"Drive-by doctoring" drives up hospital costs

Specialty surgeons insert themselves into medical procedures--often without the knowledge of the patient--driving up costs considerably, the New York Times reported.

In one case, a spinal surgeon who assisted in a fusion procedure after the patient was anesthetized billed the patient $117,000 for out-of-network charges, the Times reported. That was nearly 20 times what the patient's primary surgeon received. A neurosurgical nurse or physician assistant can often perform the assistant's work. 

"I had no choice and no negotiating power," the patient, Peter Drier, told the Times. The surgeon, Harrison Mu, apparently entered the procedure as an assistant after an anesthesiologist placed Drier under general anesthesia.

Another patient, Patricia Kaufman, was charged $250,000 by two plastic surgeons for suturing a surgical wound--a procedure that medical residents previously performed.

Such practices are known colloquially as "drive-by doctoring," used by some medical specialists to increase their revenues. It is apparently fairly prevalent among spinal surgeons, who compete with orthopedic specialists for business and have seen their incomes go down in recent years, although their salaries still approach $600,000 on average.

"The idea of having an assistant in the OR has become an opportunity to make up for surgical fees that have been slashed," said Abeel A. Mangi, M.D., a professor of cardiac surgery at Yale, who told the Times the practice was commonplace.

Hospitals also pack in extra charges during surgery. Sutter Health recently settled charges it double-billed patients for anesthesia services.

However, the use of stealth medical specialists can extend well beyond the use of assistant surgeons. It is not unheard of for physical therapists (who bill at their professional rates) to walk patients to their bathrooms, according to the Times. Drier received a bill for $679 for occupational therapy charges regarding a device intended to help him put on socks that he never used.

"The notion is you can make end runs around price controls by increasing the number of things you do and bill for," said Darshak Sanghavi, M.D., a health policy expert who most recently was affiliated with the the Brookings Institution.

To learn more:
- read the Times article