The Cost of Cutting

July 15, 2014
Surgeon Ruggieri (Confessionsof a Surgeon: The Good, the Bad, and the Complicated...Life Behind the O.R. Doors,2012) tutors readers on the economic forces that make the surgical theatertick.Over the past 25 years, the author has seen much change inthe practice of medicine: large strides in surgical procedures and tools andmoney's ever greater sphere of influence. Ruggieri is a fine storyteller, whichis a good thing, for although he peppers the book with dramatic anecdotes fromhis practice, his real exploration focuses on the financial side of the medicalequation. Surgery is big business, the very lifeblood of hospitals and, as theauthor readily acknowledges, the surgeon's as well. However, as various marketforces come into play, the surgeon's income is decreasing. Fifty millionoperations are performed annually in the United States, which raises thequestion of volume over quality. More to Ruggieri's concern, however, "all thismoney carries with it power and influence. When it comes to medical decisionmaking, power and influence are not what you want motivating your surgeon, yourhospital, or your insurance company." The introduction of diagnostic tools, like CAT and MRI scans, offers new medical information, often known as"incidental findings," which contributes to the $150 billion in unnecessary surgicalfees. Hospitals feel compelled to introduce the latest gadgetry, withoutdemonstrated superiority, to appear market-friendly. Too many pressures blurthe line between operating for love or money, though Ruggieri sees some obvioussteps to be taken: Cut payments for poor-quality outcomes, cut reimbursementfor elective surgery, and pay less for operations with dubious benefits. Theauthor has much to say about the world of bullying in medicine-both patientsand surgeons on the receiving end-as well as cautionary material on howproviders will be reacting to the Affordable Care Act.Top-shelf instruction on the mechanics of the medicaleconomy.

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September 1, 2014
In his previous book, Confessions of a Surgeon (2012), Ruggieri effectively employed humor, angst, and honesty to divulge what a professional life in the operating room is really like. This time around, he grapples with the money side of modern medicine. Though this is a less visceral and more strictly factual work, the information is solid.More than 50 million operations are performed in the U.S. every year. The surgical treatment of cardiovascular disease, cancer, and obesity especially generates huge revenue for hospitals and doctors. Some of the topics addressed are robotic surgery, cherry-picking patients for profit or good outcomes, incidental findings on imaging tests, and physicians who are not plastic surgeons doing cosmetic surgery. Turf wars between hospitals, the big business of medical-surgical devices, and hospital pricing also receive attention along with the author's wrath. A tidy explanation of the Affordable Care Act is included. Ruggieri does not apologize for his hefty income as a busy surgeon. Instead he rhetorically asks, What is a good surgeon worth? And the answer that comes to mind is priceless. (Reprinted with permission of Booklist, copyright 2014, American Library Association.)