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!

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.