Monday, July 9, 2012

Surgery at $147 per minute

Nate Johnson is a medical student at Tufts University and Maine Medical Center

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.


  1. Thanks Nate, I am sure that the costs of this procedure were high, but the hospital charges are irrelavant and misleading. They bear no relationship to the actual payment made by this patient's insurance company which is likely to be 1/4th to 1/10th of the hospital charge.

    1. That attitude is exactly why insurance costs are outrageous in the US! We ALL pay for the costs, it's just spread out over to all of us, over months and years. It's insane that the two physicians (the surgeon and the anesthesiologist) combined fee is a drop in the bucket compared to what the hospital charges to rent out a room for a couple of hours.

  2. Well sadly if the patient did not have insurance they get charged the whole amount. It makes no sense that insurance companies get a break on charges but patients without insurance (cash patients) get charged the whole amount.

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  4. The cost of surgery in this day and age is certainly a big consideration. Do you happen to have a life insurance policy? I think it's definitely something that everyone should be thinking about. Marchionne is the leading provider of Burlington MA life insurance, so I would suggest taking a look at their offerings and receiving a free consultation.

  5. wow, that is a hell lot of money. i wonder how much that surgeon makes per month