Why does it take so long for surgery?

Insurance Bureaucracy Lengthening Physician Workdays

Adventures in Prior Authorization – NY Times

Two recent articles outline the growing difficulty in communications between insurance companies and physicians.  Many patients ask me why they can’t have surgery tomorrow.  It is a difficult position as a specialist in that patients come in today and want surgery tomorrow.  While we may have just met for the first time today, they have been dealing with their pain and issues for months or years.  The decision was a long time in the making, and once the decision is made, they are ready.  This is understandable to all of us involved in the care of a patient, but not necessarily to their insurance company.  These articles outline the difficulties that primary care physicians have in getting medications approved.  We have similar, if not worse, issues with getting surgery approved.  Some highlights from the first article:

  • The administrator for Medicare and Medicaid estimated that needless administrative complexity led to $107-389 billion in wasteful spending in 2011
  • 7% of all claims are paid incorrectly by insurance companies, costing providers $43 billion
  • The average physician spends 3 weeks per year dealing with insurance companies (and therefore not taking care of patients)
  • 23 weeks of nursing staff time and 44 weeks of clerical staff time are spent on insurance claims
  • Physicians spend 45% of their workday outside of a patient’s room
  • In 2012, there was a 23% increase in claims requiring preauthorization, adding $728 million in administrative costs (while at the same time the reimbursement to physicians was decreased)

The only people that the insurance companies listen to are (1) federal agencies, (2) state agencies, and (3) their insured patients.  We have found that in many instances the patients are able to get approval and authorization much faster or more easily than we are due to the insurance company’s interest in seeing their insured patients be happy.  Nearly every procedure that requires an overnight stay in spine surgery requires preauthorization.  If you or a loved one is preparing for surgery, encourage them to contact their insurance company to help get the authorization expedited!  We love taking care of our patients and enjoy seeing them overcome their illnesses and disabilities while getting back to the lives they want to live!

Beatriz BerryBeatriz Berry
16:04 01 Dec 23
Amazing, caring, staff. They are good at what they do, from procedures to customer service this where you want to go. They are truly a blessing and I highly recommend them!
The MillersThe Millers
18:02 08 Nov 23
Dr Bruggeman and the entire Team are a blessing to our community. The folks at Texas Spine Care Center genuinely care about people! I am 3 months past my back surgery, I am 100% pain free. I have not felt this good for over 20 years!!
Mari MoralesMari Morales
16:33 25 Oct 23
Dr Bruggemann & his Amazing staff treated me with genuine care, respect & in a very Profesional manner. He allowed me to explain my concerns and provided me the best treatment & options for my needs. Truly gave me a sense of “Hope.” If I ever need orthopedic services in the future, HE is my Dr. Of choice. Thank you & God bless.
Leo H.Leo H.
16:07 29 Sep 23
Always a pleasure visiting Dr. Bruggeman’s office. The staff and facility is amazing. Kim Ruiz did such an amazing job of explaining everything in detail with me and she was very patient with me while I asked my questions. I felt safe and comfortable with the course or treatment recommended.
Marie MMarie M
15:01 06 Sep 23
There were friendly and helpful staff. Also, it was an excellent detailed explanation from the nurse practitioners and this doctor, Dr. Bruggeman. They let you decide what you would like to do.
Dianne AldreteDianne Aldrete
18:16 11 Aug 23
This is my 1st time back in 3yrsThe office is beautiful, comfortable and the staff is great as always. The Doctors are absolutely wonderful. You matter there. The care is and has been the very best.
Caliyah ClarkCaliyah Clark
03:52 27 Jul 23
I went to see Dr.Bruggeman for a cervical consultation and it was a very pleasant experience. The office is nicely decorated and organized. Front desk staff was welcoming and polite. Dr.Bruggeman was thorough and very kind! I like the fact that everything was electronic, no need to fill out papers, everything was on IPads. I would definitely recommend to anyone!
Kristi StuckeyKristi Stuckey
16:03 20 Jul 23
The staff at Texas Spine Care Center were wonderful from start to finish. This being my first visit, I arrived early and was helped promptly. The whole process was efficient and pleasant. The atmosphere is calming, almost spa-like. Excellent first impression.
B865123B865123
23:30 19 Jul 23
Has a great experience with Dr Bruggerman. I was referred to him with the thought that I would need back surgery. Dr Bruggerman and his staff talked through options with me which included a chiropractor. After 6-weeks with the chiropractor I no longer need surgery. I’ll still need to continue PT but so much better than the alternative. So nice to know it’s not all about the money but the patients overall well being!
S BryantS Bryant
04:26 11 Jul 23
Oh my goodness, I don’t even know where to start! I first went into this office after having a failed microdiscectomy done by different surgeon in January of this year (2023). I was so scared that I was going to be treated the same as I was at the other center, must jump through hoops for months and months to get a solid answer. Miss Debbie and all medical staff were so kind, even though I had my 3 year old autistic kiddo with me. I saw Yvonne first (who is THE sweetest ❤️), and she immediately gave me hope after viewing all my images at my appointment, I left in happy tears. All of my fear, anxiety, and depression was lifted as I left the building, as I thought I was going to live the rest of my life in pain (at 38). Dr. Bruggeman saw me a few days preop, and explained everything very clearly, especially the risks associated with a second surgery. The following week he performed my surgery flawlessly…. it’s probably a bit too graphic to post photos, but you would not believe the difference in the incision from my first surgeon in Jan to Dr. B’s surgery in June on my spine. It was half the size, and I swear to you, besides the day of surgery, I needed ZERO post op pain medication. It was incredible, I was ready to go back to work at my desk job immediately.Just do research… Dr. Bruggeman is hands down the best spine surgeon in San Antonio 😊
Winter ZamoraWinter Zamora
22:56 23 Jun 23
Felt supported and heard on each visit I had here. They are very prompt and provide excellent knowledge and resources for their patients. PA Ruiz was attentive and made I left with all questions addressed. Miss Debbie at the front desk was incredibly sweet and helpful when I first contacted this office and made me feel warm and welcome when ever I interacted with her in office.
I saw Dr Bode today. Great guy! Listens and looks at you when he is speaking to you. Includes you and asks how you feel about it. Would def recommend.
Nick RicketsonNick Ricketson
18:02 10 May 23
Amazing group of people. All the ladies are friendly and you can tell they care. My dr. She was straight forward and polite I enjoy having her as my dr. Any vets out there needing your back taken care of go here you will not be disappointed.
Russell EndsleyRussell Endsley
00:31 23 Apr 23
I was rolled into surgery in the worst pain of my life and a day later – I skipped out of the hospital pain free. Nearly four months later – I feel better than I have in 20 years. Can’t even see the surgical scar and still pain free. Dr. Bruggeman is a wizard in the operating room and his magic wand made my problems disappear! Only surgeon I would ever recommend for spine surgery.
El.koolinaEl.koolina
16:10 05 Apr 23
I had back surgery in 2015 performed by Dr Bruggeman. I can honestly say he changed my life. After an ALIF on my L4-5 spinal fusion I was finally able to get back better mobility. Every nurse and doctor here are outstanding!
Kim BKim B
16:04 07 Feb 23
Dr Bruggerman operated on my neck last year and I can move it, I no longer am staring at the ground 24/7, I can turn it, twist it and look at the sky! I believe he uses magic in his surgeries. Kim is wonderful, kind and understanding of what I’m going through with my pain. She helps me understand what can be done to make my back better and their team has already improved my quality of life. They are now working on making my lower back pain better.Let’s not forget the office staff, they are all so nice and welcoming and clarify everything I need to do for my upcoming procedures and appointments.
Denise De La GarzaDenise De La Garza
17:01 02 Feb 23
Just left Dr. Bruggemans office and I would absolutely recommend this Dr and his staff. His office is super nice and very clean, they were all very sweet and make you feel so comfortable as soon as you walk in! Dr. Burggeman and Mrs. Kim Ruiz were amazing at explaining what was going on with me in terms I could understand which was very helpful!!! Thank you all so much for everything!!!
Ann PieniazekAnn Pieniazek
22:51 19 Jan 23
This was my 4th surgery with Dr Bruggeman – 2 cervical & 2 lumbar. I would go anyone else. Dr.B, his assistants Kimberly & Yvonne and the rest of the staff are the best! Knowledgable, great at keeping on schedule and friendly. I have had full confidence having them treat me and know that they are truly concerned about treating my issues. Also, I’m super impressed with their Pre-op Center that handles the exam & labs for your upcoming surgery. They also set post-op TeleMed calls after surgery to check on you, answering questions, prescribing meds if needed and the personal favorite just to see how your are. All around they are concerned with your well-being from helping you from the time you walk thru their doors, treatment plans, the mental ups & downs with diagnosis, pain management, Pre-op/Post-op, etc. TexasSpine Care is best well-rounded practice! You are in great hands from day one, when you make your appointment with Debbie for that initial visit, with an excellent surgeon, staff & a complete practice that will help you get thru this difficult time.
369 432369 432
16:55 13 Jan 23
This was my first visit to the Texas Spine Care Clinic and I’m very impressed.The staff is very kind and attentive. I had a near zero wait time and was treated as if I was their only patient in the office and their attention to every detail was very assuring.I sincerely look forward to my follow-up visit as I know that I am in great hands.Thank you so much.
Denise GarzaDenise Garza
19:24 08 Jan 23
This was my 1st visit. I’ve never been more impressed with a medical practice. The entire staff was very friendly and professional. The medical staff made me feel heard. Very clean and well organized I felt a peace in trusting them with my problems.
Robert HarrisRobert Harris
16:35 10 Nov 22
From the time I entered the reception zone until the time I left their office, I was VERY impressed by the congenial, caring and very professional atmosphere and the personnel that made it so!I was the VP of Operations for a large cardiology practice and I can say from experience that Dr. Bruggeman and his entire staff are exceptional! One of the BEST practices I’ve ever stepped foot in for sure and I am left wondering how you were able to recruit Angels to work for you?THANK YOU Dr. Bruggeman for the peace and assurance that you imparted to me and kudos to you and all of your precious staff members for working to go way beyond being good to being totally exceptional!
Montgomery StewartMontgomery Stewart
15:42 21 Oct 22
Dr. Bergerman is very friendly attentive and is very prompt in getting you the best treatment needed for your complaints. His staff is very helpful and professional. The front desk is is exceptional and helpful. At this office I don’t feel like some other health care providers where everything is just professional and once you pay you get treated and leave. You are free to ask questions and if you are not sure they’re never too busy to help. I would recommend others to this off.
Excellent care, the level of care and expertise are commendable. Complete and precise explanation of what is happening and the potential plan of care was discussed at length. We never felt rushed and our questions were answered with care and compassion. Highly recommend
Admin UserAdmin User
21:18 01 Aug 22
Fantastic. Very efficient and friendly office. Very competent at providing services and scheduling. Dr. Bruggeman did two surgeries on me. Both came out absolutely fantastic! I could not recommend him more. Dr. Bruggeman does not need the practice at surgery. If he says you need surgery, you really should listen to him.
Cynthia LockeCynthia Locke
17:46 12 Jul 22
Absolutely the best in SA! Can never thank Dr.Bruggeman and his extraordinary staff enough, for giving me the absolute best care and treatment before and after my disc replacement. Wouldn’t trust anyone but them for any spinal surgeries. So happy with my results!
Army VeteranArmy Veteran
18:49 21 Jun 22
Went to Texas Spine Care Center for the first time today, and my experience was AWESOME! From the two ladies at the front office counter who greats you with a smile and professionalism. The office is very upscale, clean and very inviting. The wait time was short to be called back to see the care representative. The exam room was clean, bright and upscale. I was seen by Dr. Yvonne Paredes who was very professional, and provided in detail information about my medical concerns. She explained what her recommendations would be to bring me some relief from my condition and pain. I highly recommend giving TSCC an experience, you will definitely enjoy it.James W
Gloria FulkersonGloria Fulkerson
18:04 14 Jun 22
I have had two surgeries performed by Dr. Bruggerman since Feb. 2019. One was a fusion in the lower neck/upper spine. The other was implanting a spinal cord stimulator. Both surgeries were successful and helped me to get my life back. I would highly recommend his office! His team of employees are awesome! Everyone is very nice, compassionate, and helpful. My stimulator is made by Boston Scientific. Dr. Bruggerman’s office coordinated my appointments with Boston Scientific so that a representative was there for the appointments along the way. He also worked very well with my pain management doctor, Dr. Tisdell. I had a wonderful team of medical professionals all the way around!
Johnny BacyJohnny Bacy
17:49 26 May 22
I am very happy with the results from my neck surgery. I also really enjoy seeing ladies at the front desk, Faby does it all. Ms Dora is always so pleasant and great at her job. I have already recommend my family to come here. Very Happy!!! 😃
Jeff TuffsJeff Tuffs
16:55 13 Apr 22
Very professional, and the conversation was understandable to even a layman. They didn’t try to push an agenda, but instead provided options.Very satisfied with my visit.
Yesenia MartinezYesenia Martinez
16:42 04 Apr 22
Thank you Everyone from Texas Spine & NuHope for offering what was needed in the process of a journey & a chapter of my life. With the hope and believing God was with me every step of my journey. I was bless to meet Dr. Adam Bruggeman as my spine doctor/surgeon & his medical team assistants, the care that was much needed!The surgery was a success, recovered well, was active again going back to the gym faithfully but after 2 years feeling pain again due to alarming physical and mental pain.By the Grace of God I am healed in not needing a second surgery that was going be quite different than the laminectomy surgery.God is Good. I thank God for medical teams and doctors that have the knowledge and guidance with the gift of helping others that are in need of Medical Necessity, God bless you All.Do not have fear of what God is able to do and what a surgery can do that is needed to live a better lifestyle to reduce the pain or have no pain at all.Thank you.-Yesenia
Lupita FloresLupita Flores
18:43 11 Mar 22
I have had 2 surgeries with Dr. Bruggeman and have done well. Dr Paredes is very courteous, professional, and treats us like family. All the staff is super friendly. I highly recommend this practice.
Mario GonzalezMario Gonzalez
20:16 28 Feb 22
This was my first time surgery and I was confident to leave this kind of surgery on Dr Adam Bruggeman.
Heather BlakleyHeather Blakley
12:04 01 Feb 22
I could write a novel but will try to be brief. I spent a large portion of my life ignored for the serious pain I lived with and Dr. Bruggeman discovered exactly what I was living with. It’s a rough road but he has made such a huge difference in my quality of life. I thank God I am in his care. His staff is hands down the best I have ever experienced. Dr. Bruggeman and his staff are all smart, kind, professional and there to help in every way. God bless you.
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