Tuesday, November 20, 2012

Musings on billing

Nymeria is getting fixed today. I sorta wanted to watch, to see a dog hysterectomy. Yes, I'm a geek. I'm sure I could You-Tube it. Take it back, I just spent 15 minutes watching one.

Anyway, I was the one who dropped her off this morning. And of course, there's a consent form to sign...with options. Do I want bloodwork? EKG? IVF? Increased pain control? Laser during surgery? All of course, with extra fees, documented. BTW, I said yes to labs, IVF, and better pain management. No to the EKG & laser - they can use clamps and ties like I do, dammit!  ;)

But it got me thinking about my hysts. I do the majority of them either vaginally or lap-assisted vaginally. And there are all sorts of do-dads that I could use if I so chose. On my LAVHs and LSHs, I prefer the gyrus cutting forceps for mobilizing the uterus and dividing the pedicles. I hate the Ligasure (tissue slips out of it too easily), and have never used the Harmonic Scalpel, so I have no opinion on it. But these instruments are disposable - and costly.

But on my vag hysts, I am old fashioned - clamps and suture. Cheap as all get out (~$2.50 per suture used - most cases I use about 12-15). There are disposable instruments designed for vaginal surgery (my training program had them), but I find that the advantage they claim to bring - decreased OR time - hasn't been true for me.

But would people pay more for the new gadgets? My understanding is that the hospital gets paid a flat facility fee for the hyst, and if I can do the case cheaper, the hospital makes more money. I can just see the uproar if I charged more for better pain management.  ;)

FWIW, I'm employed by the hospital and salaried - I don't make more $$ by doing more work.

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