The Cost of Cutting: A Surgeon Reveals the Truth Behind a Multibillion-Dollar In

Description: The Cost of Cutting by Paul A. Ruggieri A fascinating inside look at the business side of surgery.Why is surgery so expensive?Surgeon Paul A. Ruggieri reveals little-known truths about his profession-and the hidden flaws of our healthcare system-in this compelling and troubling account of real patients, real doctors, and how money influences medical decisions behind the scenes. Even many well-informed patients have no idea what may be contributing to the cost of their surgery. With up-to-date research and stories from his practice, Ruggieri shows how business arrangements among hospitals, insurance companies, and surgeons affect who gets treatment-and whether they get the right treatment. Pulling back the curtain from the hospital bed, he explains how to safeguard ones own health (and finances), and how America can make surgery more affordable for all without sacrificing quality care. FORMAT Paperback LANGUAGE English CONDITION Brand New Author Biography Paul A. Ruggieri, M.D., is a board-certified general/laparoscopic surgeon and the author of books, including Confessions of a Surgeon. Review "Surgeon Ruggieri tutors readers on the economic forces that make the surgical theater tick. Ruggieri is a fine storyteller, which is a good thing, for although he peppers the book with dramatic anecdotes from his practice, his real exploration focuses on the financial side of the medical equation... Top-shelf instruction on the mechanics of the medical economy."—Kirkus Reviews "A vital conversation about money in medicine that we have not had, but desperately need to have. A deeply personal and powerful analysis with sweeping implications for addressing waste in medicine. Dr. Ruggieri challenges why healthcare continues to have an expensive carve-out to the same accountably principles that govern other industries. He offers serious ways to cut waste and increase value by making medicine more patient-centered, more efficient, and more transparent."—Marty Makary MD, Johns Hopkins surgeon and author of UnaccountablePraise for Confessions of a Surgeon "Honest and angry, this cutting memoir by a midcareer surgeon feels like an act of penitence."—Booklist"Looks hard at a profession that is changing in ways that Ruggieri does not always find to be positive…[a] look into a corner of medicine we seldom see."—Providence Journal Review Quote "Surgeon Ruggieri tutors readers on the economic forces that make the surgical theater tick. Ruggieri is a fine storyteller, which is a good thing, for although he peppers the book with dramatic anecdotes from his practice, his real exploration focuses on the financial side of the medical equation... Top-shelf instruction on the mechanics of the medical economy."- Kirkus Reviews "A vital conversation about money in medicine that we have not had, but desperately need to have. A deeply personal and powerful analysis with sweeping implications for addressing waste in medicine. Dr. Ruggieri challenges why healthcare continues to have an expensive carve-out to the same accountably principles that govern other industries. He offers serious ways to cut waste and increase value by making medicine more patient-centered, more efficient, and more transparent."-Marty Makary MD, Johns Hopkins surgeon and author of Unaccountable Praise for Confessions of a Surgeon "Honest and angry, this cutting memoir by a midcareer surgeon feels like an act of penitence."- Booklist "Looks hard at a profession that is changing in ways that Ruggieri does not always find to be positive…[a] look into a corner of medicine we seldom see."- Providence Journal Excerpt from Book --from THE COST OF CUTTING -- INTRODUCTION I had my first inkling that I wanted to be a surgeon before I was even accepted into medical school. Once I was there, it wasnt long before I knew surgery was my calling. That was more than twenty-five years ago and every day (well, almost every day) since then Ive been able to say, I love what I do . As a general surgeon, using my hands, my brain, and the tools of surgery, I can make a difference in the quality of a persons life every time I step into the operating room. Sometimes I can even save a life. Im profoundly grateful for the opportunity. A couple of years ago I wrote a book about what goes on inside an operating room from a surgeons perspective. I wanted to take people into that mysterious world where a days work can ricochet from the mundane (varicose vein removal) to the sublime (repairing a torn artery before the person bleeds to death) in a matter of minutes. Those moments when something truly exceptional happens in the operating room, and even the less exciting ones, are what keep me and my colleagues doing what we do. The work itself is truly the reward--as is the gratitude of our patients. Why, then, have I written a book about the money side of the equation? Isnt money supposed to be anathema to the high principles of the medical profession? After all, were not stockbrokers, were healers. Traditionally, its been almost unseemly to mention money in the same breath as patient care. But a new conversation is taking place in our country, and its all about money and healthcare. None of us can get away from it, including those of us who work as physicians and surgeons. And maybe thats a good thing. Im finding for the first time in my professional life that doctors are talking openly with each other about reimbursement, about expenses, about the challenge of running a viable practice while taking on more and more Medicare patients as the baby boom generation turns sixty-five. As the Affordable Care Act (ACA) kicks in, the conversation about the cost of providing care in America has become even more important. And more frantic. Who will be covered? What will it cost? How will we as a country afford it? How does all of this relate to quality--or does it? A lot of contradictory points of view are being put forth. Its a topic worth careful consideration. And thats why Ive written this book. Currently, the United States spends more than $2.7 trillion a year on healthcare. This figure translates to more than 17 percent of gross domestic product (GDP)--and more than any other nation on earth spends on delivering medical services. A healthy piece of this $2.7 trillion pie is spent by private insurers and the federal government on reimbursement for operations and all the related expenses: surgeon fees, anesthesia fees, operating room fees, recovery room fees, hospital inpatient fees, and the "state of the art" equipment used during surgery. Surgical procedures, more than any other aspect of healthcare, generate revenue. Big revenue. Operations are the lifeblood of hospitals. And of surgeons. Surgeons do not make a living seeing patients in the office; they make a living seeing patients in the operating room. Without busy operating rooms, many hospitals would dry up, closing their doors and taking away other important (nonsurgical) services as well. Without operating rooms full of busy surgeons, medical device companies (big international for-profit companies that produce a plethora of equipment used during surgery, such as artificial joints, mesh, robots, cardiac stents, sutures, surgical stapling devices, and laparoscopic equipment) could not survive. Nor could they face their shareholders. With more than fifty million operations performed in this country every year, surgery is big business. Surgery is an engine that compensates surgeons performing their craft, supports hospitals promoting their surgical services, and profits medical device companies. Unfortunately, all this money carries with it power and influence. When it comes to medical decision making, power and influence are not what you want motivating your surgeon, your hospital, or your insurance company. I believe this taboo topic should be part of our national discussion as we shape the future of healthcare. Historically, surgeons and hospitals have benefited financially by producing greater operating room volume, not necessarily greater quality. Surgeons know this, anesthesiologists know this, insurance companies know this, and hospital administrators especially know this. Ironically, the only ones who are unaware of the enormous amounts of money generated from their operations are the patients about to be wheeled into the operating room. It does not matter whether your heart is being bypassed, your stomach stapled, your knee scoped, your uterus removed, your spine fused, or your hernia repaired; a long line of healthcare providers, hospital administrators, insurance company executives, and medical device company big shots are profiting before, during, and after your operation. Maybe thats as it should be. Money must be made from surgery or there would be no surgical care at all. The question before the nation is, How much is that worth? Over the last ten years, healthcare costs have spiraled out of control. The average person knows something is awry but not exactly what, or how to address the problem. What we do know is that there is a limit to the amount of federal money we are comfortable designating for medical care, and insurance companies are in business to make money. We want greater access to care and we want quality care and we want lower insurance premiums. So whos going to foot the bill for all that quality care? The ACA means greater access to care for more of the population, but it also means even greater government scrutiny on healthcare costs, and it has already resulted in significant reductions in reimbursements to providers, including surgeons. In many ways, this scrutiny is a good thing. To remain viable, however, hospitals in every community across this country are consolidating to gain patient "market share" and buying up primary care doctors and specialists alike. This shopping spree is an attempt to control referrals to their operating rooms and retain patients in their network. Retention is the battle cry of hospitals today. As a potential patient, you are affected by all this. Hospitals attempts to control surgical referrals affect your choice of surgeon. Insurance companies are encroaching on your choices, too, with limited healthcare plans and provider networks. Sure, you can still choose your surgeon, but it will cost you sky-high deductibles if he or she is an "out of network" provider. If youre very lucky, you may never need to see the inside of an operating room. But even if fate is that kind to you, the cost of healthcare and how it will be provided in this country is something that should matter to all of us. I dont claim to have all the answers to this puzzle, but I do hope the information and perspectives offered in this book will be enlightening. I hope youll gain insights that will get you thinking about this topic in a new way. Meanwhile, I look forward to getting back to what I love to do. PAUL A. RUGGIERI, M.D., F.A.C.S. 1 The woman seated on the exam table was lean and fit and seemed to be enjoying perusing one of the magazines from our slightly out-of-date offerings. She looked like she was in her midforties; her chart showed her age to be fifty-two. Her face did not express any distress and when she returned my greeting she spoke in a clear, friendly tone. As I scanned her medical history, the portrait of a person in good health came into view--her lab work, blood pressure, weight: All were excellent. Healthy and thin are two adjectives I do not often use to describe my patients. Why was this woman in my office? Several weeks earlier, it turned out, her primary care physician had ordered an abdominal CT scan to investigate a nagging pain that he hadnt been able to diagnose. Eureka: The radiologist reviewing the scan noticed gallstones. Mystery solved. The patient (well call her Mrs. Brogan) was subsequently referred to me for a "surgical opinion," a consultation to determine whether surgery could help. As I performed the physical exam, I questioned her and soon concluded that her gallbladder was working perfectly. While some of her symptoms were vague and nonspecific, the gallstones found during the CT were what we in medicine call an incidental finding , nothing more. The true source of Mrs. Brogans pain had yet to be determined. An incidental finding happens when an apparent abnormality of some kind--unrelated to the source of the persons symptoms--is discovered during a diagnostic imaging exam. For example, if a CT scan of the abdomen is ordered to help with the diagnosis of a bowel problem and the radiologist notices a dark area, a "density," on the kidney, that information becomes part of the report and is considered an incidental finding. Similarly, if a CT scan of the chest for diagnosis of coronary artery disease reveals a nodule in the lung, that incidental finding is shared with the referring physician and, ultimately, with the patient. Let the testing (and worrying) begin. Over the past fifteen years there has been a dramatic increase in the use of two sophisticated diagnostic imaging tools: CT and MRI scans. CT (often referred to as a CAT scan), stands for computerized (or computer-aided ) tomography , which uses x-ray technology. MRI , which stands for magnetic resonance imaging , uses a magnetic field and radio wa Details ISBN0425272311 Author Paul A. Ruggieri Short Title COST OF CUTTING Language English ISBN-10 0425272311 ISBN-13 9780425272312 Media Book Format Paperback DEWEY 338.476 Year 2014 Publication Date 2014-09-02 Imprint Berkley Publishing Corporation,U.S. Place of Publication New York Country of Publication United States Subtitle A Surgeon Reveals the Truth Behind a Multibillion-Dollar Industry US Release Date 2014-09-02 UK Release Date 2014-09-02 Narrator Jonathan Glover Birth 1908 Death 1988 Affiliation Associate Professor of Psychiatry, Bipolar Clinic and Reseach Program, Massachusetts General Hospital Position Associate Professor of Psychiatry Qualifications M.D. Pages 320 Publisher Penguin Putnam Inc Audience General NZ Release Date 2014-09-01 AU Release Date 2014-09-01 We've got this At The Nile, if you're looking for it, we've got it. With fast shipping, low prices, friendly service and well over a million items - you're bound to find what you want, at a price you'll love! TheNile_Item_ID:159450951;

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