Answer Line: What operations cost, and how much you’re charged, two different numbers | Answer Line | #insurance | #seniors | #elderly
Editor’s note: Answer Line was on assignment this week. Look for new questions and answers to return soon. In the meantime, enjoy this best-of column from 2017:
QUESTION: The medical establishment has made so many operations almost routine now and we patients don’t usually know what it costs. What is the total cost of a knee, hip operation or organ transplant?
ANSWER: The answer is affected by a lot of factors, including how you’re defining “cost.” Also, it would vary from hospital to hospital and, I suspect, insurance plan to insurance plan. Also, I’m sure there are variables that can arise during surgery.
I turned to the Agency for Healthcare Research and Quality and its Healthcare Cost and Utilization Project database. This database can create state-by-state reports.
I’ll get to the specific information you requested, but I thought it important to note how that report defines “costs.” In this database, that is essentially what each surgery costs the hospital. This report uses the term “charges” to reflect what is billed to the patient and insurance company.
The database shows that organ transplants other than bone marrow, corneal or kidney in 2013 in Texas had a median cost of $124,859. Kidney transplants had a median cost of $47,854, while hip replacements logged a median cost of $16,982 and knee replacements $15,970.
Hospital charges, though, had medians in 2013 in Texas of: $578,207 for transplants other than bone marrow, corneal or kidney; $220,500 for kidney transplants; $77,377 for hip replacements; and $73,022 for knee replacements.
I’ll offer a reminder that these are statewide figures and not specific to Longview. Also, most of those figures do not reflect any billing that might occur separately from the hospital for surgeons or anesthesiologists, for instance.
Q: I am an elderly woman, and I have had many mammograms. They are extremely painful and unpleasant for me. I have just about decided to live out my life without having to endure another one. The staff have insisted on an ultrasound after my last few mammograms, “to be sure.” Is there some explanation for why we start with a mammogram and then proceed to a sonogram?
A: Answer Line took the liberty of merging a few different questions I received on this topic. Dr. Christine Moulds-Merritt, with the Diagnostic Clinic of Longview, Dr. Randy Erwin, a Longview Regional Medical Center radiologist, and Christus Good Shepherd Health System all agree mammography is the way to go for breast cancer screening. Good Shepherd described it as “the gold standard” for detecting abnormalities.
“Mammography is the only proven screening exam for the detection of breast cancer,” Erwin said. “Mammography is far superior to ultrasound as a screening exam. Mammography has reduced the mortality rate from breast cancer more than 30 percent. Ultrasound is an ancillary procedure that is helpful in symptomatic patients (focal pain, tenderness, mass, discharge, etc.) or when a possible abnormality is seen on mammography. Typically, less than 10 percent of patients undergoing screening mammography will need a follow up sono. At the Center for Breast Care of Longview Regional Medical Center, all patients receive 2D and 3D imaging of each breast. This technology increases the detection rate for cancer and reduces the recall rate.”
Moulds-Merritt said mammograms are able to find small cancers, and sonograms are not able to scan the whole breast.
Both doctors suggested talking to your primary care physician about whether you should continue receiving mammograms.
“If your life expectancy is not greater than 10 years, maybe you don’t need to be worrying about mammograms,” Moulds-Merritt said. She told her own grandmother to stop having them at age 85. She lived to be 97, with no breast issues.
Erwin suggested mammography is not necessary for patients with a life expectancy of 5 to 7 years, or if no action would be taken for “abnormal results.”
Mammography breast pain typically occurs when breasts are sensitive because of “fibrocystic breast tissue,” Moulds-Merritt said.
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