Saturday, July 28, 2018

$2,200 for a Screwdriver, and the Military Didn’t Buy It


Well, it has been an interesting summer, to say the least. On Memorial Day, I was playing basketball and injured my foot. Another player stepped on it while knocking me over. The combination of his weight on my foot and my body falling sideways created enough torque to cause what I will fondly call the “Taysom Hill injury.” The more technical term is a Lisfranc injury. According to the internet, “The Lisfranc joint is the point at which the metatarsal bones (long bones that lead up to the toes) and the tarsal bones (bones in the arch) connect. The Lisfranc ligament is a tough band of tissue that joins two of these bones. This is important for maintaining proper alignment and strength of the joint.”
There are all sorts of Lisfranc injuries, most caused by car accidents. Others are sports-related, some from contact, like mine, while others, like Taysom’s, are noncontact injuries. The severity can range from sprains to fractures and dislocations. In my case, the first two metatarsals were displaced, and the cuneiform bone was cracked. So it was pretty serious. It took a couple of weeks for me to find the right doctors and for them figure out how messed up my foot was, but on June 20 I had surgery. I now have a plate and six screws to hold all the pieces together. I was instructed to not put any weight on the foot for seven or eight weeks. Being both active and stubborn, I wasn’t about to spend almost two months on a scooter and crutches. So I bought a “pirate crutch” (officially named the iWalk 2.0, see photo). It’s not good for long distances, but for getting around the house or office (or even walking the dog), it’s great. Whenever I go to a store, I get comments and questions. Most people haven’t seen a contraption like this, but they think it’s cool. I do too, but I’m getting rather tired of it.

I’m five and a half weeks into the no-weight portion of my recovery and will get an x-ray next week to see how things are mending. On the surface, things seem to be progressing nicely, but I know I’m in for a long stretch of no basketball. The surgeon told me it would probably be a year before the foot feels “normal” again.
This encounter with the American health-care system leaves me both amazed and baffled. The knowledge and technology we have is impressive, and so is our messed-up, profit-oriented medical industry. I use that word intentionally, because it really is an industry. It’s not a sector of society aimed at providing a public good, like, say, education (although some would like to see education become an industry too). This week I received the itemized bill from Intermountain Health Care for my morning in the operating room. The doctor’s bill as actually quite reasonable, but let me share with you a few of the highlights from the hospital’s “Itemized Statement of Services.” The prices I will list are what IHC billed my insurance. What the insurance paid was, of course, much lower, since the hospital was in their network.
I was surprised, when I received the initial summary from the insurance company that the biggest item was “medical supplies.” The hospital billed the insurance about $25,460 for these medical supplies. The operating room, by contrast, was a mere $7,547.40. The total charges amounted to $35,542.13, 70 percent of which was for medical supplies. I wondered what on earth could be that expensive. Well, this week I found out.
The plate (Plate Ankle Lapidus CP 0 Offset) was billed at $5,332.32. I don’t know why the name includes “ankle,” because my ankle is fine, thank you. The plate is on my instep, right where you’d expect it, holding the metatarsals in place. One of the six screws was billed at $2,852.28. I have to wonder about the twenty-eight cents. Really? They couldn’t round it to $2,850? Three other screws were $907.39 each. The other two were only $653.86. The Home Depot apparently doesn’t carry these screws. The hospital also billed for a pin, three reamers, a K-wire, and other odds and ends. One of the reamers was billed at $2,219.32. And some sort of unthreaded guidewire came in at $2,935.68. I’d hate to see what a threaded guidewire costs. But the item on this itemized statement that has me scratching my head is the “Bit Screwdriver T8 AO Quick Coup.” Yes, my insurance got billed for a $2,201.76 screwdriver. I can’t help but wonder why. Don’t they do surgeries like this rather frequently? Don’t they have a screwdriver in the drawer from the last surgery like mine? Couldn’t they sterilize it and reuse it? If not, then I want the screwdriver from my surgery. I mean, they obviously don’t need it. I think I’ll ask for it when I see the doctor next week. I’m sure he’ll look at me like I’m nuts, but hey, that screwdriver is a testament to the insanity of the American health-care system. I’d bet even the military doesn’t pay that much for a screwdriver. And even if they did, they’d probably use it at least twice.
Oh, I almost forgot. By comparison, the iWalk 2.0, which can be purchased on Amazon, cost me $149, and the insurance wouldn’t cover it. Maybe if it had cost $10,000, they would have.