Is Your Metal Implant MRI Safe? There's a Website for That...

Although one could always contact the manufacturer or surgeon who performed your metal implantation directly to determine whether it is MRI safe or not, there's also a website that contains a comprehensive database of metal implants and how compatible they are with MRI scans.

Who knew that certain metal implants are compatible with MRI scans up to a certain strength?

Who knew a metal implant that may not necessarily be compatible with MRI, but given enough time after implantation (usually 6 weeks), it is still safe to get an MRI scan?

Check this website www.MRIsafety.com out!

The actual searchable list of implants is here.

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Unhappy with Your Appointment Day/Time with your Doctor?

A common complaint for patients is how long it may take to get in to see a medical specialist. A new patient appointment may be 1-2 weeks away when an earlier appointment may be desired.

What to do?

Of course, one can call around to every single specialist office in the region to see who has the next earliest appointment.

Other options which may work just as well include the following:

• Do NOT limit yourself to a specific day of the week and time. Always use the phrase "the very next available appointment whenever that may be."

• Ask your regular doctor to call and make an appointment for you. Be aware that if you resort to this option, you will have to accept whatever day/time you are given. Do not use this option if you will most likely end up changing the appointment to suit your schedule, otherwise risk being given an appointment far into the future.

• Although in theory, there are appointment wait lists you can put yourself into, it only works if the medical office checks it regularly... which typically does not happen. What works better is to call everyday! On a daily basis, there are ALWAYS cancellations that occur. In my office daily, there are usually 1-2 new patient appointment cancellations and double that in established patient appointment cancellations. Such cancellations usually are called in by 10AM for that afternoon or 4PM for next day cancellations. So call around that time to see if any appointment slots have opened up that you can slip into. This is why medical offices beg patients to always call if you are not going to show up and even charge a fee if you fail to inform in advance. It is to help other patients who desperately want to be seen and who could have been scheduled into your appointment slot that ended up being wasted.

Based on a study by ZocDoc, here are other appointment related trivia:

• Tuesday is the most popular day for doctor appointments; it's also the day with the most last-minute openings.
• For pediatricians, the most popular day for doctor appointments is Monday
• The most popular appointment of the week is Friday at 10AM, followed closely by Friday at 2PM.
• Thursday has the longest wait time.

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Costs of Surgery... How Is This Calculated?

So I have blogged about this topic a few times in the past, but there still seems to be confusion regarding the costs of surgery.

As mentioned in the past, the cost of surgery is broken down into basically 3 separate charges:

• Surgeon's charge
• Anesthesia's charge
• Hospital's charge

So... after surgery, a patient typically will get 3 bills; one each from surgeon, anesthesia, and hospital.

At least in the United States, the three charges are completely separate from each other to the point that anesthesia will have no idea what the charges for the surgeon as well as hospital will be.

Same goes for the surgeon... the surgeon will know his charges, but will have no idea what the charges will be for anesthesia and the hospital.

Even if the surgeon demands to know what anesthesia and the hospital will charge for a surgical procedure (s)he will perform, a specific charge will not (can not) be provided in the United States typically.

Why is that?

If I am going to perform for example, a tonsillectomy, why can't anesthesia give even me the surgeon a specific dollar amount of what anesthesia will charge? Why can't the hospital administration provide me the hospital charges?

Here's why... or at least part of the reason why in the United States...

Surgeon's Charge

The surgeon's charge is set. For a given surgeon, his/her charge will remain the same regardless of time or difficulty of the surgery. It may be different between different surgeons... but for a given individual surgeon, it will always be the same for a given procedure.

For example, if the surgeon's tonsillectomy charge is $250. It will remain $250 whether it takes 15 minutes or 3 hours. It will remain $250 if the surgery was technically difficult or a piece of cake.

So, the surgeon's charge is easy. It is what it is.

The harder question to answer is what the anesthesia and hospital charges will be...

Anesthesia Charges

Anesthesia charges on a per time basis (in increments of 15 minutes) on top of a "base" charge that depends on the surgical procedure.

For example, let's say a given anesthesia group has a base charge of $500 for tonsillectomy.

Let's also assume this particular anesthesiology group charges $500 per 15 minutes of anesthesia.

SO... if the surgeon performs a tonsillectomy and it takes the surgeon 30 minutes to perform the procedure, the anesthesia charge will be $500 base charge PLUS $1000 for the time ($500 per 15 minutes) for a total anesthesia charge of $1500.

If it so happens that the surgery takes only 15 minutes... than the anesthesia charge will be $1000 ($500 base charge plus $500 for the 15 minutes surgical time).

In other words, for the SAME exact surgical procedure, the anesthesia charges may be different for different patients depending on how long the surgery takes.

Hospital Charges

Different hospitals calculate their charges differently... but in essence, the hospital will charge whatever it cost them to allow the surgery to happen in their facility plus a nebulous "profit" factor.

SO, a given hospital charge will include the:

• Salary of all the personnel used in the surgery (surgical tech, registered nurse, circulating nurse, anesthesia tech, secretary, etc)
• Equipment used during the surgery (IV lines, needles, anesthesia tubing, masks, endotracheal tube, surgical equipment, etc)
• Medications used during the surgery (gases, IV drugs, etc)
• Facility costs expended during the surgery (electricity, water, oxygen, medical waste disposal, etc)

To take the example of tonsillectomy, the hospital charges will include all the equipment, medications, personnel, and facility costs utilized during the tonsillectomy surgery.

In Summary, the Cost of Surgery is... It Depends

Given anesthesia charges vary based on the time duration of surgery regardless of WHAT the surgery is as well as hospital charges which may vary based on how much was "expended" during the surgery regardless of WHAT the surgery is, the anesthesia and hospital charges are moving targets which roughly correlate with how long the surgery takes.

The surgeon can certainly state what their charges will be up-front because this charge is fixed, but anesthesia and hospital charges are NOT fixed and depend on a certain time factor regardless of WHAT surgical procedure is being performed.

Because of this time dependence, that's why anesthesia and hospital charges can not typically be obtained prior to surgery in most places.

That's also why most places can't (won't) post the total cost of surgery up-front.

Of course, if a given surgeon is very consistent and always takes 15 minutes to perform surgery and always uses the same exact equipment, than anesthesia and the hospital may be able to provide an "averaged" charge up-front.

It is also not uncommon that additional "discounts" may be offered based on a patient's income.

Some places like the Surgery Center of Oklahoma somehow persuaded the anesthesiologist, surgeon, and facility administrators to sit around a table and force an agreement on a fixed TOTAL charge for different surgical procedures. Once an agreement is made on a fixed charge for each, an up-front cost can be publicized... but this can never happen as long as anesthesia and hospital refuses to agree to a fixed charge and rather stick with a time-based framework to determine their charges.

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Surgery Center Posts Prices of Procedures

Given the uproar over the lack of transparency of surgery prices, it was only a matter of time before an operating facility in the United States (oversea facilities have already done so) takes the step of posting the cost of surgery... a set cost that is exactly what a patient pays. Complete cost transparency.

The Surgery Center of Oklahoma is an AAAHC accredited facility since 1998 and has over 40 participating surgeons. And they are the first that I'm aware of that has taken the step of posting the cost of surgery on their website. The caveat being the cost shown ONLY applies to those who do not have health insurance.

On their website, they state:

"Transparent, direct, package pricing means the patient knows exactly what the cost of the service will be upfront. Fees for the surgeon, anesthesiologist and facility are all included in one low price. There are no hidden costs, charges or surprises."

Keep in mind that this cost is NOT just the surgeon's fee, but also includes the anesthesia charges as well as facility charges. Read more about such charges here.

So what are the charges? They have it all posted on their website!

But below is a list of charges for ENT procedures as of 6/3/12 (surgeon, anesthesia, and facility charges all bundled into a single charge). The webpage also includes prices for general surgery, orthopedics, urology, ophthalmology, etc.

I wonder if other facilities in the United States will start following suit???

Neck
Thyroidectomy		$ 6,160.00
Lymph Node Excision / Biopsy		$ 2,255.00
Ear
Myringoplasty		$ 2,400.00
Bilateral Myringotomy with tubes		$ 1,700.00
Tympanoplasty		$ 5,060.00
Tympanoplasty - Mastoidectomy		$ 7,050.00
Mastoidectomy		$ 6,640.00
Inner Ear - Stapedectomy		$ 5,390.00
Ossiculoplasty		$ 5,060.00
Cochlear Implant		$ 8,800.00
Foreign Body Removal		$ 1,500.00
Nose
Bilateral SMR Turb		$ 2,700.00
Sinus / Turbinates 1 side		$ 3,795.00
complex		$ 4,950.00
Sinus / Turbinates both sides		$ 4,510.00
complex		$ 5,885.00
Septoplasty		$ 3,550.00
Septoplasty and Sinus/Turbinates		$ 5,060.00
Nasal Fracture Simple Closed		$ 1,900.00
Nasal Frature Complex Open		$ 4,015.00
Throat
Tonsillectomy		$ 3,050.00
Adenoidectomy		$ 2,695.00
Tonsillectomy and Adenoidectomy		$ 3,695.00
Adenoidectomy and BMT		$ 3,300.00
Tonsillectomy and Adenoidectomy and BMT		$ 4,400.00
Frenulectomy		$ 1,600.00
Uvulopalatopharyngoplasty		$ 5,445.00
Diagnostic Laryngoscopy with biopsy		$ 2,970.00

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