Pacemaker implant cost!!

That is ridiculous

by IAN MC - 2018-07-26 09:08:26

Interestingly I have just read an article reviewing what it actually costs our National Health Service here  to have a pacemaker installed.    UK figures were quoted so I have converted them to US dollars :-

$ 2, 640       Cost of average pacemaker

$ 1,980        Services of a 4-strong implant team

$ 925           One overnight hospital stay

TOTAL  COST      $  5, 545

Accepting that actual costs will vary between countries this still highlights  the extent that the  US system is ripping you off . 

Ian

PS   Can anyone beat Tony's $ 72,000 ???

$72000

by AgentX86 - 2018-07-26 09:54:45

Was $72,000 the charged cost or the amount paid? There is usually a huge difference between the two.  The difference is often 2.5:1 or 3:1.

My CRT-P actually cost about $15K, $12K for the hospital and $3K for the EP  and his team. That included an overnight stay, though it may technically have been less than 24hours.

normal

by Tracey_E - 2018-07-26 09:54:48

That's about average in the US for what's billed. Insurance companies have a negotiated contract amount that's only a fraction of what's billed. I think insurance paid $13,000, or thereabouts, on my last one plus my dedutible. The bill was $80-ish, if I remember correctly. 

Billed

by Tonydig11 - 2018-07-26 09:58:17

72k was the amount the Dr billed to United Health Care. This does not include the 6k emergency room visit when I realized I had a slow heart rate. 

Seems about average

by Alyson - 2018-07-26 10:03:55

Just checked my bill from February my ICD implant was charged at $74,200.00, it appears the insurance only actually paid them $59,300.00.  I honestly daren't add up the total cost for my procedures this year considering a month later I was back in for lead replacement.  All I know is that by the end of January I'd met my deductible and out of pocket for the year.  I don't think I'll ever get my head around how health insurance works here in the US being originally from the UK.

Cost

by AgentX86 - 2018-07-26 11:37:12

I paid my out-of-pocket maximum for the year on January 8th, more than a month and two hospitalizations before my pacemaker implant.

Since you brought politics into the discussion, I MUCH prefer a system where I'm responsible for me, rather than hoping some nameless bureaucrat with life and death power over me does me the right thing. Recent events only make me more sure of my skepticism of government and bureaucrats.

Agent

by IAN MC - 2018-07-26 11:44:32

I haven't a clue what you're talking about. I don't think you do either !

Ian

Ian

by AgentX86 - 2018-07-26 12:18:31

It's nice that you contribute so many facts here.

$72K and Shopping for a pacemaker

by Gotrhythm - 2018-07-26 12:45:05

Stunned by a $72,000 price tag for a pacemaker, I felt I had to do some research. Seven years ago, the cost for mine was around $12,000. Could the price have jumped that much?

I found this website which puts a fair market price at $18 to $19K. 

https://www.healthcarebluebook.com/page_ProcedureDetails.aspx?cftId=47&g=Pacemaker+Insertion

I have no information about how reliable this website is. I tend to believe it because allowing for inflation, the figures they give are much more in line with what I was charged. (Between Medicare and my supplemental policy, I actually paid out-of-pocket less than $500.)

With these figures in mind, clearly it behooves us big-ticket medical consumers to do a little comparison shopping before choosing a hospital.

Ebay

by Paulb - 2018-07-26 13:41:58

I see on ebay they are available for $290.

In Canada my op was covered by the province Medical Services Plan. My son is a nurse and estimated the total cost was CAD89000 including 2 emergency room visits, 1 night intensive care, 2 PM ops (a lead moved) 6 nights in hospital Cardiac ward and 1 ambulance trip. 

Shopping

by AgentX86 - 2018-07-26 14:15:18

As I said in an earlier article,  my insurance paid $15K. That was in February of this year, so I think your number is reasonable. My cost was $0.  Well, we had to pay for parking.

Evil profit

by AgentX86 - 2018-07-26 22:59:14

Are you a non profit worker?  You do know that the average insurance company has a 5% profit margin.  You're welcome to start an insurance company for the express purpose of saving your customers that 5% in premiums but it won't do ONE THING to reduce the cost of medical care.

Profit

by DAVID H - 2018-07-26 23:20:13

From my Full-Time RVing days a few years ago: While RVing in the RGV (Rio Grande Valley) in Texas, I took note of the vast number of Canadians that would head North for some medical sign up period (March, April Maybe?). They considered the cost and benefits of the Canadian system far superior to the U.S. system..............that's all I'll say.  On a similar note, the VA health care system in the U.S. is considered "broken."  I have three friends dependent on the VA, one a 1st Air Cav Vet, another a USMC Vet, and the third a USCG Vet.  They ALL speak highly of their Doctors and the care they receive.

Profit

by DAVID H - 2018-07-27 13:12:57

From the Atlantic: 

Earlier this year, the Commonwealth Fund released a ranking of 11 developed countries' healthcare systems. The American one, the world's most expensive, ranked dead last. As I wrote at the time, the U.S. scored poorly on managing administrative hassles for both doctors and patients, avoiding emergency-room use, and reducing duplicative medical testing, among other things.

To be fair, the Canadian system didn't fare much better, coming in 10th out of 11. Still, according to a new interactive released by the Commonwealth Fund and based on the earlier report, if Americans had Canada's healthcare, we might see some surprising gains in our quality of life and reductions in our healthcare expenditures.

The whole story:  https://www.theatlantic.com/health/archive/2014/10/what-if-america-had-canadas-healthcare-system/381662/

Can there be TOO MUCH profit ?

by IAN MC - 2018-07-27 14:15:17

Interesting article, David....thanks !

Looking at the league table ranking the best to the worst healthcare I see  

it is :-

1. UK,  2. Switzerland  3. Sweden  4 . Australia 5. Germany 6 Holland   7. New Zealand

8. Norway  9. France  10. Canada  11. USA

What leaped out at me is that there is no relationship between what a country spends on health and its performance.    The UK is the smallest spender as a % of total national wealth and the USA is by far the biggest spender.  ....... which is where we came in with Tony's original question re $ 72, 000 for a procedure costing well below  $10,000 .

Yes, Tony it is far too much ,no matter which way you look at it !

A final irony is that there is ALOT of discontent in the UK regarding our under-funded NHS with ever-growing waiting lists for nøn life-threatening situations . 

  I believe that it is only a matter of time before economics forces us to contribute lots more money in some way.  Paying to see your GP is often floated as an idea here in the UK

But I do hope that we don't run out of cash before I need my Medtronic friend replacing . ( any donations will be gratefully accepted )

Cheers

Ian

Health Rankings

by DAVID H - 2018-07-27 15:17:26

I'd say more, but I'll behave.............................but.........................I wonder where Putin's Russia ranking sits?

David

by IAN MC - 2018-07-27 15:35:12

Vodka is probably on free prescription so they don't care about the rankings !

Ian

From the Atlantic...

by AgentX86 - 2018-07-28 00:26:13

As long as we're taking this forum even further into political territory...

It matters who you're reading and who is doing the ranking.  These are not facts, they're opinion (spun at a very high speed).  If you don't believe me, look at the national rankings for slavery around the world. 

I write the Checks...

by donr - 2018-07-29 03:56:07

...for a medical practice  in the USA..  Guess I know a bit about thecost of care.

Sole practitioner - our #2 daughter.  I am her practice manager; her sister does our billing.  we have three paid employees - receptionist, scribe (takes MD's notes during an appt), lab tech.  Dr gets her expenses paid - about $35K per year.  I work for nothing (retired); sister works for nothing (Also retired). Last month it cost us $17,000 to run the practice.  For 21 open for business days, that's about 210 hours,  we have to bring in roughly $80 per hour to stay afloat.  That's with about $90K in FREE labor!  If all of us were paid what the going rate is, it would take better than $100 per hour to keep going.  To simplify the math, assume we did ALL of our business w/ Medicare.  To net $100 per hour, we'd have to bill them in excess of $250 per hour (averaged out) - they reimburse that small a percentage of what they are billed!  Now face it - some patients don't require that much care, & only get billed about $80 for their 15 minute appt - After Medicare cuts our bill to $34 for reimbursement.  Now we are not a surgical practice - we are primary care, low rung on the ladder & the poorest  compensated of the entire spectrum of medical  care.  

Now before you multiply that out & come up with 4X34 = $116, or moret hanenou ghto maaket  he magic $100 per hour, answer a question for me!

Everyone who thinks that a 15 minute appt  will net them quality medical care raise your hand & shout!  Ah, silence, just as I expected.  That, my friends (15 min appts), are what is expected of my Cardio in his major hospital owned practice.  Before he sold his soul to corporate medicine, that 15 minute appt lasted an hour on some occasions.  In our practice, there is NO SUCH THING as a 15 min appt.  Minimum of 30 min.  Often longer.   

I know an Orthopaedist who once told me that he realized 15% of what he charged for a typical surgery.  Out of that he had to pay for ALL the same things we pay for - plus he had a rather large staff.  PA's (Physicians Assistants) PT specialists, X-ray techs, Billers, receptionists, etc.  Also - he could only perform 4-5 surgeries in a day and only did that on two - three days per week.  A hidden secret of Insurance/Medicare is a thing called a "Global" period.  This applies to all surgeries, BTW.  The surgeon must absorb in his charges the cost of follow-up visits - usually for 90 days. 

Now am I defending the $72K for the PM implant?  Yes and no!  If you followed Medicare billing /reimbursement structures, you'd swear they were designed by J.K. Rowling!  They are a bigger fantasy than Harry Potter.    Doctors have to "Play the system" in order to get reimbursed what is considered a fair return.  You bill too low, you are penalized by a low reimbursement.  Bill too high and you are subjected to an audit that makes a complete autopsy look like a tea party - plus you are penalized for billing too high.

IMHO, $72K is outlandish for a bill.  The numbers down in the teens are far more realistic for actual reimbursement.   You do not do PM implants as a sole practitioner - it takes a staff of specialists, and they must be paid commensurate with their skills.  Therefore, one surgeon is supporting as many as half a dozen others on whatever he can bring in on a limited number of procedures per week.  The reimbursements for the "Associates" in this business are close to zero.  There are very few reimbursements for RN's, PA's and other necessary folks.  For my Orthopod friend, he was paid nothing for the assistants in his operating room, which he owned and managed.  

In that line, let's talk realistic costs.  We contract w/ a lab in New Jersey for our blood work.   We draw the blood and ship it by FedEx Air over 1000 miles and get the results w/i 24 hours.  They charge us lass than $5 for the job.  The cost for the same lab work a mile away in the local hospital is more than $50.  That's OVERHEAD at its worst.  The hospital pays it, the lab doesn't.  Imaging - a series of knee Xrays costs over $3000 at the hosp & they demand cash on the barrelhead.  Drive 50 miles and the same Xray at a standalone facility costs $1300 and they will finance the cost for you.  In our small town there's no competition - 50 miles away in a large city there must be 2 dozen facilities competing for the business.

Yes, US costs are outrageous.  All caused by Gummint meddling, starting in 196X by Lyndon Johnson's Great Society plans.  You want to see medical costs go down?  Google "Direct Primary Care," a new concept in that branch of medicine.  22 states of the 50 have laws permitting it.  Ours has it, and we are the 3rd practice in the state following that model.   It requires a contract; flat fees on a monthly basis; NO insurance (cash only), all costs must be published & transparent;  No maximum on the number of appts per year for your monthly fee.  APPts w/i 24 ours are the rule, not the exception.  Most practices charge between $50 & $100 per month.  How do we do it?  Not by cutting corners on medical treatment.  We do it by saving on billing overhead.  We do not have to perform the billing Macarena. One person can do it all for a 1000 patient practice.  Appts can routinely run 30 min - minimum.  You don't need an Ins co's pre-approval for anything.  You go find the lowest cost provider that you have confidence in - including a hospital.  You walk in w/ cash & you'd be surprised at what you can get.  The concept is spreading to outpatient surgery clinics now.

BTW:  We are NOT insurance - the state law that created us expressly states that.  We are not under any regulatory control other than that of licensure  and acreditation.  Open market forces determine costs.  Open market forces deteremine quality - you don't cut the mustard & the word gets out very fast & you sink like a rock. 

Donr

Politics?

by MissFitts - 2018-07-30 05:59:40

Why is commenting on the cost of pacemakers deemed to be "political"? 

$$$

by MamaBear+ - 2018-08-02 23:57:34

Wow! $72k? That's insane! What was the out of pocket price y'all had to pay? So blessed to only have had to pay for parking. 

Shocked

by karinirene - 2018-08-03 09:18:45

I live in Colombia and I had to pay for mine as my insurance wontwpay the bill for a preexistin decease.

I paid around usd 5000 for the whole thing, pacemaker, St. Jude, latest technology, OR, my physician and his team, etc... Usd 72000 seems a little high for considering I had a very good PM fitted, new pair of leads, etc... I didn't want to stay overnight so I went home 8 hours after the surgery.