NYT: Total knee arthroplasty in Mexico

[okayplayer]

https://www.google.com/amp/s/www.nytimes.com/2019/08/09/business/medical-tourism-mexico.amp.html

I'm surprised an orthopod could be bothered to fly to Mexico, miss work in the US, etc for $2700. The article implies he was flying down for this one procedure only.

Who does the postop care? What happens if there are complications?

[Panscan]

Why can't they just get post op care in America? I doubt there's going to be an immediate complication for a knee replacement unless they're like a raging diabetic or etc.

Just shows how convoluted and screwed up our system is.

[SValleyMD]

I like the idea.

The fly down for one case seems a little silly but group 4-10 cases together, pay cash and I can see how that’s appealing

[PhysicianOnFIRE]

Genuinely curious about the aneshesia. Not surprisingly, there was no mention of it in the article. Anesthesia just happens, right?

[G]

PhysicianOnFIRE wrote:

Genuinely curious about the aneshesia. Not surprisingly, there was no mention of it in the article. Anesthesia just happens, right?

Click to expand...

You get what you pay for: a couple aspirin and a local.

 

[nephron]

they probably hire some illegal crna's do do the anesthesia.

 

[ACN]

He's making double Medicare reimbursement in cash. Seems like a genius. Do 6 joints in Mexico for cash for the same as 12 in the US with overhead and taxes not included.

[AR]

okayplayer wrote:

https://www.google.com/amp/s/www.nytimes.com/2019/08/09/business/medical-tourism-mexico.amp.html

I’m surprised an orthopod could be bothered to fly to Mexico, miss work in the US, etc for $2700. The article implies he was flying down for this one procedure only.

Who does the postop care? What happens if there are complications?

Click to expand...

Did you actually read the article?  It said that a local orthopedic surgeon (who apparently did a fellowship at Harvard) assisted on the case and checked on her post-op.  So it seems like post op care should have been adequate.

PhysicianOnFIRE wrote:

Genuinely curious about the aneshesia. Not surprisingly, there was no mention of it in the article. Anesthesia just happens, right?

Click to expand...

They didn't mention it, but there is no reason they couldn't do the same thing with an anesthesiologist.  Just set up a day full of cases, pay them a bit of a premium per case, and cover a free trip to Cancun. I'm sure they wouldn't have much trouble filling that position.

But it wouldn't surprise me if your implication is correct. Patients probably don't even consider anesthesia (at least not nearly as much), so they could just use a local anesthesiologist and most patients wouldn't think twice.  Just as the journalist didn't even think to mention it.

[AR]

OK, it looks like this thread is one where some of the posts are missing.   I can only see a few.

Apologies for double posts and or repetition of something someone else may have already said.

[okayplayer]

Presumably the patient is not staying in Mexico all that long (maybe a week). Who deals with more delayed postop complications, since the surgeon is located nowhere near the patient geographically?

I would not have anything permanently implanted in me in a third world country to save a few bucks, but that is just me. I’d be very worried about sterilization processes, who is anesthetizing me and what is their competency, etc. I’ll pay my $5,000 copay and sleep in my own bed on POD 1/2, thank you very much.

[AR]

okayplayer wrote:

Presumably the patient is not staying in Mexico all that long (maybe a week). Who deals with more delayed postop complications, since the surgeon is located nowhere near the patient geographically?

Click to expand...

You don't need to presume.  The article stated that she stayed for 10 days.

The article alludes to the fact that she had a choice of having the procedure done locally, but she was incentivized to go abroad with an additional payment.   So presumably she lives in proximity of surgeons who do knee replacements.  That's not as ideal as having f/u with the same surgeon for a delayed complication, but it's not terrible.  Even if she were to develop a complication after a surgery performed here, her surgeon could move, go on vacation, get taken off her insurance plan, etc.

okayplayer wrote:

I would not have anything permanently implanted in me in a third world country to save a few bucks, but that is just me. I’d be very worried about sterilization processes, who is anesthetizing me and what is their competency, etc. I’ll pay my $5,000 copay and sleep in my own bed on POD 1/2, thank you very much.

Click to expand...

I'd act the same way, but because I have good insurance and am lucky enough that an extra $5K isn't going to change my life.  However, I don't think that there is anything inherently wrong with medical tourism. If my financial situation were different, I would certainly consider it for an elective procedure.  However, I would research it extensively (including all the questions you brought up and more).  Many patients probably couldn't do this effectively, but I think with enough time and effort, I'm pretty sure I could.    Of course, I could likely earn more than 5K in the time it would take me to research those things to my satisfaction, which is why, like you, I would not take the $5K to go to Mexico.

[Stronach]

I’m an arthroplasty surgeon in Mississippi. She has plenty of solid local options, some of which that are 20 minutes from her house. We aren’t quite a third world country.

I can get the economics of this. The problem with medical tourism is when she [language] out. Get back on a plane to Mexico? Unlikely. Complications happen in the best of hands and many are greater than 10 days after surgery. And now that cost savings goes right out the window.

I have taken care of several patients who had complications after flying to “the best”. It then implies that you are not. And yet I have had to clean up after other surgeons and fix their complications. It’s a frustrating situation.

Our system simply costs too much. That price tag is not from the clinical care we deliver. It’s from the administrative burden of CMS, JHACO etc and the medicolegal costs associated with doing business.

Would I do this? It’s not worth it for one case. I can almost guarantee he’s stacking 4-6 in a day and pulling home $10,000 for a day or more. This is a young surgeon who trained under the surgeons that built this system. They are also surely profiting from this without physically having to go do the surgery by providing surgeons into the system. Let’s just say I have mixed feeling about being a surgeon doing this just as I have mixed feelings (more negative than positive) about a patient doing it.

I sincerely hope she does well. Going to be very interesting follow up article if she doesn’t.

[FunkDoc83]

PhysicianOnFIRE wrote:

Genuinely curious about the aneshesia. Not surprisingly, there was no mention of it in the article. Anesthesia just happens, right?

Click to expand...

POF, I know you just quit work, but this could be a new side hustle for you!  Medical tourism anesthesiologist.  And you get to visit some exciting places.

[HumbleInvestor]

What is a typical cost for patients for such surgery with Medicare?

[gap55u]

I had a patient who worked for Lowe’s who had his hip replacement at Hopkins. It sounds like they had the contract for Lowe’s nationwide. The patient saw local ortho then Hopkins, had preop evaluation there, and I did preop too (mini mental and phq9 dementia/depression screens were a nice addition to the usual requests). He stayed at a local hotel until a post-op check.