What’s the “Cost” of a Mesh Implant: Are Mesh Victims Re-Victimized?
October 8, 2014
Implant codes are attached to a patient’s operating room report/chart and submitted to the insurance company and how the hospital and the surgeon gets paid.
CMS (Medicare/Medicaid) determines the payment schedule (usually the lowest price paid to the hospital and surgeon for the implant). Private Insurance payments are usually (90% of the time higher than Medicare/Medicaid) payments. An implant is unique in that it’s paid back (depending on the contract) 4-6 times the cost of the implant at 80%. Confused yet?
Here’s an example:
We need to be addressing the entire problem which includes the FDA, the device makers, the private insurance carriers and the hospitals; but you know who shouldn’t have to keep paying for a broken system? The Victims. #CleanUpYourMeshFDA
Pastor Jim
Jeezus. This goes beyond inhumane and immoral. And the question becomes, then, why isn’t it illegal? Crooked docs, crooked corporations and crooked politicians conspire around one thing: M-O-N-E-Y.
Melayna Lokosky
There are good and bad within all it’s just weeding out the bad and keeping the good. To clarify the surgeons are paid on the procedure (not the device) and the hospital are paid on both in this case because it’s an implant. Not all disposables are reimbursed at that rate implants are a unique exception. Not a justification just a clarification.
Janet
Surgeons generally love the idea of mesh implants, because they can do so many of them in a day, whereas the traditional “burch” procedure is more time consuming and takes a more experienced surgeon to perform. There’s recent research that proves that a polypropylene mesh implant is not any stronger nor does it last any longer than the traditional method. And none of the complications mesh causes would happen in the traditional procedure – complications such as mesh erosion, extrusion, infection, autoimmune disease from the chemicals in the plastic, etc etc etc. There’s really no reason for surgeons to continue to use mesh to treat POP or SUI – other options exist that are just as viable and that eliminate many of the very severe complications. It’s all about money at this point – sad, but true.
Melayna Lokosky
It’s interesting you say that Janet about the “burch,” I was speaking to a retired GYN today who told me that only skilled surgeons could do them and the mesh products opened the door to less skilled surgeons doing procedures who should never have been doing them. He also said that with the “burch” results were at about 80% (not the 97% Ethicon TVT-O boasts on their site) but not the complications either. He also mentioned that perhaps C-sections (I know that doesn’t help many of you now-but future generations) may be a more realistic way to go (and of course there are risks there as well). I think that’s great advice to women who are experiencing the problem Janet-for women to seek out a surgeon who does the “burch” and not one who opts for mesh first. This doctor I was speaking with today said mesh was just becoming popular when he was getting ready to retire but and he always gave his patients the options between the two. Now we know what we know about mesh-and I’d say there is only one option-finding a surgeon who is capable and opts for traditional methods (that’s really the “gold standard”).
Melayna Lokosky
It’s interesting you say that Janet about the “burch,” I was speaking to a retired GYN today who told me that only skilled surgeons could do them and the mesh products opened the door to less skilled surgeons doing procedures who should never have been doing them. He also said that with the “burch” results were at about 80% (not the 97% Ethicon TVT-O boasts on their site) but not the complications either. He also mentioned that perhaps C-sections (I know that doesn’t help many of you now-but future generations) may be a more realistic way to go (and of course there are risks there as well). I think that’s great advice to women who are experiencing the problem Janet-for women to seek out a surgeon who does the “burch” and not one who opts for mesh first. This doctor I was speaking with today said mesh was just becoming popular when he was getting ready to retire but and he always gave his patients the options between the two. Now we know what we know about mesh-and I’d say there is only one option-one who is capable and opts for traditional methods (that’s really the “gold standard”).
Lana Keeton
Court testimony by J&J executives in Linda Gross trial in Feb 2013 in New Jersey said complication rate was 33% for Gynecare Prolift mesh product and they put it on the market anyway. Barbarians.
Sales strategy was, no skills needed which emboldened surgeons who would not normally consider doing the surgeries. “Instructions for Use” only state how to put it in, not how to repair the defect. Compare it to a flat tar roof that is leaking. They just pour on the tar and pray the leak stops.
Also when the surgeon is implanting the mesh, he/she might actually be cutting through the defect being “repaired”.
That’s why J&J took the Prolift off the market in 2012 instead of doing the mandated 522 studies. J&J/Ethicon knew they would never prove safetyyour or efficacy.
No doctor. No hospital. No one ever ask/verified the Gynecare Prolift had been cleared by the FDA between 2005 & 2008. It was not. So thousands and thousands were implanted with the Prolift mesh with a 33% complication rate that had never been cleared for sale by the FDA. No one is protecting women!
Aaron Leigh
Great slides Melayna – simple numbers, makes perfect sense. I’m just so distraught that it’s all true.
Mandy
True. The surgeons do get paid by the procedure. However, the mesh cuts the time and allows surgeons to do many more procedures in a day. This is especially true with the TVT mid-urethral sling that is reported by AUGS surgeons as a “22-minute procedure”. The surgery to harvest and implant a native tissue fascia sling is 1.5 to 2 hours. A surgeon can earn 3-5 times as much using mesh. So there is a payoff. Many med schools (in their infinite wisdom) have reduced or eliminated training in the pubovaginal fascial sling procedure. Not smart. Teach the native tissue procedures. Manufacturers of devices are more than willing to train surgeons in the procedures using their devices.
Melayna Lokosky
Mandy you bring up a great point: new devices to advance surgery are often thought to make the average surgeon a better surgeon (a device industry held belief example: http://www.medtechy.com/boards/companies/intuitive-surgical/1219). Several of the hernia mesh cases I’ve seen were used in conjunction with the Da Vinci robot which added exponentially more time to any procedure. Yes, mesh can allow for surgeons to possibly do more procedures per day; but, I’ve seen way too many hospitals worried about the clock (amount of time per procedure) rushing surgeons because they need the room or the procedure time is cutting into their profit. That’s certainly part of the problem.
Just as everyone is not meant to play in the NFL or be a supermodel not every surgeon is meant to do the most difficult procedures (harvesting and implanting native tissue creating a fascia sling.) You bring up another great point that I wasn’t aware of-medical schools reducing or eliminating training for the pubovaginal fascial sling procedure. Thank you for giving the readers of the site more information to help make better decisions regarding their health. I personally would not go to a surgeon who wasn’t trained on traditional as well as the new techniques. The extremes on either end (only does traditional or only does new techniques) are not who I’d personally trust with my body.
Thank you Mandy for reading and actively advancing the conversation to help patients make better decisions regarding their healthcare.-Melayna