Why are medical costs skyrocketing?......its not your doctor!

I had a funny experience yesterday in the office. A very happy patient returned to see me three months after her arthroscopic rotator cuff repair. She was feeling great. She had no pain, normal function, and was back to doing all her activities.

She presented me with a  jar of honey from her farm, and said, "I saw your bills from Medicare. I can't believe that's all you get paid for these surgeries. I wanted to give you something extra!" We shared a laugh and I am now the proud owner of a fresh pound of honey.

The point of this is not to say that doctors don't make enough money. We do just fine, and are blessed to be in this profession. The real point is that physician fees make up a very small portion of health care expenditures. For instance, surgeon reimbursement for a medicare rotator cuff repair is roughly $1,000. The amount we are paid for a shoulder replacement is in the neighborhood of $1,500. On the other hand the total cost of a shoulder replacement surgery is $10,351 according to a study out of Johns Hopkins. Based on this math, 90% of the cost is not your surgeons fee. Does that seem right?

As health care costs continue to spiral out of control the American public should understand where these costs are coming from: hospital charges, device manufacturers, insurance companies. Of course, these entities have powerful lobbyist, who ensure that money continues to flow to these industries. As a result, it is easy for politicians to cut reimbursement to physicians instead of tackling the real problems.

What is a frozen shoulder?

Frozen shoulder is one of the most common conditions that I treat in my practice. There are a lot of misconceptions about this common problem. The first thing that patients should know is that most people will get better without surgery, and will regain normal function. Unfortunately, the recovery process can take a very long time and is often frustrating. I have found that many patients simply want to know what is happening with their shoulder. Once they understand the process their recovery goes better.
Here is a webpage that I have written to provide basic information on this topic.

Planning your Ream and Run Shoulder Replacement

The Ream and Run shoulder replacement is a new type of shoulder replacement that has advantages for patients who wish to remain active. Dr. Carofino is one of a few shoulder surgeons in the country with extensive experience with this operation, and is commonly contacted by patients interested in traveling to Virginia for this procedure.

This is a description of how you can arrange to visit Virginia Beach for a Ream and Run Shoulder Replacement

Step 1. Determine if you are a candidate for this surgery:

Dr. Carofino will review your records, x-rays, MRI, etc. to determine if you may be a candidate for this operation. If you would like to start this process you may send an email to carofinob@atlanticortho.com. After the records have been reviewed he will discuss his finding with you by phone.

At that point if you are interested in visiting Virginia Beach to have surgery further arrangement will be made.

Step 2: Planning Your Trip

You should plan to arrive in Virginia Beach on the Saturday or Sunday prior to your surgery.

Monday: Office consultation with Dr. Carofino to review x-rays and perform physical examination. The surgical procedure and recovery process will be reviewed. All additional questions will be answered at this point. Pre-operative lab work is completed.

Tuesday:  Surgery is performed at the Sentara Princess Anne Hospital. The surgical procedure takes approximately 1.5 hours. Post operatively patients are admitted to the hospital for pain control and initiation of physical therapy. Most patients will be discharged from the hospital in one to two days.

Post Hospital Course: (Wednesday until departure)

After discharge from the hospital you will stay in a nearby hotel until your departure. During this time physical therapy will be performed at our office on a daily basis to ensure you are stretching the shoulder properly. We recommend that you plan to stay in Virginia Beach until Saturday at the least. This will allow plenty of time to ensure that you are comfortable after surgery, and progressing with physical therapy.

Step 3: Planning your follow up care

You will need to continue with your physical therapy at home. We will coordinate this with a therapist of your choosing and provide them detailed instructions. It is encouraged that you send us pictures of you doing your stretching exercises so that we may monitor your progress.

You will need to have stitches removed two weeks after your surgery. A local doctor or physical therapist can perform this.

Ideally, you will return to Virginia Beach at three months after your surgery so that we can check your progress. However, if you are doing well we can monitor your recovery by sending a video, and phone discussion.

Miscellaneous

Travel

If you are flying the Norfolk Airport is 30 minutes from the office and hospital.

Insurance Coverage

Shoulder replacements are common procedures and typically covered under insurance. If you are from outside of Virginia then Dr. Carofino is most likely considered an “out of network” physician by your insurance. Therefore, you will need pre-authorization from your insurer prior to treatment. Our billing department can assist you with this process.

The Truth about Tommy John Surgery

The Truth About Tommy John Surgery

If you watch any professional baseball there is a good chance that at least one pitcher on the roster has had a “Tommy John Surgery”.  This is a surgical procedure to rebuild the ulnar collateral ligament of the elbow, which can be torn due to repetitive throwing. The number of these surgeries being performed is increasing each year, but not just in professional athletes. In fact, more and more of these operations are being performed on youth baseball players as young as twelve years old. This is partly a product of the shear amount of baseball that kids are playing at a young age. Many high-level youth baseball players compete year round, and often play on more thane one team at a time. Their young arms never get a chance to rest and heal.

Another possible reason for the increase in this operation is that kids believe it will make them better pitchers. I have had several young patients tell me that they think they will throw harder and come back stronger if they have a Tommy John procedure. There also is a perception that the surgery works every time. Its understandable that people would think this because there are so many major leaguers who have had the operation and returned to competition.

However, the truth is that not all baseball players return to their desired level of function. In fact, a study published this year in the Journal of Shoulder and Elbow Surgery found that nearly 20% of athletes undergoing an ulnar collateral reconstruction failed to return to their prior level of competition. We should discuss this openly with young athletes who are weighing their options and considering Tommy John surgery, and remind them that surgery is never a sure thing.

Dr. Carofino is an orthopaedic surgeon who specializes in shoulder and elbow surgery. He has expertise in Tommy John surgery, and treatment of baseball injuries. Dr. Carofino sees patients in Virginia Beach and Chesapeake, and is a team physician for the Norfolk Tides. If you have questions Dr. Carofino can be contacted at carofinob@atlanticortho.com