for the initial consult and a moderate bit of cash for incidental specialist and testing costs that weren't fully covered.

I wasn't happy with the nursing care I got at HSS and ended up hiring a private nurse during my 10-day stay there. It was a rough place, in my opinion. HOWEVER, what I liked about HSS is that it has one of the very lowest post-op infection rates in the country. It's a clean, well-run and efficient hospital, but you definitely need a private nurse after this big of a surgery.

Dr. Boachie is not the only fish in the sea...there are a lot of options if you need to stay with an in-network surgeon.

[Susie*Bee]

Debbe-- I feel for you and having to make this decision. Maybe after you find out a little more it will all fall into place and seem an easier choice. There are so many parameters that come into play... finances being a major one for many of us, as well as feeling good about our surgeon and hospital. It might help to write down the pros and cons of the different possibilities and also list your priorities. That might help you to "see" how you really feel about it. Yes, having THE best of surgeons or hospitals may seem really important, but maybe some other factors can counterbalance things so it's not the final decider. I would think that if you feel confident in your surgeon because he/she has substantial experience, is board certified, etc., and the hospital isn't some little podunk place, you will do well.

I've been giving your hospital article some thought and will share this with you. I too was impressed with my hospital's rankings in their orthopaedic division... last year, when I was having surgery, it had ranked 6th. (I see if has dropped to 8th this year, but that's still pretty impressive...) After having spent 11 days there, this is what I think. It's mixed, like me! The ranking gave me a little peace-- and it made me feel confident that all was well and that I was being taken care of well. I have absolutely no complaints about the hospital at all, from my stay or to any of the payment/insurance aspects. They were very easy to work with. It was a rough time being in there-- and you are totally dependent on the staff's abilities. (Although I've seen some of you folks are pretty good at demanding your rights! Good for you!) In general, I was quite pleased. Even so, any major hospital will be able to meet your needs. They all have standards to comply with, and any major scoliosis surgeon, I feel sure, only does surgeries at hospitals that meet the technical and care demands needed for such a huge surgery. I really don't think the rankings are something to be that concerned with. One of the main things you'll bring away with you from your hospital visit is how you were treated by the staff. Regardless of rankings, size, etc., people are people. You'll find some compassionate, caring people-- and some who seem to have a chip on their shoulders... I have fond memories of a few-- nurses and "helpers" both, and also remember one I didn't like at all. Her mind and manners were somewhere else. James was a "helper" (nurses aide?) who brought sunshine into my room whenever he came, even though he was very black himself. He would "dance" me to the bathroom (v-e-r-y s-l-o-w-l-y) and help me smile and laugh. What a delight! Jesus (very fitting! but pronounced hay-soos) was a nurse whose compassion and helpful nature made the tough times so bearable. When I needed understanding for my inabilities, and help with embarrassing matters, he ranks with the best there is, anywhere. What a blessing! People like these are found in all hospitals, I'm sure. As far as food and amenities go, all hospitals (I think!) can't really get very far away from having institutional tasting food. Mine was fairly good but still institutional-- and does it really matter? It's not like a nice restaurant or anything... And other amenities? I did have a private room, which was very nice. But there sure wasn't much room in it! They never offered more than a chair for my husband. I've stayed at a little (I mean LITTLE) county hospital when a daughter had pneumonia, where they brought a fold out comfy bed, provided free meals, let me shower, etc., all gratis. Nothing like that happened here, believe me. So you'll find all hospitals have their good points and their bad.

I know I wrote WAY too much and apologize... I guess I was just rambling on about hospitals and probably didn't say anything helpful anyway. I'm sure you will be treated well in either of the ones that you are considering. Best wishes in coming to a decision!

[txmarinemom]

I finally got around to looking at this - LOL. Interesting, but did anyone else notice once you get past the top 10 or so there isn't a lot of difference in rank?

Methodist Hospital was ranked #30, which isn't that big a deal to me - good or bad. I've been through the ER there, had breast augmentation there, my fusion surgery was performed there, and my neurosurgeon operates there. Overall, I've been pleased with every experience (as well as one can consider themselves "pleased" with a hospital stay).

I don't care where you go, there always seems to be a token, grouchy night nurse - LOL. You almost have to wonder if that's actually their title . I do wonder why those types (who seem to consider the patients an inconvenience, at best) continue to pursue the vocation (much like teacher who seem to loathe kids).

Most, if not all, surgeons associated with Baylor College of Medicine (Houston) operate there, and I was actually a bit surprised they even tried to rank them in the categories of Cancer (because M.D. Anderson is right there) and Heart Surgery ... St. Lukes is just across one of the many walkways of the Texas Medical Center.

Here's what I found most dubious about the article rankings:

"They (doctors) were asked to list the five hospitals they think are best in their specialty for difficult cases, without taking location or expense into account (or naming their own hospital). The numbers in the "reputation" column are the combined percentages of responding physicians in the 2005, 2006, and 2007 surveys who listed the hospitals. Nearly half of the 3,200 doctors surveyed this year responded."

A few points that aren't clear:

What is considered a "difficult case"?

Would an ankle reconstruction that requires a tendon graft be "difficult"?

A window-shaded Achilles tendon? Rotator cuff revision surgery?

A hip replacement? Scoliosis fusion surgery (1st time - or only 4th time?)?

What I'm getting at is the term is somewhat subjective, and all surgeries above would normally be performed by specialists in those areas.

What was the response rate in 2005 and 2006, and did doctors from each subjective area actually respond to the survey?

There are several hospitals with a Reputation = 0% (Methodist included), and the data geek in me has to wonder about who responded, their specialty, and what they consider "difficult".

(hopefully all that made sense! ;-)

All that aside, debbei, Susie*Bee is exactly right about the importance of weighing all the factors (not just hospital or surgeon rank) when you decide. It's certainly a personal decision for everyone.

You'll figure it out ... hang in there!

Regards,
Pam

[CHRIS WBS]

Spinal Fusion at Beth Israel *****

Perhaps this will help ease your mind.

http://www.healthgrades.com/consumer...&useragree=yes