Why my orthopod didn't install a pain pump

[Lionel Mandrake]

An orthopedic surgeon operated on my shoulder a month ago. He removed a bone spur that was hurting my rotator cuff and thereby limiting my range of motion. He had planned to install a pain pump, but changed his mind for the reason mentioned in an article in Outpatient Surgery Magazine, September, 2001: A Primer on Pain Pumps ....

"Deciding whether or not to offer pain pump implantation comes down to a question of reimbursement. If you have an ASC and a large Medicare population, experts generally agree that the procedure is a money loser. Says Dr. Parker, 'With the amount that Medicare reimburses , the price of the device is not even close to being covered. For an $8,000 implantable infusion pump, Medicare will only reimburse about $5,500, and they will not allow the patient to make up the difference. Therefore, implanting these pumps is often not economically viable for ASCs. Almost all Medicare patients have these procedures done in a hospital' ..."

I find this article quite illuminating. It shows an aspect of Medicare that patients don't usually see. Note: ASC stands for "Ambulatory Surgical Center". An ASC has operating rooms, but is not a hospital. The one I went to is owned by doctors.

Some patients really need pain pumps, but I didn't. My pain after surgery wasn't too bad and didn't last very long. So it seems my surgeon made the right choice for the wrong reason.

I especially like the part about not being allowed "to make up the difference". That means the ASC, like hospitals and doctor's offices, can't send me a bill. The anesthesiologist, for example, wanted $1805.00 but was only allowed to charge me $238.96, of which $191.17 was paid by Medicare. I expect the other $47.79 to be paid by my medigap policy. And these are typical numbers. Only the uninsured pay full price (if they can) for medical services here in the USA.

[KitchenWitch]

1. Disgusting, isn't it?

x(

I am glad you did not need the pain pump, though. I have heard that shoulder surgery can be rather painful.

[Lionel Mandrake]

2. It sure is. I was uninsured for a while and didn't like it one bit.

I was lucky not to run up any big expenses during that window of vulnerability.

I thank you for your kind thoughts. I don't have any other experience with shoulder surgery, but I imagine you are right. The surgeon said that if he had found extensive damage to my rotator cuff, the surgery would have been more complicated and taken longer. I suspect the recovery would also have taken longer and been more painful in that case.

Has anyone else in the Lounge had shoulder surgery?

[KitchenWitch]

4. My mom did about two years ago

They had to completely re-attach her rotator cuff. She will never have full range of motion again. But she is as healed as she can be now.

[Lionel Mandrake]

7. I hope she had good insurance.

Surgery like that is stressful enough without a financial hassle on top of everything else.

I don't have full range of motion, either, but I am making progress with physical therapy.

[Roon]

6. My 70-something-Grandfather had rotator cuff surgery a few years back

He originally tore it pitching baseball when he was a boy, it finally caught up with him after all these years. He had to have a pillow strapped to his body that kept his arm sticking out while he healed.

[Lionel Mandrake]

8. Ouch. That doesn't sound like fun at all.

I hope the final result made it all worthwhile for your Grandpa.

[Roon]

9. Oh yeah

Once he was healed and was able to drive again, he was totally happy with the surgery.

[Lionel Mandrake]

10. Driving is pretty important.

If I couldn't drive, I would have to use public transportation, which is lousy where I live. Driving with only the right arm is easy, but driving with only the left arm would be difficult for me, assuming no modification of the car. It was my right shoulder, naturally, that was operated on. Most people are right handed, and I would bet that it's usually the right shoulder that gets damaged. I haven't seen any statistics on this. Please excuse the lack of organization of this post. I haven't the time right now to put my comments in a more logical order.

Bottom line: I'm glad your grandpa had a good outcome.

[Roon]

11. Thanks! eom

[GardeningGal]

12. I did on July 3rd.

I didn't have a pain pump either. Not sure if the cost was the reason, but I'm actually glad I didn't. Still working on range of motion exercises and hope to be able to work on building strength after I see the dr. again on Monday.

[Lionel Mandrake]

13. Welcome aboard!

It sounds as if your surgery went very well, as mine did. I hope it didn't cost you an arm and a leg.

If we don't need pain pumps, then we are much better off without them. Besides being expensive, they are harder to remove than stitches. Also, they occasionally cause serious problems.

I saw my orthopod today. He is happy with my progress but says to continue with physical therapy for at least another month.

[GardeningGal]

14. It did.

I was glad to not get the pump because the thought of removing it made me a little queasy. As to the cost, still waiting to get the bills for my portion.

I was doing well until I accidentally bumped it today and now it is not feeling so great. Back to the pain pills tonight. I see my dr. again on Monday.

[Lionel Mandrake]

18. Good luck at the doctor's office.

I trust the pills will help you get a good night's sleep. They did so for me.

[CaliforniaPeggy]

3. My dear Lionel Mandrake!

This makes me think about how much better things will be once we have single payer health insurance!

Glad you're doing well.......:hug:

[Lionel Mandrake]

5. My dear CaliforniaPeggy

Thank you for the kind thought. It's always an honor when the Queen of the Lounge visits one of my humble threads.

I also think single payer is the way to go. But we need to keep in mind that a single payer system can have serious problems (e.g., the NHS in the UK).

[dropkickpa]

15. "Make up the difference"

It's called balance billing and it blows chunks. I have ruined credit due to an illegal attempt to balance bill a medicaid patient (me). It took me 3 years and my old medicaid insurance company setting their fraud squad on 'em to get them to leave me alone. The stuff mysteriously disappeared from my credit reports but the damage had already been done.

[Lionel Mandrake]

16. That's pretty scary.

Maybe the law hasn't any teeth in it. If MediGreedCorp can hassle you like that and get away with it, then none of us are safe.

If the bad stuff all disappeared from your credit reports, I'd think you could get new credit. Maybe I'm naive.

[dropkickpa]

17. I wish

But the damage that 3 years of having that on my reports snowballed into other things so on and so on, so, even though that is no longer on my report, the aftershocks of it will affect me for years to come.

It was a private hospital; I went to the ER when visiting my grandmother out of state in a little podunck town in Iowa, they were the only hospital for miles around (actually, they were in my grams backyard!). Their reasoning for balance billing (even though federal law prohibits it with medicaid patients)? Because they don't accept medicaid (even though they DID accept payment, nullifying that arguement). I was harassed by a collection agency until I filed a harassment by communication complaint AND got my old insurance company's lawyers to call with a cease and desist. I have to say, the medicaid ins company was great. I stopped being a client of theirs 1.5 years into the whole mess (got a job with health coverage), and they still went to the mat for me.

[Lionel Mandrake]

19. Wow, a good insurance company.

That blows me away. I thought all medical insurance companies were like the one in the movie The Rainmaker.