I get the NY Times e-mail for movie reviews. I got it today, in fact. I don\’t really watch many movies in the theater (I have long lost the stomach to be able to pay that much for what I will be able to rent later), but I like to keep up on the popular culture and know what to rent when they do finally come out.
So when today\’s came I was surprised to find a little nugget tucked away in the middle of the newsletter:
ADVERTISEMENT
![\"\"](\"http://newsletter.adsonar.com/nwrss/imgs/nwr_1324146_5841223_73051_866767_178016_4_2.PNG?placementId=1324146&plid=73051&pid=866767&ps=5841223&topicid=178016&rotation=4&type=2&zw=336&zh=280&v=5&url=NA\")
![](\"http://www.medpagetoday.com/images/blogMedia/drrob/rudy-giuliani-headslap-731342.JPG\")
No, it wasn\’t the Ethanol Stock News or the cruises that caught my eye, it was the fact that a physician group was advertising to little ol\’ me in Georgia in case I wanted my spine operated on. My spine is fine, however, and so I went to the website out of curiosity rather than a real interest in getting lasers aimed at my back.
The Laser Spine Institute website looks really nice. It plays very loud music when you enter, so be careful you are not at a meeting when you surf on over there. There is a "mute" link in the upper right corner. There is much information about back problems and laser surgeries to fix them. Unfortunately, there is virtually no information about where this place is located. I had to look around quite a bit to find that they are actually located int Tampa, FL. I guess this makes sense, given the number of New Yorkers living in Florida (Who knows, it could have been the reason Rudy Giuliani spent so much time in Florida – it was not a campaign strategy, it was a nagging case of sciatica).
I am not certain what demographic that reads the movie reviews in the NY times is especially well-suited to laser surgery on the back. Perhaps the chairs in movie theaters are not as good as the seem. Perhaps folks who watch movies are more likely to think lasers are "cool as heck." Perhaps they figure anyone who is willing to pay $5 for a box of Junior Mints and $10 for a hot dog is a worthwhile demographic to tap into. Sounds reasonable to me.
While I am not sure about any of this, from the website, it seems that this place looks pretty good. Even Peter Jacobson (as pictured below in his mug shot) the golfer has used them.
![](\"http://www.laserspineinstitute.com/images/testimonial.jpg\")
It appears his back is not bothering him.
So the obvious question is, why am I writing about this? Well, I find it quite interesting that some doctors in Tampa should be advertising in the Movies e-mail of the New York Times. We have an ad in the phone book (that costs us a bundle), but we have yet to land someone as prominent as Peter Jacobson (although I do have a shirt that looks like his).
This does say something about our system; primary care physicians are getting more scarce, people have no money for drugs that they need, primary care physicians cannot buy an EMR for their office as it costs in excess of $50,000 per doctor (often), yet these physicians in Tampa can afford easily that much for an ad in the NY Times e-mail, reaching out to patients all over the country, and even the world.
Despite the opinions of some, we really do have a two-tiered system in this country. There are the haves (the procedure specialists and those who perform cosmetic procedures) whose income is growing, and the have-nots (the thinkers and those who coordinate care for the average person) whose income is dwindling. Here we have a healthcare crisis, and yet have some people becoming tycoons off of the same system.
Odd.
Sad.
![](\"http://www.medpagetoday.com/images/blogMedia/drrob/buckets.jpg\")
I smell popcorn.
I must not be charging enough, because I couldn’t (can’t) afford those ads (even if I wanted to). My bank account holds far less than most of my patients. They just “assume” that I am rich (as do many of my fellow physicians). Bad practice — assuming.
I must not be charging enough, because I couldn’t (can’t) afford those ads (even if I wanted to). My bank account holds far less than most of my patients. They just “assume” that I am rich (as do many of my fellow physicians). Bad practice — assuming.
I’m sure you’ll be interested to know that in the recent email bulletin from the American College of Surgeons, the critical shortage of general surgeons is addressed.
“Sen. Lisa Murkowski (R-AK) noted that the dearth of general surgeons in Alaska
has become a matter of public concern. Confirming Senator Murkowski?s
claims was Beth Landon, director of the Alaska Center for Rural Health. In
addition, John E. Maupin, Jr., President of the Morehouse School of
Medicine in Atlanta, GA, echoed the sentiments of the College and said
that the lack of general surgeons is becoming extremely critical”
My point is that the two-tiered system to which you allude may be crumbling into one layer of disgruntled docs. Oh, to be gruntled again.
I’m sure you’ll be interested to know that in the recent email bulletin from the American College of Surgeons, the critical shortage of general surgeons is addressed.
“Sen. Lisa Murkowski (R-AK) noted that the dearth of general surgeons in Alaska
has become a matter of public concern. Confirming Senator Murkowski?s
claims was Beth Landon, director of the Alaska Center for Rural Health. In
addition, John E. Maupin, Jr., President of the Morehouse School of
Medicine in Atlanta, GA, echoed the sentiments of the College and said
that the lack of general surgeons is becoming extremely critical”
My point is that the two-tiered system to which you allude may be crumbling into one layer of disgruntled docs. Oh, to be gruntled again.
Would “universal healthcare” level the playing field?
If you think it would, HOW would it do that for docs?
Do you have a remedy in mind?
Chris and Vic
Would “universal healthcare” level the playing field?
If you think it would, HOW would it do that for docs?
Do you have a remedy in mind?
Chris and Vic
I have a theory that’s been kicking around in my head. People whose job it is to serve others meaningfully are not well respected, and therefore not well paid in our society. People that fall under these catagories are teachers, social workers, primary care, etc. Being a mom isn’t a paid job, but the very fact there are Mommy Wars is another symptom.
There might be lots of good words, and even hero stories, but people appreciate fantasy and vanity more than reality.
I have a theory that’s been kicking around in my head. People whose job it is to serve others meaningfully are not well respected, and therefore not well paid in our society. People that fall under these catagories are teachers, social workers, primary care, etc. Being a mom isn’t a paid job, but the very fact there are Mommy Wars is another symptom.
There might be lots of good words, and even hero stories, but people appreciate fantasy and vanity more than reality.
Why is it people are always trying to link respect with compensation for services, as if only we respected others more, we would pay them more. They are in NO WAY connected in the marketplace. I believe we are largely ignorant of the forces and mechanisms that drive the world of commerce. The answer lies in this question. What do the following 3 things have in common: the law of supply and demand … a better mousetrap … and what the market will bear?
Today there are but a few highly qualified professionals able to perform these laser surgeries that the Laser Spine Institute offers and like anyone in any occupation where the demand is high and the supply is scarce, these specialists can command top dollar, and everyone should know that working for yourself in your own facility beats working for a hospital that will dictate how much money you can earn plying your craft on their premises.
And one is not less humane because he seeks to earn a comfortable living and pass on the fruits of his labor to his family and loved ones. When LSI opened its doors, only one laser surgeon was on staff, Dr. James St. Louis. Now there are 9, each one trained and supervised until proficient by Dr. St. Louis. And they will need to hire and train more because the need is great and the demand is growing throughout the country for this kind of minimally invasive surgery. LSI is simply letting the world know they are open for business. So how do they afford those kinds of ads the writer wonders? Well, they have performed over 6000 surgeries in less than 3 years in business; that might explain it.
Well, wouldn’t it be wonderfully humanitarian of doctors if only they provided free healthcare for their patients? Those greedy, GREEDY doctors! Just because they have some staggering expenses of their own, starting with 10 years of medical school, 3 years for their specialty, an expensive office, a professional and clerical staff to run it, equipment – both medical and office, lab costs, association dues, insurance on the practice … and then there’s the cost of malpractice insurance, continuing education, supplies and healthcare for their workers. And speaking of malpractice insurance, back surgery is the most litigious in the industry.
The laser surgery techniques employed at LSI are not an arcane and closely guarded secret handed down to only a few that know the secret handshake. Anyone, willing to spend 13 years in school and apprenticeship in training before hanging out their first shingle, can earn what these doctors are earning.
Why is it people are always trying to link respect with compensation for services, as if only we respected others more, we would pay them more. They are in NO WAY connected in the marketplace. I believe we are largely ignorant of the forces and mechanisms that drive the world of commerce. The answer lies in this question. What do the following 3 things have in common: the law of supply and demand … a better mousetrap … and what the market will bear?
Today there are but a few highly qualified professionals able to perform these laser surgeries that the Laser Spine Institute offers and like anyone in any occupation where the demand is high and the supply is scarce, these specialists can command top dollar, and everyone should know that working for yourself in your own facility beats working for a hospital that will dictate how much money you can earn plying your craft on their premises.
And one is not less humane because he seeks to earn a comfortable living and pass on the fruits of his labor to his family and loved ones. When LSI opened its doors, only one laser surgeon was on staff, Dr. James St. Louis. Now there are 9, each one trained and supervised until proficient by Dr. St. Louis. And they will need to hire and train more because the need is great and the demand is growing throughout the country for this kind of minimally invasive surgery. LSI is simply letting the world know they are open for business. So how do they afford those kinds of ads the writer wonders? Well, they have performed over 6000 surgeries in less than 3 years in business; that might explain it.
Well, wouldn’t it be wonderfully humanitarian of doctors if only they provided free healthcare for their patients? Those greedy, GREEDY doctors! Just because they have some staggering expenses of their own, starting with 10 years of medical school, 3 years for their specialty, an expensive office, a professional and clerical staff to run it, equipment – both medical and office, lab costs, association dues, insurance on the practice … and then there’s the cost of malpractice insurance, continuing education, supplies and healthcare for their workers. And speaking of malpractice insurance, back surgery is the most litigious in the industry.
The laser surgery techniques employed at LSI are not an arcane and closely guarded secret handed down to only a few that know the secret handshake. Anyone, willing to spend 13 years in school and apprenticeship in training before hanging out their first shingle, can earn what these doctors are earning.
Except that we need primary care physicians more than we need laser back doctors. What if all the internal, family, and pediatric doctors decided they needed more money?
You are not contracted with insurance companies. To avoid back billing after surgery? In other words, you require payment up front, right? Also, since you aren’t in contract, you are able to charge more.
And some of your procedures are not covered by insurance, even out of contract. That is a strong indication that the procedure is either experimental or the effectiveness has been deemed not worth the money (a cheaper procedure can get the same or better results with the same risk, etc). Lasers are expensive, and sometimes the same minimally invasive procedure using something other than a laser is going to be just as effective.
Any back doctor or orthopedist could take a mug shot of his patients where the procedure they performed was most effective and get them to write testimonials. If you’ve done 6000 procedures, where are your actual statistics on success?
You, sir, are praciticing market based medicine. You are more focused on volume and profit than healing.
Except that we need primary care physicians more than we need laser back doctors. What if all the internal, family, and pediatric doctors decided they needed more money?
You are not contracted with insurance companies. To avoid back billing after surgery? In other words, you require payment up front, right? Also, since you aren’t in contract, you are able to charge more.
And some of your procedures are not covered by insurance, even out of contract. That is a strong indication that the procedure is either experimental or the effectiveness has been deemed not worth the money (a cheaper procedure can get the same or better results with the same risk, etc). Lasers are expensive, and sometimes the same minimally invasive procedure using something other than a laser is going to be just as effective.
Any back doctor or orthopedist could take a mug shot of his patients where the procedure they performed was most effective and get them to write testimonials. If you’ve done 6000 procedures, where are your actual statistics on success?
You, sir, are praciticing market based medicine. You are more focused on volume and profit than healing.
I don’t think it is immorality that drives the LSI docs to do what they do. I don’t think it is greed. They are simply taking advantage of a system that is significantly skewed away from primary care. The problem is that this is not a zero-sum equation, and the amount of money spent on procedures that are not necessary (there are actually other ways to do the surgery). When the resources that could be spent on preventing heart disease and diabetes are spent on “better mousetraps, the system breaks down. My point was not to criticize those physicians for doing what they do, but simply point out the things are askew when these things are happening while they cannot get anybody to go into primary care. Primary care is the infrastructure of medical care in the US. The infrastructure is failing. Medicine is not just a commodity like cars, it is a basic infrastructural component of society.
I don’t think it is immorality that drives the LSI docs to do what they do. I don’t think it is greed. They are simply taking advantage of a system that is significantly skewed away from primary care. The problem is that this is not a zero-sum equation, and the amount of money spent on procedures that are not necessary (there are actually other ways to do the surgery). When the resources that could be spent on preventing heart disease and diabetes are spent on “better mousetraps, the system breaks down. My point was not to criticize those physicians for doing what they do, but simply point out the things are askew when these things are happening while they cannot get anybody to go into primary care. Primary care is the infrastructure of medical care in the US. The infrastructure is failing. Medicine is not just a commodity like cars, it is a basic infrastructural component of society.
By the way, I spent did a total of 12 years advanced education. I don’t argue with them doubling, or even tripling my income. I just don’t like that 10-20 times my income. It says something about society.
By the way, I spent did a total of 12 years advanced education. I don’t argue with them doubling, or even tripling my income. I just don’t like that 10-20 times my income. It says something about society.
Didn’t I just read somewhere that surgery doesn’t help most back problems?
I hope those folks who are getting laser spinal surgery are paying for it themselves.
The crime is that we waste money on things of marginal significance and then plead poverty on things that might actually make a difference – like your PCP suggesting that your tummy carrying less fat might ease the strain on your spine!
Didn’t I just read somewhere that surgery doesn’t help most back problems?
I hope those folks who are getting laser spinal surgery are paying for it themselves.
The crime is that we waste money on things of marginal significance and then plead poverty on things that might actually make a difference – like your PCP suggesting that your tummy carrying less fat might ease the strain on your spine!
First, let me clear up a misconception, I am not a doctor and I do not work for LSI. I own no stock or shares of ownership in this company and I have no vested interest in this organization other than wanting to see them prosper and protected from unwarranted negative accusations and insinuations. I am not compensated in any form for the charitable things I say on their behalf. I DO have personal knowledge in this area, having had endoscopic laser surgery on my neck (C3-C4 discs) at LSI in July 2006. The Laser Spine Institute in Tampa, Florida enjoys a reputation that is second to none among the finest medical facilities in this state.
I am a professional researcher by occupation. I work as the chief research analyst for a large legislative lobbying firm in Florida, where I am called on to provide sound, in-depth research on a number of issues that will come before the state legislature in one form or another. I read the article and the postings in this thread and was disturbed by some of the remarks and assumptions; many are logical and some are not. Some of what I found turns out to be largely erroneous. I am not saying these remarks are intentionally false, but just the same, they can be misleading. In my job and profession, our clients (and my bosses) rely on me to be accurate and thorough in all my research. And no, LSI is not one of our clients. An occupational hazard, I am compelled to set the record straight, whenever and wherever I find egregious distortions of fact.
Before I contracted with LSI to operate on my neck I vetted them, researching their record in great detail (as well as many other facilities and surgeons offering this type of procedure). What I found was that LSI had, and continues to have, a spotless record and an enviable reputation. And when I do research, I do thorough, THOROUGH research and I am very good at what I do. Things I discovered about LSI are: over an 80% success/satisfaction rate … no post-operative complications from surgeries … no lawsuits … no AMA or state board of medicine sanctions or disciplinary actions … a long list of satisfied patients who gladly serve with enthusiasm as non-compensated references, fielding calls from those who are contemplating having surgery performed there. I have now joined the people in that group of gratified clientele and I can attest to the effectiveness of their surgery in treatment of cervical stenosis and facet joint problems.
You make a number of specious claims that are not supported by fact. Let me dissect theses items one by one because I must take issue with their validity.
And some of [LSI’s] procedures are not covered by insurance, even out of contract. That is a strong indication that the procedure is either experimental or the effectiveness has been deemed not worth the money (a cheaper procedure can get the same or better results with the same risk, etc). Lasers are expensive, and sometimes the same minimally invasive procedure using something other than a laser is going to be just as effective.
ITEM 1: I can fully appreciate that people do not want to be experimented upon. However, the arthroscopic laser method of surgery LSI uses is not experimental; in fact it is not new at all. It was pioneered in Japan in the late 1970’s and exported to the United States in the early 1980’s, once it had undergone numerous trials and peer-reviewed examinations … or succinctly put, once it had been perfected. The trials that validated their worth were completed overseas nearly 3 decades ago. Here in America we are a bit late to catch on.
ITEM 2: They are indeed covered by every major insurance plan, including Medicare, in whole or in part. These carriers do not appear to share a consensus of reimbursement or a standard uniform percentage of repayment, but each of the 5 largest major medical companies pay some amount based on a formula predicated on what they deem usual and customary. For instance, the various state Blue Cross plans pay anywhere from $8,000 to $18,000 for each of these surgeries, although they routinely deny the claim with the first submission. The same is true of Aetna, which has the worst record of pay-out at near $2,000. LSI has a patient services department solely dedicated to working with the patient and their insurance carrier to ensure the customer recoups the maximum compensation allowed. This group works very hard at it and they are graded on how successful they are at securing the greatest remittance for the patient post-operatively. I personally know this to be true because I had Aetna when I had my surgery and Aetna was difficult to deal with – first denying the claim, then agreeing to pay the comprehensive charges, only to remit a paltry sum of small payments and finally, after much dickering, compensated me for 60% of the total cost. United Healthcare seems to recognize the merit and success rate of these surgical treatments with payments from $18,000 to $24,000, with a minimum of wrangling. Core Source is the best payor, reimbursing their subscribers up to $42,000. Medicare pays $14,900 per surgery and bills the remainder to the subscriber’s supplemental insurance, if they have one. Generally, Medicare and Medicare supplement insurance will pay something on everything but the facilities costs. How do I know these facts? Two of these insurance companies are our clients.
Insurance companies by and large are not proactive when it comes to paying out benefits because the benefit is not theirs. The less they have to pay, the more money they keep and the longer they can stretch out the payment process, the more they earn in invested interest on the pending funds they ultimately will disburse. It is true, the history of payments by insurance companies for this kind of surgery is a short one and partially accounts for the marginalization in usual and customary reimbursement.
ITEM 3: If there truly were procedures that were both less expensive and less risky, laser surgery would not be enjoying the nascent swell in popularity today. Lasers are indeed expensive, and sometimes another procedure using something other than a laser can be as effective, but at what costs? There are no ‘same minimally invasive procedure(s) using something other than a laser’. Name one … just one.
Here are the facts. Open back surgery currently leaves the patient recuperating at home from 6 to 9 months before they can fully return to work. Laser back surgery allows the patient to return to work in 2 to 3 weeks; many report they have returned to work the same week. Open back surgery has a success rate of less than 50%. Laser back surgery (at LSI) has a success rate of greater than 90% … a satisfaction rate of over 80% (the difference flows from higher than reasonable expectations for some patients who believed they would return to youthful flexibility as well. LSI records both statistics.).
The median cost for open back surgery in the state of Florida is $62,545 (including hospitalization for traumatic surgery, home nursing visits, a 6-9 month medication regimen during convalescence, etc.). These costs soar to over $100,000 if the placement of hardware is involved. Cost for laser back surgery at LSI is $29,500 (no hospital stay, no protracted regimen of medication). Open back surgery will often create the development of scar tissue and problems that result from it later. Laser back surgery results in no scar tissue development. Open back surgery often produces collateral damage to the dura matter, adjacent musculature and surrounding tissues. Laser back surgery at LSI does not. In over 6,000 surgeries done at LSI, only one patient had to be hospitalized as a precaution due to numbness in her extremities following surgery, which fully attenuated after 24 hours.
According to the National Center for Health Statistics more than one-quarter of Americans (26%) age 20 years and over — or, an estimated 76.5 million Americans — report that they have had a problem with back pain. Studies from the Pain Management Research Institute reveal a non-surgical annual cost of $1.85 billion per 1 million people, or $1850 per person per year every year. If you are interested in the psychopathology associated with reward function and the dark side of neurobiological drug addiction to pain medication, read the Nature and Nurture of Pain in the weekly Science News, an article adapted from materials provided by American Academy of Pain Medicine, via EurekAlert!, a service of AAAS.
Surgery may not be the only option, but it may be the best one to relieve constant, excruciating pain and laser spinal surgery is the most successful, least harmful, least invasive and least likely to generate additional problems. Need I state that the demand for these types of surgeons is great or underserved. Back to the law of supply and demand. And if there becomes a movement away from primary care physicians to specialists that can command more money … when there’s a dearth of general practitioners, we will see a shift in the dollars paid as well. When something is unique or rare, we pay more for it, including services of every sort. If it is true that the general practitioner is vanishing like the buffalo, then prepare to pay more money for office visits when everyone is vying for their limited time.
Any back doctor or orthopedist could take a mug shot of his patients where the procedure they performed was most effective and get them to write testimonials. If you’ve done 6000 procedures, where are your actual statistics on success? You, sir, are practicing market based medicine. You are more focused on volume and profit than healing.
ITEM 4: Really, then why don’t they? It has a great, reassuring effect on prospective patients to see so many satisfied customers. There are thousands of these patients’ pictures adorning the walls of 5-storied LSI building, all with grateful permission granted; the same for the testimonials in their files. What statistics are you speaking of? If you know of an official repository where these statistics are housed and published for public consumption, for or by any doctor, clinic, center, government authority or venerated, impartial clearinghouse, please let me know. It would make my job so much easier.
The Laser Spine Institute and others like them are regulated and monitored by the various agencies, commissions and departments of the government of the state of Florida. No less than 9 different entities oversee the business of surgical centers such as LSI and their attendant surgeons and doctors, chief of which is the Florida State Board of Medicine. Other authorities that scrutinize their operations are the Agency for Health Care Administration, which regulates and disciplines physicians for malpractice, malfeasance, mismanagement and professional misconduct, etc. To name a few more: The Senate and House Committees on Professional Regulation, The Commission on Professional Ethics, The State Board of Health, The Florida Board of Standards and Practices, OPPAGA – Office of Program Policy Analysis and Government Accountability, The American Medical Association (AMA) – Florida Chapter and The Florida Attorney General’s Office. This is not the comprehensive list. There are numerous lesser watchdogs of government that these businesses have to please by compliance.
ITEM 5: I hate to burst your bubble, but all medicine is market-based medicine. NO ONE creates medicine where there is not a significant lucrative market, despite there noblest intentions. NO ONE practices medicine where there is not a significant need for their services and promise of financial security. Those few saints that travel into the backwoods of America or the poverty-stricken inner cities or remote Africa have lucrative practices or sponsors that afford them that courtesy. God bless them all for their extreme sacrifice, but the seamy side of every enterprise is that it takes money. Where the Marxist Socialists have taken over, the quality of medicine is flagging and the incentive for doctors to enter the field has been greatly decimated.
And by all means, let’s all run away from the promise of the advancing medical frontiers and away from a remedy that has worked for so many grateful patients for whom it was the only cure for their anguish. Surely, it’s a novelty that will not gain permanence, soon to be replaced by the next fad … much like the PC, the cell phone and the microwave. After all, nothing good has ever come from technological invention and innovation … and there is no Bill Gates.
First, let me clear up a misconception, I am not a doctor and I do not work for LSI. I own no stock or shares of ownership in this company and I have no vested interest in this organization other than wanting to see them prosper and protected from unwarranted negative accusations and insinuations. I am not compensated in any form for the charitable things I say on their behalf. I DO have personal knowledge in this area, having had endoscopic laser surgery on my neck (C3-C4 discs) at LSI in July 2006. The Laser Spine Institute in Tampa, Florida enjoys a reputation that is second to none among the finest medical facilities in this state.
I am a professional researcher by occupation. I work as the chief research analyst for a large legislative lobbying firm in Florida, where I am called on to provide sound, in-depth research on a number of issues that will come before the state legislature in one form or another. I read the article and the postings in this thread and was disturbed by some of the remarks and assumptions; many are logical and some are not. Some of what I found turns out to be largely erroneous. I am not saying these remarks are intentionally false, but just the same, they can be misleading. In my job and profession, our clients (and my bosses) rely on me to be accurate and thorough in all my research. And no, LSI is not one of our clients. An occupational hazard, I am compelled to set the record straight, whenever and wherever I find egregious distortions of fact.
Before I contracted with LSI to operate on my neck I vetted them, researching their record in great detail (as well as many other facilities and surgeons offering this type of procedure). What I found was that LSI had, and continues to have, a spotless record and an enviable reputation. And when I do research, I do thorough, THOROUGH research and I am very good at what I do. Things I discovered about LSI are: over an 80% success/satisfaction rate … no post-operative complications from surgeries … no lawsuits … no AMA or state board of medicine sanctions or disciplinary actions … a long list of satisfied patients who gladly serve with enthusiasm as non-compensated references, fielding calls from those who are contemplating having surgery performed there. I have now joined the people in that group of gratified clientele and I can attest to the effectiveness of their surgery in treatment of cervical stenosis and facet joint problems.
You make a number of specious claims that are not supported by fact. Let me dissect theses items one by one because I must take issue with their validity.
And some of [LSI’s] procedures are not covered by insurance, even out of contract. That is a strong indication that the procedure is either experimental or the effectiveness has been deemed not worth the money (a cheaper procedure can get the same or better results with the same risk, etc). Lasers are expensive, and sometimes the same minimally invasive procedure using something other than a laser is going to be just as effective.
ITEM 1: I can fully appreciate that people do not want to be experimented upon. However, the arthroscopic laser method of surgery LSI uses is not experimental; in fact it is not new at all. It was pioneered in Japan in the late 1970’s and exported to the United States in the early 1980’s, once it had undergone numerous trials and peer-reviewed examinations … or succinctly put, once it had been perfected. The trials that validated their worth were completed overseas nearly 3 decades ago. Here in America we are a bit late to catch on.
ITEM 2: They are indeed covered by every major insurance plan, including Medicare, in whole or in part. These carriers do not appear to share a consensus of reimbursement or a standard uniform percentage of repayment, but each of the 5 largest major medical companies pay some amount based on a formula predicated on what they deem usual and customary. For instance, the various state Blue Cross plans pay anywhere from $8,000 to $18,000 for each of these surgeries, although they routinely deny the claim with the first submission. The same is true of Aetna, which has the worst record of pay-out at near $2,000. LSI has a patient services department solely dedicated to working with the patient and their insurance carrier to ensure the customer recoups the maximum compensation allowed. This group works very hard at it and they are graded on how successful they are at securing the greatest remittance for the patient post-operatively. I personally know this to be true because I had Aetna when I had my surgery and Aetna was difficult to deal with – first denying the claim, then agreeing to pay the comprehensive charges, only to remit a paltry sum of small payments and finally, after much dickering, compensated me for 60% of the total cost. United Healthcare seems to recognize the merit and success rate of these surgical treatments with payments from $18,000 to $24,000, with a minimum of wrangling. Core Source is the best payor, reimbursing their subscribers up to $42,000. Medicare pays $14,900 per surgery and bills the remainder to the subscriber’s supplemental insurance, if they have one. Generally, Medicare and Medicare supplement insurance will pay something on everything but the facilities costs. How do I know these facts? Two of these insurance companies are our clients.
Insurance companies by and large are not proactive when it comes to paying out benefits because the benefit is not theirs. The less they have to pay, the more money they keep and the longer they can stretch out the payment process, the more they earn in invested interest on the pending funds they ultimately will disburse. It is true, the history of payments by insurance companies for this kind of surgery is a short one and partially accounts for the marginalization in usual and customary reimbursement.
ITEM 3: If there truly were procedures that were both less expensive and less risky, laser surgery would not be enjoying the nascent swell in popularity today. Lasers are indeed expensive, and sometimes another procedure using something other than a laser can be as effective, but at what costs? There are no ‘same minimally invasive procedure(s) using something other than a laser’. Name one … just one.
Here are the facts. Open back surgery currently leaves the patient recuperating at home from 6 to 9 months before they can fully return to work. Laser back surgery allows the patient to return to work in 2 to 3 weeks; many report they have returned to work the same week. Open back surgery has a success rate of less than 50%. Laser back surgery (at LSI) has a success rate of greater than 90% … a satisfaction rate of over 80% (the difference flows from higher than reasonable expectations for some patients who believed they would return to youthful flexibility as well. LSI records both statistics.).
The median cost for open back surgery in the state of Florida is $62,545 (including hospitalization for traumatic surgery, home nursing visits, a 6-9 month medication regimen during convalescence, etc.). These costs soar to over $100,000 if the placement of hardware is involved. Cost for laser back surgery at LSI is $29,500 (no hospital stay, no protracted regimen of medication). Open back surgery will often create the development of scar tissue and problems that result from it later. Laser back surgery results in no scar tissue development. Open back surgery often produces collateral damage to the dura matter, adjacent musculature and surrounding tissues. Laser back surgery at LSI does not. In over 6,000 surgeries done at LSI, only one patient had to be hospitalized as a precaution due to numbness in her extremities following surgery, which fully attenuated after 24 hours.
According to the National Center for Health Statistics more than one-quarter of Americans (26%) age 20 years and over — or, an estimated 76.5 million Americans — report that they have had a problem with back pain. Studies from the Pain Management Research Institute reveal a non-surgical annual cost of $1.85 billion per 1 million people, or $1850 per person per year every year. If you are interested in the psychopathology associated with reward function and the dark side of neurobiological drug addiction to pain medication, read the Nature and Nurture of Pain in the weekly Science News, an article adapted from materials provided by American Academy of Pain Medicine, via EurekAlert!, a service of AAAS.
Surgery may not be the only option, but it may be the best one to relieve constant, excruciating pain and laser spinal surgery is the most successful, least harmful, least invasive and least likely to generate additional problems. Need I state that the demand for these types of surgeons is great or underserved. Back to the law of supply and demand. And if there becomes a movement away from primary care physicians to specialists that can command more money … when there’s a dearth of general practitioners, we will see a shift in the dollars paid as well. When something is unique or rare, we pay more for it, including services of every sort. If it is true that the general practitioner is vanishing like the buffalo, then prepare to pay more money for office visits when everyone is vying for their limited time.
Any back doctor or orthopedist could take a mug shot of his patients where the procedure they performed was most effective and get them to write testimonials. If you’ve done 6000 procedures, where are your actual statistics on success? You, sir, are practicing market based medicine. You are more focused on volume and profit than healing.
ITEM 4: Really, then why don’t they? It has a great, reassuring effect on prospective patients to see so many satisfied customers. There are thousands of these patients’ pictures adorning the walls of 5-storied LSI building, all with grateful permission granted; the same for the testimonials in their files. What statistics are you speaking of? If you know of an official repository where these statistics are housed and published for public consumption, for or by any doctor, clinic, center, government authority or venerated, impartial clearinghouse, please let me know. It would make my job so much easier.
The Laser Spine Institute and others like them are regulated and monitored by the various agencies, commissions and departments of the government of the state of Florida. No less than 9 different entities oversee the business of surgical centers such as LSI and their attendant surgeons and doctors, chief of which is the Florida State Board of Medicine. Other authorities that scrutinize their operations are the Agency for Health Care Administration, which regulates and disciplines physicians for malpractice, malfeasance, mismanagement and professional misconduct, etc. To name a few more: The Senate and House Committees on Professional Regulation, The Commission on Professional Ethics, The State Board of Health, The Florida Board of Standards and Practices, OPPAGA – Office of Program Policy Analysis and Government Accountability, The American Medical Association (AMA) – Florida Chapter and The Florida Attorney General’s Office. This is not the comprehensive list. There are numerous lesser watchdogs of government that these businesses have to please by compliance.
ITEM 5: I hate to burst your bubble, but all medicine is market-based medicine. NO ONE creates medicine where there is not a significant lucrative market, despite there noblest intentions. NO ONE practices medicine where there is not a significant need for their services and promise of financial security. Those few saints that travel into the backwoods of America or the poverty-stricken inner cities or remote Africa have lucrative practices or sponsors that afford them that courtesy. God bless them all for their extreme sacrifice, but the seamy side of every enterprise is that it takes money. Where the Marxist Socialists have taken over, the quality of medicine is flagging and the incentive for doctors to enter the field has been greatly decimated.
And by all means, let’s all run away from the promise of the advancing medical frontiers and away from a remedy that has worked for so many grateful patients for whom it was the only cure for their anguish. Surely, it’s a novelty that will not gain permanence, soon to be replaced by the next fad … much like the PC, the cell phone and the microwave. After all, nothing good has ever come from technological invention and innovation … and there is no Bill Gates.
Well-defended, David . . .
Regarding medicine being market-based, I agree. I work for the largest private employer in my state, which happens to be an integrated healthcare delivery system, Aurora Healthcare. Aurora serves fully one third of the state, with 25 hospitals, 24,000 employees (not counting the privately-contracted docs) and many ancillary clinics, pharmacies, the Visiting Nurses Assoc., meals-on-wheels, etc. Aurora is trying with all its might to be frugal and to rein in runaway healthcare costs. We feel the pinch in the hospitals where I work and we feel the pinch as employees who have had benefits cut back.
I believe, as well, that PCPs are under-appreciated, and they may indeed become a scarcity–and then the specialty practices and PCP practices will be on equal footing with respect to supply and demand.
If any specialty should come under scrutiny, it is the cosmetic surgery specialty groups. It seems to me that much of what they do could be under the rubric of the vanity industry. Not healthcare.
If LSI has good results, as you claim, addressing pain with minimally invasive methods, then THAT is one of the ethical mandates of medicine–pain control. I’m okay with that.
Chris and Vic
Well-defended, David . . .
Regarding medicine being market-based, I agree. I work for the largest private employer in my state, which happens to be an integrated healthcare delivery system, Aurora Healthcare. Aurora serves fully one third of the state, with 25 hospitals, 24,000 employees (not counting the privately-contracted docs) and many ancillary clinics, pharmacies, the Visiting Nurses Assoc., meals-on-wheels, etc. Aurora is trying with all its might to be frugal and to rein in runaway healthcare costs. We feel the pinch in the hospitals where I work and we feel the pinch as employees who have had benefits cut back.
I believe, as well, that PCPs are under-appreciated, and they may indeed become a scarcity–and then the specialty practices and PCP practices will be on equal footing with respect to supply and demand.
If any specialty should come under scrutiny, it is the cosmetic surgery specialty groups. It seems to me that much of what they do could be under the rubric of the vanity industry. Not healthcare.
If LSI has good results, as you claim, addressing pain with minimally invasive methods, then THAT is one of the ethical mandates of medicine–pain control. I’m okay with that.
Chris and Vic
An anology.
In the New York Times, Sandra Boynton, an entrepreneur and creator of humorous cartoon characters for many years, says she does NOT regard making money as her main focus. She does what works for her.
Likewise, in medicine, you do what works for you, not necessarily what is the most lucrative. If it is being a surgeon, so be it. If it is being a Primary Care Physician, so be it. If it is not working for you, then you must get thee to another niche.
Just my $0.02.
Chris of Chris and Vic
An anology.
In the New York Times, Sandra Boynton, an entrepreneur and creator of humorous cartoon characters for many years, says she does NOT regard making money as her main focus. She does what works for her.
Likewise, in medicine, you do what works for you, not necessarily what is the most lucrative. If it is being a surgeon, so be it. If it is being a Primary Care Physician, so be it. If it is not working for you, then you must get thee to another niche.
Just my $0.02.
Chris of Chris and Vic
This is precisely the conversation I hoped to get. David makes good points, although I think his understanding of specialty medicine outstrips primary care. He is dead on with his defense of LSI. I am not really attacking them at all. I would probably use them if they were in town and it seems they are doing a good job. The problem with primary care medicine is: A. Someone else tells us what we can charge (unless we go “concierge” and most of us don’t have the stomach to do that; B. We are prosecuted if we act in a free market way – for instance, if I decide a patient is poor and does not have the ability to pay, I can’t just charge them a lesser fee. If I do so, I am committing Medicare fraud by offering a discount that Medicare is not able to get. This is but a small example of how the tentacles of non free-market forces have infiltrated my practice. The specialists have a much easier time just setting rates, especially for care that is not covered. If any of our visits are uncovered then our patients bitterly complain.
My real point, however, was that the SYSTEM is a mess. It may work for these doctors in Florida (as witnessed by their ad in the NY times), but it fails miserably for the primary care physicians, who are, by the way, more important in that their care reaches to a greater population at a more basic level. Most specialists would also say that the situation sucks for primary care. I was simply using this ad to point out the incredible disparity that exists. A few of my specialist friends (Sid and Ramona) who have lived in this world would agree that even the specialists who try to play by the rules of the system will get the shaft. It is only when you leave the system that you have the freedom you want (or if you work on the “cutting edge” as many of the procedural physicians and device manufacturers have benefited from).
This is precisely the conversation I hoped to get. David makes good points, although I think his understanding of specialty medicine outstrips primary care. He is dead on with his defense of LSI. I am not really attacking them at all. I would probably use them if they were in town and it seems they are doing a good job. The problem with primary care medicine is: A. Someone else tells us what we can charge (unless we go “concierge” and most of us don’t have the stomach to do that; B. We are prosecuted if we act in a free market way – for instance, if I decide a patient is poor and does not have the ability to pay, I can’t just charge them a lesser fee. If I do so, I am committing Medicare fraud by offering a discount that Medicare is not able to get. This is but a small example of how the tentacles of non free-market forces have infiltrated my practice. The specialists have a much easier time just setting rates, especially for care that is not covered. If any of our visits are uncovered then our patients bitterly complain.
My real point, however, was that the SYSTEM is a mess. It may work for these doctors in Florida (as witnessed by their ad in the NY times), but it fails miserably for the primary care physicians, who are, by the way, more important in that their care reaches to a greater population at a more basic level. Most specialists would also say that the situation sucks for primary care. I was simply using this ad to point out the incredible disparity that exists. A few of my specialist friends (Sid and Ramona) who have lived in this world would agree that even the specialists who try to play by the rules of the system will get the shaft. It is only when you leave the system that you have the freedom you want (or if you work on the “cutting edge” as many of the procedural physicians and device manufacturers have benefited from).
Thanks, Chris and Vic. I appreciate the kind words. I know I can come off as a bit ‘anal’ at times … who knew … so I am glad someone found merit in my long-winded epistle. When I started it, I had no intention of penning a couple thousand words of explanation which very few would find interesting enough to read to the end, but one sentence led to another and I was on a roll, so thanks again for your comments after wading through it.
Aurora Healthcare. I’m somewhat familiar with Aurora Healthcare, by reputation anyway. There’s a big time cardiac hospital associated with AH, too. Isn’t there? Gosh, what is its name? Aurora St. something-or-other. St. Paul or Vincent or … oh, heck, it’ll come to me later. I think it is ranked in the top 5 cardiac centers in the world, if I’m not mistaken. Ahhh, this is aggravating! Anywho, so are you in Milwaukee or elsewhere in Wisconsin?
Yes, I agree with you on cosmetic surgery and probably every elective surgery where health concerns are not an issue. The lone exception might be to correct a child’s disfigurement or maxillofacial surgery to correct severe speech problems, but those have health implications.
You’re right; it does fall under the rubric of the vanity trade. Not healthcare. I couldn’t agree more with that statement. I don’t have a problem with folks who want cinch up the old baggage as long as it’s on their dime. God knows, I could use a little overhaul and tune-up myself, but I doubt there’s enough cosmetic surgery out there to make a significant difference, in my case. Besides, with a daughter in medical school, my extra expendable income has long since been appropriated for a higher calling. And strange as it may seem after my verbose rant, she wants to be a PCP.
As to your reference to cartoonist Sandra Boynton, it occurred to me that perhaps I gave the wrong impression that I believed everyone in any occupation was motivated solely or chiefly by money and not for the love of its practice. I don’t. I know, in fact, that most of us who have a job we like, do it for other than financial considerations. I’m a good example. I could have gone back to school to become a high-priced attorney. I have a way with words. I could have gone back to school to become a doctor. My aptitude for dogged, exhaustive analysis would have enabled me to serve my patients well. I could have gone back to school to become many things that would have brought more lucre into the family coffers. But I haven’t because I like what I do; people need my talents, depend on me and appreciate my efforts; and after more years than I want to recount, I am generally recognized in my little esoteric sphere as the top in my field … okay, top 3 anyway. And I’m paid decently, but I will never have 7-figure income. But I don’t have a problem with those who do. They drive the commerce wheel. I believe in America. I believe in capitalism. It makes everything that we hold dear possible and everything that could not sustain itself on its own.
And Chris, I enjoyed your 2¢ worth — a very level-headed and concise assessment. Now if I could only shrink mine down to just 2¢.
And I’ll bet there’s good story behind the duality of ‘Chris and Vic’.
Warmest regards,
David
Thanks, Chris and Vic. I appreciate the kind words. I know I can come off as a bit ‘anal’ at times … who knew … so I am glad someone found merit in my long-winded epistle. When I started it, I had no intention of penning a couple thousand words of explanation which very few would find interesting enough to read to the end, but one sentence led to another and I was on a roll, so thanks again for your comments after wading through it.
Aurora Healthcare. I’m somewhat familiar with Aurora Healthcare, by reputation anyway. There’s a big time cardiac hospital associated with AH, too. Isn’t there? Gosh, what is its name? Aurora St. something-or-other. St. Paul or Vincent or … oh, heck, it’ll come to me later. I think it is ranked in the top 5 cardiac centers in the world, if I’m not mistaken. Ahhh, this is aggravating! Anywho, so are you in Milwaukee or elsewhere in Wisconsin?
Yes, I agree with you on cosmetic surgery and probably every elective surgery where health concerns are not an issue. The lone exception might be to correct a child’s disfigurement or maxillofacial surgery to correct severe speech problems, but those have health implications.
You’re right; it does fall under the rubric of the vanity trade. Not healthcare. I couldn’t agree more with that statement. I don’t have a problem with folks who want cinch up the old baggage as long as it’s on their dime. God knows, I could use a little overhaul and tune-up myself, but I doubt there’s enough cosmetic surgery out there to make a significant difference, in my case. Besides, with a daughter in medical school, my extra expendable income has long since been appropriated for a higher calling. And strange as it may seem after my verbose rant, she wants to be a PCP.
As to your reference to cartoonist Sandra Boynton, it occurred to me that perhaps I gave the wrong impression that I believed everyone in any occupation was motivated solely or chiefly by money and not for the love of its practice. I don’t. I know, in fact, that most of us who have a job we like, do it for other than financial considerations. I’m a good example. I could have gone back to school to become a high-priced attorney. I have a way with words. I could have gone back to school to become a doctor. My aptitude for dogged, exhaustive analysis would have enabled me to serve my patients well. I could have gone back to school to become many things that would have brought more lucre into the family coffers. But I haven’t because I like what I do; people need my talents, depend on me and appreciate my efforts; and after more years than I want to recount, I am generally recognized in my little esoteric sphere as the top in my field … okay, top 3 anyway. And I’m paid decently, but I will never have 7-figure income. But I don’t have a problem with those who do. They drive the commerce wheel. I believe in America. I believe in capitalism. It makes everything that we hold dear possible and everything that could not sustain itself on its own.
And Chris, I enjoyed your 2¢ worth — a very level-headed and concise assessment. Now if I could only shrink mine down to just 2¢.
And I’ll bet there’s good story behind the duality of ‘Chris and Vic’.
Warmest regards,
David
Dr. Rob,
I agree with your contention that the Primary Care Physician is our first and best line of defense against disease, both transient and persistent. I have had the same PCP for 24 years and I trust him implicitly with my health. And I certainly hope that my little girl will not be the last in the long line of noble practitioners of that art. I hope that in my passionate defense of LSI and laser surgery specialists, I did not inadvertently impugn the honor and worth of the PCP.
With warmest regards,
David
Dr. Rob,
I agree with your contention that the Primary Care Physician is our first and best line of defense against disease, both transient and persistent. I have had the same PCP for 24 years and I trust him implicitly with my health. And I certainly hope that my little girl will not be the last in the long line of noble practitioners of that art. I hope that in my passionate defense of LSI and laser surgery specialists, I did not inadvertently impugn the honor and worth of the PCP.
With warmest regards,
David
Aurora St. Luke’s, “flagship” hospital. I believe it is credited as the site of the first heart transplant . . . and I am proud to have donated blood for that transplant recipient, Mary Anick. Long-time-passin’ . . .
Chris and Vic’s story can be pieced together at the old Neonatal Doc blog and more recently, on The Preemie Experiment blog. Yes, Vic is an ex-preemie . . .
We have had a lot of trafficing with the medical community, and I try to sniff-out the docs who can see the big picture and maintain their humanity–that is why I like Dr. Rob’s blog.
C & V
Aurora St. Luke’s, “flagship” hospital. I believe it is credited as the site of the first heart transplant . . . and I am proud to have donated blood for that transplant recipient, Mary Anick. Long-time-passin’ . . .
Chris and Vic’s story can be pieced together at the old Neonatal Doc blog and more recently, on The Preemie Experiment blog. Yes, Vic is an ex-preemie . . .
We have had a lot of trafficing with the medical community, and I try to sniff-out the docs who can see the big picture and maintain their humanity–that is why I like Dr. Rob’s blog.
C & V