Post-Surgical Complications Result In Higher Hospital Revenues

It's no secret that medical care in the United States is extremely expensive. What is more surprising, though, is that botched medical care in the United States is even more expensive. A published article in the Journal of the American Medical Association tells us that surgical complications can give more money to the hospital. How? Let's take a look at some stories.

Robert received six stents in five procedures for blocked arteries after he had a heart attack, and after six weeks in the hospital, he was released with a bill of $474,301. Ten days later his cardiologist told him that "Oops, we really should have done a bypass," and he was readmitted for another hospitalization that cost $250,000. Overall both visits to the hospital were extremely expensive.

Jill was diagnosed with a cancerous bone tumor in her right leg. The surgeon, however, amputated her left leg instead of her right. After the realization, she had to have her right leg amputated, too, and her insurance company was billed for both procedures. 

Reggie was admitted to the hospital to receive a pacemaker. When the interventional cardiologist took a look at his EKG, however, he realized that Reggie probably wouldn't survive cardioversion, which is restarting the heart, this is required if a pacemaker is installed for a patient. Not willing to waste an entire half an hour in the operating room, however, the surgeon just decided to install a defibrillator instead, at a cost of $45,000. Three months after the procedure the same doctor put Reggie in a hospice program, and Reggie died just six weeks later. Reggie's family was rightfully horrified that the hospice nurse did not know how to turn off the defibrillator after Reggie had passed away.

In fact, mistakes happen to make hospitals lots of money. A team of researchers affiliated with the Massachusetts Eye and Ear Infirmary and Harvard Medical School, who published their findings in the Journal of the American Medical Association found out in their research that:

• Depending on the procedure, between 3 percent and 17 percent of patients suffered at least one post-surgical complication.
• The average cost of a surgical complication was usually an additional $8,084, when all payment types (self-pay, Medicaid, Medicare, and private insurance) were considered when evaluating this number.
• The average post-surgical complication netted the hospital system the authors studied $1,749 per patient when Medicare paid the bill.
• The average post-surgical complication netted the hospital system the authors studied a whopping $39,017 per patient when private insurance paid the bill.

So when doctors make mistakes, hospitals make more money. The clear finding of this study, which only considered nine common surgeries, ten common complications, and 12 hospitals in a non-profit hospital system in the southern United States, is that hospitals don't have an incentive to get you well. They have an incentive to treat you longer. What can you do about that?

How To Avoid Becoming A Hospital Profit Center

The first thing everyone needs to know about going to a hospital is that how you are able to pay almost always makes a major difference in how you will be treated. Just how big a difference does insurance co coverage make?

Researchers affiliated with the University of Virginia Health System analyzed nationwide data on heart valve operations. Analyzing the records of 477,932 patients from the National Inpatient Sample database, they found that:

• 2.9% of privately insured patients died or suffered serious complications from heart valve surgery.
• 5.2% of uninsured patients died or suffered serious complications from heart valve surgery.
• 5.7% of Medicaid patients died or suffered serious complications from heart valve surgery.
• 6.9% of Medicare patients died or suffered serious complications from heart valve surgery.

Medicare, of course, is usually only available to Americans who have past the age of 65, so one might expect more deaths or complications among the elderly receiving the surgery. However, when the authors of the study found that the longest hospital stays were endured by patients whose bills were paid by Medicaid. The authors also found that Medicaid patients were the most likely to suffer complicating conditions such as alcoholism or drug abuse. Studies of other procedures, such as resection of the colon after treatment for colon cancer, have found similar results.

Why does having insurance make a difference?

• If you have insurance, you are more likely to get treated when surgery is an elective procedure rather than when it is an emergency.
• If you have insurance, you are more likely to be referred to the most experienced surgeons or specialists in your area of need.
• If you have insurance, you are more likely to get the follow-up care you need, and the medications you need, to avoid post-surgical complications and relapses of your underlying condition.

Many Americans will be able to get excellent private insurance at affordable rates, often as little as $100 per month, in lieu of Medicaid, and families of four earning up to $90,000 per year will be able to get insurance at lower rates.

Go to hospitals associated with medical schools.

You'll be a teaching case, but your care will be reviewed by more than just one doctor with the literal power of life and death. You're also far more likely to be referred to a Medical Assistance Program, which will help you obtain expensive medications if you need them.

Go to hospitals run by local governments.

Your city, county, or state has an interest in your not, for instance, dying of a heart attack while you are driving into an intersection at the same time as a school bus. You may have to wait to get care, and the conditions may not be especially pleasant, but you won't be denied care just because you don't have money.

Go to local "safety net" hospitals.

True charity hospitals are rare, but they are more likely to make sure you are fixed up during your stay so they can use their resources serving other patients.

Make it very clear to your doctors that you are going to do everything you possibly can to get well, and then do everything you possibly can to get well. Doctors are motivated by making their patients well, sometimes more than by receiving high fees.

Most Americans who need major surgery or long-term medical treatment can get it, although it may not be easy to find. The situation should improve in 2014, but don't wait. Get needed care now, and keep complications to a minimum.