Wednesday, April 17, 2013

hey, I'll do that for 50 bucks

As a nurse in the ER, you don't think much about cost.  That is, how much what we do costs.  It is only when you or your family go to the ER for something and get the bill, that you realize just how riduculously expensive it all is.

Case in point:  My friend developed a bad cellulitis.  So they went to the ER.  Even though, the cellulitis was already bad, they chose to give here antibiotics and send her home.  Of course, it got worse.  Way worse.  So back she went to the ER.  Mind you, she had called her doctor, but they said they didn't handle something like that is in the office.

She was seen by a NP.  She ended up having and I and D (incision and drainage).  She got an an IV antibiotic. Probably should have got all this on the first visit, but whatever....

So here's the point of all this: The I and D cost over 1,000 dollars.  Now mind you, here is what happens in an I and D:

1) Area is numbed up.
2) An incision is made by a scalpel and pus is squeezed out.
3) Iodoform guaze is put in hole that is left.
4) Dressing is applied.

Time this takes: about 5 minutes.

So a five minute procedure that uses a bottle of numbing med, a syringe and needle, and I and D tray, sterile gloves, idoform gauze, a dressing costs 1,000 dollars.  Okay......

Next time, I'll do it for her and I'll only charge her 50 dollars.  I mean seriously folks, this is not rocket science.  You could train a ten year old to do this.  Numbing up an area is simple, similar to injecting for a dog bite where there is concern about rabies.  I've done that a few times. I think I could make an incision and squeeze.  I also think I could put gauze in a hole, having done so back in my med surg days.  Honestly, can someone tell me why this costs 1,000 dollars?

Oh by the way....that 1,000 dollars is only part of the bill - it is called a "minor surgical procedure".  Then they are the other charges adding up to a few thousand dollars.  Then we wonder why medical care costs so much...


Aesop said...

I+D tray $19.17
Iodoform gauze packing $3.97
Lidocaine 1% w/epinephrine $12.03
Syringe and needle $0.98
#11 scalpel $0.88
pair of sterile gloves $3.26
Subtotal for supplies $40.29

Your pro-rated share of getting a PA (or doctor) trained and skilled enough not to cut through your nerves or vessels, puncture a lung, or perforate other various body structures
PA $0.22
(@$160K education divided by 30 years practice divided by 2000 hrs/year divided by 1/12 hr of actual time)
MD $0.42
($250K education divided by 25 years of practice divided by 2000 hours/year divided by 1/12 hr of actual time)

Cost of keeping an ER staffed, open, and available for you 24/7/365 for piddly little complaints that you could have had done at Urgent Care from 8A-10P, but instead brought in to us at 11:45PM when it was finally convenient for you, and too painful to ignore $459.57

Penalty fee to cover the guy right next to you with the same complaint, who's in the U.S. illegally and/or homeless, doesn't pay taxes, and will never pay his hospital bill $500.00

girlvet said...

I've got news: urgent care wouldn't do it either.

Meghan said...

Ugh...took my son in for a lac near his eye (was borderline on if it needed a stitch on not)...any way, got glue. $500 charge. (same as stitches, b/c it's still a "simple repair.")

Anonymous said...

American hospitals charge INSANE amounts for things that hospitals in countries with single-payer health care systems handle easily. There is absolutely no good reason why a CT at a hospital in Canada should cost 60 bucks but a hospital in the US can charge thousands for it. Actually, there is a good reason, and that's because they can. It's ridiculous and terrifying.

Aesop said...

Whereas in Canada, they have something like 4 MRI machines for the whole country, so the wait is only 8 months to get one, so they all come to Minneapolis and Seattle, which makes so much more sense.

How do you like that great service at the DMV and the Post Office?

Ethan said...

Informative Article! Good to see somebody who really knows what they are talking about and can additionally produce common sense blog for us the reader. Certainly looking forward to your next article.

Anonymous said...

Supplies $50
Doctor $150
Hospital $1,500
Insurance $2,500


Mal said...

I would think there's a market out there for basic 'self-diagnosis and repair of minor injuries' seminar.


Minor illness and injury, what to do, and when to get help.

Infection; how to avoid it, and do you need the ER when you've failed.

Pus under pressure; opening and draining wounds and abscesses.

Superglue and steri-strips, and how to tell if it really does need stitches.

Is it broken or can I just strap it?

Basic commonsense self-care or care for children that could be managed at home or by a nurse or PA at the family doctors surgery seems to be increasingly ending up in the ER.

Aileen Bay said...

Urgent cares that don't do "urgent care" annoy me. The urgent care that I work for does I&D's. Cost if you pay out of pocket- $175 plus $100 for the clinic visit. Thousands of dollars? Ridiculous.

Anisha Cason said...

I remember when my boyfriend had to have this done. It literally took longer to get called back than to have the procedure done. We were just as astonished as you were by the bill. Long story short, it came to almost $1600. They didn't decide to operate until the third ER visit and Urgent Care just gave him antibiotics.

Anisha Cason @ U.S. HealthWorks Berkeley