Interesting - Or Maybe Not - December 21, 2008

I have a reasonable amount of traffic on this blog, about 20 people per day. The blog shows up on the first page of results, often near the top, on most Google searches. If the visitor hits from Google or other searches, you can see what they searched for. I've been browsed as a result of several search hits beyond my buddy in Michigan who were also curious about BCG and TUR and beer, so I'm happy to have served that crowd - pun intended! A lot of others hit and move on quickly, and a few do deep hits and run. No comments left, no repeat visits, just harvest and move on. This is not a problem, because this is exactly what the blog is for! And if affirms that I'm not personally as interesting as I think I am - a good thing to keep in mind...

I did want to comment about last week's post about TURBT protocol differences. I did update that post to include the hospital ward ambiance information that David F. provided for the UK - fascinating stuff. Do go back and check that out, if you missed the update. I also wanted to comment on the cost data I provided for my two TURBT surgeries in the USA, one in April and one in May of 2008. The two procedures were IDENTICAL with one exception. For the first one they intended to do a chemotherapy "bake" with MytomycinC, but they did not, because of a bladder perforation (puncture). For the second one, they did do the chemo bake. According to my receipts, the retail cost of of the Mytomycin was just over $2000, which accounts for most of the cost difference. But there is still about $500 of difference - the second procedure costing about $2500 more (at retail) than the first. Being the curious type, I looked into the details, such as were provided. They proved interesting if not informative. "Recovery Room" was about $80 more for the same nurse (Millie) and the same amount of time as before. Maybe the extra charge was for Mytomycin disposal? Pharmacy was about $100 more - no idea why. I might have received an extra bag of saline or two, but that would be covered in the Pharmacy-IV solutions increase of $50, one would think. Lab was $100 more also - maybe it costs more to look at one small sample vice two large ones? Med supplies was $40 more, but that was explained by the fact that I had supply kit Steri-4 the second time and Steri-3 the first time - again for identical procedures. No idea what the difference is, or why a 3 tray was fine before. Having worked in a hospital (albeit 25 years ago), a likely scenario is that the supply rack was empty of 3 trays, so a 4 tray was grabbed. Or vice versa, since my first surgery was much later in the day. All in all it's a mystery. I have seen the same phenomenon when visiting the specialist's office. Some days the "Office Visit" code is different and the charge is $10 higher (on contract cost), some days they charge $7 for the urine cup (for which the contract rate is $0.50) and other days they don't, though I use one EVERY time. I think the system is so complicated that things are often overlooked (like the urine cup) or overcharged (tray 4 instead of 3), and it all gets lost in the shuffle. All the checkers can do to check is see that appropriate things were used for the related procedures. I suspect that things are NOT included more often than up-charged - at least that's been my experience. Of course by now I should be getting a "good customer" discount from the specialist's office. Maybe a coupon or punch card - "After completing 10 BCG treatments, the 11th one is FREE!" All in all the US system seems to be working well for me, and the errors (if any) have not been very substantive in amount. I think the complexity drives errors and omissions by design, and the insurance companies "win" every time an item is forgotten. That's about as political as I care to get on this blog.

In other news, exercise continues to suck.