How much does surgery cost? About $147 a minute

The patient had a large abscess surrounding his spleen. On a large screen in the middle of the operating room, I watched a surgeon drain the fluid collection and remove the organ with small metal tools.

I remember the surgeon navigating the complex anatomy with alacrity, handling the laparoscopic equipment with expert finesse, and quickly and confidently answering the battery of questions from the assisting medical student. To a young and reverent observer, this surgeon seemed to know everything.

So at the end of the case I asked how much the procedure would cost the patient.

“I’m not really sure. It’s … kind of complex,” the surgeon vaguely responded.

Indeed, surgical procedure charges are confusing and consist of many different fees. There are fees for medications, instruments, and devices, there is the “initial” operating room fee, the recovery room fee (billed per hour), the anesthesia fee, the surgeon’s fee, and the operating room fee (billed per minute), among others.

But at the time I was surprised and a little disappointed that this surgeon – who expertly performed the surgery and had an incredible breadth of medical knowledge – had no idea what the patient would be charged. It just seemed like such a simple question. I decided to look into it myself.

As it turns out, the total charge to the patient in this case was $43,226.18. The patient was in the operating room for 3 hours and 31 minutes and was charged a $30,966 operating room fee. That’s just under $147 per minute! A closer look also revealed that, from incision to surgery end, the procedure lasted 2 hours and 35 minutes. This leaves 56 minutes of non-surgical operating room time.

Of course, this time is not squandered. Before the surgery begins, for example, anesthesiologists need time for induction, the sterile surgical field must be set-up around the patient, instruments have to be prepared, checklists have to completed, and the surgeons have to scrub in.

Yet the question must inevitably be asked: did all of this additional work require almost an hour? At $147 per minute, the question deserves serious consideration. And the answer should be anything but vague.

Nate Johnson is a medical student who blogs at Costs of Care.

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  • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

    This article was very eye opening. Thank you for sharing this with us.

  • http://www.facebook.com/profile.php?id=662132748 Lata Potturi Schaedler

    I remember having an elective procedure done about a year ago. I wasn’t sure insurance would cover it, but I was happy to pay out of pocket for it. So, I asked the physician doing the procedure how much it would cost. “Let me refer you to our billing coordinator.” I asked her the same question. “It depends on how the doctor codes it.” Can you ask him what code he will probably use? “He decides at the time of the procedure.” I just want to know, will it cost $400 or $4000 or somewhere in between? “You’ll have to ask the physician.”

  • maribelchavez

    All instruments and supplies need to be opened aseptically. Items need to be counted. Additional equipment such as monitors, special devices that cut/coag tissue need to be set up. Local meds/saline need to be transferred. Some large cases require lots of stuff to be opened. This all requires the circulating nurse’s assistance. Then he or she fetches the patient. Sometimes an epidural is placed for postop pain management. Sometimes an a-line is placed. The patient is usually intubated and induced. You have the positioning and prepping (cleaning the area where the incision is to be made) of the patient. The patient needs to be draped. All this is done before the surgeon even comes into the room. You’d be impressed by how efficiently the process is carried out. No time is wasted.

  • doc99

    Compare your pricing as posted with this Free-Market Oriented Surgicenter in OK.

  • Broooski

    I don’t like the way this post ends. The author suggests that the surgeon was somehow vague in answering the question he asks in the last paragraph: did this additional work require almost an hour? Yet that is not the question he asked the surgeon. He asked how much the surgery cost. And he got a vague answer. If he had asked the surgeon whether the procedure required 56 minutes of surgical time, he likely would have gotten a much more concrete answer, and that answer would almost certainly have been yes. The only tasks he mentions are prior to the surgery (induction, draping, etc.) and doesn’t mention post-procedure time at all (reversal, extubation, etc.) So it’s not as if it took the team 56 minutes to get the surgery started. But it really bothers me that the author, a medical student, chose to use such a cheap rhetorical trick to wrap up his article. So I’ll use of of my own: hey Nate, if you want to know whether it really takes 56 minutes of non-operative time to do that procedure — you apparently did a surgical rotation. Now do an anesthesiology rotation, and then you tell me if you need 56 minutes.

  • Remy_C

    This is more than a bit flawed, in that we don’t know how the cost would have changed were the procedure done in two hours forty minutes, three hours exactly, or five hours; even at a location that bills by time, there is not a linear relationship between total cost and total time when base setup fees and the like are taken into account. Most likely, the cost per minute in the operating room is a negligible portion of the total amount due, and the hour total it took to get the room set up and taken down around the surgery would not have changed anything too substantially.

  • PJT27

    Okay, the bill for the next cat spay I perform will be $2940.

    No wonder human medicine is going bankrupt.

  • wahyman

    The charge might have been 43,000, but what actually got paid? My expeience with Explanation of Benefits for cost controlled care is that the amount paid is often vastly less (sometimes almost comicly so) than the amount billed, with no one ponying up the difference. Also, why is it implied that the non-surgical time has waste but the surgical time did not? Nor is it considered that the $147 was excessive, as opposed to the time it represented.

  • http://twitter.com/Hootsbudy John Ballard

    The insurance companies are not in a position to carve away the non-healthcare dollars embedded in every bill from hospitals, clinics, doctors and pharmacies. The medical-industrial complex has only one revenue stream — charges to patients.
    I’m posting my laundry list again here and will continue to do so until someone besides me decides to shift the discussion to actual costs for professional services and actual medical expenses.
    If Medicare and other medical expenses are to be lowered the answer lies not with rationing or tweaking the insurance industry, but with the reduction of the numerous non-medical expenses sucking the system for other purposes. Here are a few more expenses, all of which have but one revenue stream — medical
    bills.
    § TV ads — some of the most expensive air time for some of the most costly productions in the ad industry.
    § Mammoth executive bonuses and golden parachutes for both health care administrators and insurance companies
    § Facilities with manicured landscaping, marble floors, lived plants, flat-screen TVs in every room, and concierge food service
    § Elaborate accounting arrangements by which large so-called “not
    for profit” health care systems, often augmented by equally large,
    embedded insurance companies (BCBS comes to mind) launder bills mostly for the benefit of very profitable clinics, specialty practices and
    device manufacturers.
    § ”Free scooters” advertised for Medicare beneficiaries. Sometimes comes with a free recipe book or lighted magnifier “just for making the
    call!”
    § Catered meals and other treats for hungry office staffs, compliments of your favorite drug or other supplies sales representative.
    § And speaking of sales, don’t forget the sales bonuses for high
    performers. The only people in America with no limit to how much they
    might earn are not in medicine or other specialties, but in sales.
    (Investment bankers are in the running, of course, but they are in fact
    limited by how much capital and/or credit they have. Enterprising sales
    people have only transportation, cosmetics and a few other expenses.
    § Don’t let’s leave out some red meat for the tort reform crowd —
    legal and accounting services, and a grey area often called “defensive
    medicine.”
    With the exception of a dedicated group of community volunteers who provide a few ancillary goods and services, every dime of all that has but two sources:
    1.) Medical bills
    2.) Government grants for teaching hospitals and research by NIH. (taxes)
    What am I missing?
    *
    *
    *
    *
    *
    *
    * Yes, of course. I almost forgot — MEDICAL CARE!
    ~~~~~~~~~~~~~~~~~
    Don’t you love watching those ED ads where the whole landscape goes tumescent?
    That’s a really great special effect, huh?
    Makes you all horny just watching.
    Production expenses for those advertisements, special effects, prime-time broadcast air time and profits for the agency that were paid to put them all together…. all that money has only one source, medical bills. The money has to come from someplace and that is the only source of money feeding the whole medical-industrial complex.
    The insurance people manage risk. And they do a helluva good job. If they don’t they cannot stay in business. But they are no more responsible for the costs than weather forecasters are responsible for the weather.
    This post and comments illustrates a high level of medical professionalism with an embarrassingly poor level of understanding business economics.

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