By Consumers For Quality Care, on December 19, 2018
When Sarah Witter fell skiing and could not get back up, she knew that she had suffered a serious fall. What she did not know – or even anticipate – was the aftermath that the fall would create, Kaiser Health News reports. At the hospital, x-rays showed that Witter had broken two major bones in her left leg and needed surgery.
A surgeon at Rutland Regional Medical Center screwed two gleaming metal plates onto the bones to stabilize them. “I was very pleased with how things came together,” the doctor wrote in his operation notes.
By late spring, Witter could tell that something was wrong. She returned to the doctor’s office, where she learned that the plate in her leg had broken. The surgeon replaced the broken plate with a larger one. Witter was nervous that she had done something to cause the plate to break, although she was following her doctor’s post-op instructions. Her doctor assured her that the broken plate was not her fault.
Witter’s bill for the surgeries brought a whole new set of issues. The bill totaled nearly $100,000 including emergency services, physical therapy, and hospital care. Roughly $53,000 of the bill was for the initial surgery, with an additional $43,000 for the subsequent surgery to replace the broken plate. Witter’s insurer, Aetna, paid $76,783, leaving her responsible for $18,422. Much of the portion that Witter ended up paying is what is known as a “balance bill.” When Aetna considered some of the bills excessive and refused to pay them, Rutland Regional passed the charges along to Witter.
Dr. James Rickert, president of the Society for Patient Centered Orthopedics, says that when the surgery is performed correctly and the patient follows the post-op plan honestly, the plausible explanation for a plate failure is a product defect. Unfortunately, warranties covering surgeries or medical devices are uncommon.
When devices or treatments fail and need to be replaced or redone, patients (and their insurers) are expected to foot the bill. That may be understandable if a first course of antibiotics doesn’t clear a bronchitis, requiring a second drug. But it is more problematic — and far more expensive — when a piece of surgical hardware fails, whether it’s a pacemaker, a hip that dislocates in the days after surgery or a fractured metal plate.
Vice president for quality and patient safety policy at the American Hospital Association, Nancy Foster, says that hospitals will often not charge for a second surgery if they believe they are responsible for its need. Rutland Region refused to discuss its policy regarding charging a patient for a second surgery, KHN reports.
Hospitals do not consider it their responsibility if a medical device failure is the problem, Foster said. But manufacturers are reluctant to take the blame for an unsuccessful surgery.
The medical device manufacturers’ trade group, AdvaMed, said that in some circumstances medical device companies would provide a replacement part. Other times, they won’t. Medical devices are not cheap for consumers. Witter was billed $9,700 for the first set of plates and more than $12,800 for the second.
“The biggest annoyance with this whole thing, even though it took eight months out of my life, is I hate to pay for it again, and the doctor clearly said it wasn’t anything I did,” she said.