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NYT: Total knee arthroplasty in Mexico

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  • Zaphod
    replied




    Perfect example why we shouldn’t do unnecessary procedures. Nothing is benign.
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    Life aint benign.

    The vast majority of things arent 'necessary', which itself is a spectrum not a point.

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  • Tim
    replied
    Centers of Excellence is not a new concept. In this approach, a private company is simply marketing this using this a low cost (preferable) alternative.

    I saw mentioned two US trained physicians, one of which was a “fly in”. I didn’t see any representations that the readmit, complications or success rates were comparable to the USA.

    I’ll bargain shop at Centers of Health models in the US.

    https://hitconsultant.net/2019/03/06/walmart-centers-of-excellence-model-quality-care/

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  • Panscan
    replied
    Perfect example why we shouldn't do unnecessary procedures. Nothing is benign.

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  • MSooner
    replied
    Reminds me a bit of this disaster:

    https://www.nbcdfw.com/news/local/Dallas-Realtor-in-Hospice-Care-After-Botched-Mexican-Procedure-500812582.html

    Leave a comment:


  • bonebrokemefix
    replied
    I had a patient awhile back that came in for sole purpose of establishing relationship so I could care for her after her already scheduled surgery several hours away, set up by her employer. Told her I’d be happy to do as good of a job for the same price, but I’m not a PA, and I won’t be seeing someone else’s postops unless there is a darn good reason. Wished her luck and haven’t seen her since.

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  • AR
    replied


    I’m an arthroplasty surgeon in Mississippi. She has plenty of solid local options, some of which that are 20 minutes from her house.
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    I agree with a lot of what you said in your post, but these two parts seems quite contradictory:


    Complications happen in the best of hands and many are greater than 10 days after surgery.
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    I have taken care of several patients who had complications after flying to “the best”. It then implies that you are not.
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  • Panscan
    replied
    Also flying to Hopkins is not much different than Mexico imo, probably(maybe?) cleaner but same issue of not being near your surgeon and whoever is local is going to be annoyed they are managing somebody else's complication if anything happens

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  • Panscan
    replied
    By same token I'm not sure it's worth it to fly to Hopkins to get a knee replacement. These high volume relatively low level cases don't need to be done at ivories and many people would argue that community peolle who do hundreds would be better ( Ortho might be an exception becsuse even academic ortho guys who do joints seems to do very high volume)

    But if you're asking me if I want a lap chole at ivory or community guy who does a million a year? In my experience I'll pick the community guy.

    If it's an ortho onc thing? Yes go to ivory tower, but IMO there are levels of complexity to things and the ivories don't necessary do everything best. It also seems like primary care is not done well by a lot of ivory institutions.

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  • Zaphod
    replied




    Working an ER in Texas I can tell you that plenty of people go to Mexico for cheap procedures and end up getting screwed. Sure there are top notch programs with good doctors and support staff..but there are plenty of outfits that do bariatric procedures, cosmetic procedures that just dump septic patients across the border when they screw it up. Some of them just load the patients up with steroids for a few days to make sure they feel good and then send them home. I am not a fan of traveling for procedures. You have virtually no recourse if something goes wrong.
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    Absolutely. Its just plain dumb from a risk management perspective. Having worked in both TX/CA I saw a lot, especially since many of the procedures people like to attempt to cheap out on are cosmetic, but oddly enough, add in the travel and the expenses are sometimes more than here in the US, so nuts.

    I think there are many talented surgeons in many countries, but everyone has complications, and being hours by plane away from your surgeon or anyone that did it is not a good thing. I always discouraged people that traveled from afar, even just in the states. Its annoying and not worthwhile. Too many good doctors wherever they lived.

    Also its not like its some replaceable thing people are messing with, I will buy something I know is inferior quality if I think I might get a decent use life out of it and its replacement several times over is still cheap. Your body/life are not that way, these things are permanent and can maim or kill them. So stupid. Dont walmart your surgeries, though one day that will likely be a thing.

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  • Dicast
    replied
    Working an ER in Texas I can tell you that plenty of people go to Mexico for cheap procedures and end up getting screwed. Sure there are top notch programs with good doctors and support staff..but there are plenty of outfits that do bariatric procedures, cosmetic procedures that just dump septic patients across the border when they screw it up. Some of them just load the patients up with steroids for a few days to make sure they feel good and then send them home. I am not a fan of traveling for procedures. You have virtually no recourse if something goes wrong.

    Leave a comment:


  • gap55u
    replied
    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.

    Leave a comment:


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

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  • FunkDoc83
    replied




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

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  • Stronach
    replied
    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.

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  • AR
    replied




    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?
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    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.




    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.
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    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.

    Leave a comment:

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