[Andy7894]

Hello All,
I was wondering if someone with some medical manufacturing expertise could provide some insight in to the costs of bone screw manufacturing? The reason I ask is because my daughter recently had outpatient surgery for her broken ankle.
The hospital billed my insurance $70,000 for this outpatient surgery. Naturally I was curious about what was driving this insane cost for only a few hours of service. I immediately demanded the detailed bill from the hospital and found that $30,000 of the cost was attributed to medical implants. Each bone screw was charged at $239 dollars per screw. Also a pair of bone plates with a $4000 dollar price tag
After reviewing the design of the screws I would guesstimate maybe $10 in material, machining and finishing, and maybe a $30 final price to the hospital when you take into account regulation and cost of sales.

So am I missing something? or am I just being blatantly ripped off by the hospital?

Thanks for any insight you may have

[Jim Dawson]

........ am I just being blatantly ripped off by the hospital?........

Yup. Just like $10 aspirin. But maybe add a bit more for FDA approval, maybe your $30 figure is a bit low, more like $35 I think

[RCaffin]

am I just being blatantly ripped off by the hospital?
Not just by the hospital, but by the entire system.
I am guessing of course, but the screws are probably titanium self-tappers, 1.5 mm x 10 mm, or thereabouts. They might be SS - maybe. I leave it to you to figure out what 1,000 of those will cost the mfr. Steam sterilise and package.

The real problem is the American medical system in its entirety. I recently had an ambulance ride, several hours of micro-surgery on my thumb with a team of several doctors working on it, A plate with about 7 screws and 2 wires, several days in Recovery ward, then about 5 return visits for dressings and monitoring. It was all successful, given where it started from. Now, Australia has a Medicare system (it comes out of our taxes). So total cost to me for all this?
$0

America is of course the most advanced country in the world.

Cheers
Roger

[Fastest1]

am I just being blatantly ripped off by the hospital?
Not just by the hospital, but by the entire system.
I am guessing of course, but the screws are probably titanium self-tappers, 1.5 mm x 10 mm, or thereabouts. They might be SS - maybe. I leave it to you to figure out what 1,000 of those will cost the mfr. Steam sterilise and package.

The real problem is the American medical system in its entirety. I recently had an ambulance ride, several hours of micro-surgery on my thumb with a team of several doctors working on it, A plate with about 7 screws and 2 wires, several days in Recovery ward, then about 5 return visits for dressings and monitoring. It was all successful, given where it started from. Now, Australia has a Medicare system (it comes out of our taxes). So total cost to me for all this?
$0

America is of course the most advanced country in the world.

Cheers
Roger

Who pays your taxes? Nothing is free.


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[Andy7894]

No nothing is free, but should we have to go to court every time we get a medical bill, and pay 12k a year premium to company's that do
nothing to control cost? The worst part of the bill was $173 a minute just to be in the OR. Median wage in the US is .50 cents a min
Someone is cutting a fat hog off all this

And the screws weren't even titanium they were SS

[ger21]

I read an article the other day where a hospital billed a patient $27,000 for a stent that other hospitals charge $1000 for.

or am I just being blatantly ripped off by the hospital?

Not just the hospital, but the whole system. Why is it acceptable for insurance companies to get 30% of what Americans pay for healthcare?

Who pays your taxes? Nothing is free.

No,but it's a heck of a lot cheaper than our way...

[RCaffin]

I hesitated about replying any further, but maybe.
The difference is that NO-ONE in Australia hesitates about going to a GP or to a hospital for medical treatment.

I have no idea how they handle purely cosmetic surgery - I imagine you might have to pay to get your lips Botox'd.

Cheers
Roger

[mactec54]

No nothing is free, but should we have to go to court every time we get a medical bill, and pay 12k a year premium to company's that do
nothing to control cost? The worst part of the bill was $173 a minute just to be in the OR. Median wage in the US is .50 cents a min
Someone is cutting a fat hog off all this

And the screws weren't even titanium they were SS

Any hospital visit are expensive even in countries that have socialized medicine Rodger is an example of that, there is a cost the tax payer is paying for it

Any type implant's are expensive but yours does sound way more than it should of been, Hospitals do have huge over heads which is where most of the problems are

The screws should of been titanium, just the coatings on the screws plates Etc cost way more than what other post here are saying what the screw should cost, as does the manufacturing, if the screws are SS then expect to have another surgery to have them removed, I have made many different types of these implant's bone screws rod and plates and every part of them costs a lot to manufacture

With using SS screws the patient can not have any MRI's done, and they normally are removed after 2 years if they don't get a rejection before hand, SS screws are a lot cheaper then Titanium

The equipment that is needed to use Bone screws is very expensive Drills Taps drivers not all Bone screws are self tapping

[mactec54]

Yup. Just like $10 aspirin. But maybe add a bit more for FDA approval, maybe your $30 figure is a bit low, more like $35 I think

You can't get the coatings done for that price the coating alone can be as much as $75 a piece depending on what the requirement's are for the screw

[mactec54]

No,but it's a heck of a lot cheaper than our way...

Yes but only for the person in need, everyone pays no matter where you are, to get the best care even where they socialized medicine you still want to have some kind of insurance

[Andy7894]

Since you have experience with medical manufacturing. What would you think this screw should cost

https://www.arthrex.com/products/AR-8827L-16

[mactec54]

Since you have experience with medical manufacturing. What would you think this screw should cost

https://www.arthrex.com/products/AR-8827L-16

That screw would have a special drill and tap if you see the thread at the top that works as a lock to hold the screw in place

It would depend on the manufacture, it's not really the cost of just the screw it's everything else that is needed by the doctor to do the job the price you where charged is close to double of what I guess that manufactured screw would cost, they can't just buy ( 1 ) screw though, they have a kit and may have as many as 3 or more kits to do one job, just like if you have ever brought a cellphone replacement screen or battery it comes with all the need tools to do the job these medical kits are expensive

It must of been a complicated break for them to even have to use any screws and plates, but I agree with you the cost of $70,000 was more than it should of been

[Andy7894]

They itemized out the a plate, hook, various drill bits, and screws totaling around 30k. No taps

Both plate, and hook were $3600 each. I'm wondering if they billed a kit price and then itemized out every item in it to increase the bill.

[mactec54]

They itemized out the a plate, hook, various drill bits, and screws totaling around 30k. No taps

Both plate, and hook were $3600 each. I'm wondering if they billed a kit price and then itemized out every item in it to increase the bill.

You would of paid for every package they opened no matter what they used out of that package, nothing can be used again once opened from the sterile packaging

They over charged by at least 50% by my take on this, did your insurance cover this

[Andy7894]

Yeah insurance covered most of it. The real kicker is I researched the entire bill on fair health consumer,
Almost all of the medical charges were marked up between 400 to 800%. If Cigna was really working for me they would have caught that.

The reason I asked about the bone screw is because Arthrex won't share pricing, and you can't find that information on fair health consumer or health care blue book

[RCaffin]

To them that have ... invoices shall be delivered.

Cheers
Roger

[dharmic]

A small anecdote - the complexity of and expense incurred from dealing with the TGA (Australia's equivalent of the FDA) for therapeutic equipment meant, if we hadn't found a loophole, gear we were making on one job would have ended up costing ten times - no exaggeration, ten times - as much by the time it hit the end user. And that was for therapeutic equipment. Implants were a whole different category, huge step up in complexity.

So a titanium screw costs $35 to make with its special thread etc, then another $35 to coat. Then double it to cover handling, packaging and QA tracking costs to make sure it's going to be clean and perform as expected (no duds allowed). Now add to that a million bucks in R&D to get the pattern, divided by the number of screws they sell of just that particular thread design. Now add the cost of convincing the FDA that any competent person can shove this thing into another person's body without damaging them further - which is a huge, labyrinthine process that takes years of testing and paperwork and labour.

I'd not be surprised to see that $35 screw end up costing $1500-$2000 by the time it ended up in its sterile wrap in the kidney dish in the surgery. And probably double that again by the time it ended up in its flesh bag at the end of that surgery. And, in Australia, if you went in for that procedure as a private patient via insurance instead of via Medicare (where the procedure prices are kinda fixed) and the hospital knew they could get away with it, double it again.

[RCaffin]

I agree: the final cost of a titanium screw or bone plate is probably 99% paper work. Such is life.

in Australia, if you went in for that procedure as a private patient via insurance instead of via Medicare (where the procedure prices are kinda fixed)
I had occasion to ask recently at a major teaching hospital what was the difference between being a public patient (anyone, zero extra cost) or a private patient. The reply was illuminating: after a thoughtful pause the person said that the use of the TV over the bed was free for the latter.

But what I do know is that if you go into an Australian hospital through the ER doors, the last thing the medics want to know is whether you have private insurance. They just don't care. All they care about is YOU, and how to deal with your problem - fast. And they don't count the screws.

Cheers
Roger

[dharmic]

Almost. If you're crashing through the ER doors on a gurney from an amber-lamps, then yeah, no questions. But if you walk into an ED under your own steam, private/public is about the third question they ask (after 'what's your name' and 'what's your medicare number?').

Still, it's nowhere near the insanity in the US. Just paid 2000 Australian Pesos for middle-of-the-road annual private this morning, which I thought was pretty exxy considering how much you get for not having any insurance at all here and I wonder why you'd bother (obviously for elective surgery and my free pair of specs each year, but otherwise?).

Then I thought of the good folks in the US of A paying their $10k a year plus or getting turned away from EDs.

Yikes!

[RCaffin]

A very timely explanation of what is going on:
https://www.nytimes.com/2018/09/05/o...insurance.html
Basically, it's the result of an unfettered capitalist system helped by subservient pollies.
This is NOT how it works in Oz.

Cheers
Roger