Currently browsing: Physician/Surgeon

Prediction: Only Providers with low Infection rates will do total joint surgery

4/26/2014: Prediction. Only surgeons and hospitals with low infection rates will do total joint surgery. The incidence of operative infection will control who will do surgery of this type in the future. The reason is that a surgical infection is very costly to treat as well as the morbidity, loss of work, even mortality. Here are the numbers concerning infection and total knee replacement. The relative incidence of operative infections was reported as 2.0% and 2.4% following total knee surgery. The annual cost of infected revisions to U.S. hospitals increased from $320 million to $566 million during the study period and was projected to exceed $1.62 billion by 2020. (Kurtz SM, et al Economic burden of periprosthetic joint infection in the United States. J Arthroplasty. 2012 Sep; 27(8 Suppl) The average cost of the surgical revision of an infected total knee replacement was $116,383 in the years 2001 through 2007. (Kapadia BH, et al. The Economic Impact of Periprosthetic Infections Following Total Knee Arthroplasty at a Specialized Tertiary-Care Center. J Arthroplasty. 2013 Oct 17). Under the new rules for quality assurance under the affordable health care act (Obamacare) the hospital will eat this loss. Another often overlooked factor for those not on Medicare have a higher deductible under Obamacare. No patient going through the prolonged treatment for post operative infection will be able to pay their deductible. It can be $1000 to $10000. This problem already exists in Germany. This is a burden on the patient if they pay. If they do not pay then the cost is shifted to the doctor and the hospital. (Haenle M. et al. Economic impact of infected total knee arthroplasty. Scientific World Journal. 2012; 2012:1 96515). So the hospital gets the expense shifted to them. Cost shifting is major feature of government health care insurance public policy. Therefore only hospitals and surgeons with no or very low infection rates will do total joint surgery. Notice I said surgeons. The hospital will not be able to afford even a “large producer” who has infections. “Sorry Doctor SoandSo, we know you are a nice guy and a good surgeon, but we can not afford to underwrite the risk of your incidence of infection.”

Health Care Fraud: government style

11/4/13: Health care fraud occurs when billing is made for services not rendered. If the transgression is by a physician, there is a large financial penalty for every occurrence whether intended or not. Would it not be health care fraud if an agency collected money for services not ever rendered? The federal government is an example. ObamaCare authors knowingly wrote a law that charges women insurance premiums for pregnancy services when it could be known they are out of the child bearing age. Furthermore, consider those women who have already had a hysterectomy which is known by government databases. If the hysterectomy and or oophorectomy were for cancer, the woman is assigned to a higher premium pre existing condition group. The later reason is logical by actuarial accounting, but fraudulent when charging premium for a pregnancy service that could never be rendered. Now that the law is passed it may be time for the American people to read this law to learn if the above is verified.

Wedged Insoles for Knee Arthritis? Point/Counter Point

8/22/13: It was reported yesterday that a review of the literature by meta analysis concluded that lateral wedged insoles have only a potential placebo effect for patients with medial compartment osteoarthritis of the knee. Parkes MJ, Maricar N, Lunt M, LaValley MP, Jones RK, Segal NA, Takahashi-Narita K, Felson DT. Lateral Wedge Insoles as a Conservative Treatment for Pain in Patients With Medial Knee Osteoarthritis; A Meta-analysis. JAMA. 2013;310(7):722-730. doi:10.1001/jama.2013.243229. Counter Point: The necessary factor for shifting of axial loads away from the meidal compartment of the knee were not present in the studies. The essential inclusion criteria for effective use includes the patient having a compliant subtalar motion plus compliant passive laxity of the medial knee joint capsule and ligamentous structures. See for illustrations of such testing. If the foot and ankle cannot be passively moved into eversion (turned out) position then there would be no angulation force transmitted up the leg to the knee by the use of a lateral wedged insole. If the inner structures of the knee are tight and not compliant to allow the the transmitted axial force up the leg to open the medial aspect of the knee, there would be no physical change to the force on the medial compartment of the knee. The medical literature supports the effectiveness of a reduction in force across an arthritic joint to result in architectural structural changes in the bone next to the joint and grow cartilage on a joint surface. Look at Another factor for success of wedged insoles is the nature of the material to maintain its integrity to transmit the force without significant deformation of the material.

Redefining Value in Healthcare: Why Providers need to take back their OR

Click the link to read “Redefining Value in Healthcare: Why Providers need to take back their OR” Read it here:

Sushi Lessons for Physicians

3/6/2013:  I think there is value in this article  for physicians.  The 7 steps outlined by the sushi chef may be overlooked in our present culture. He clearly outlines 7  “take home messages” critical for aspiring physicians and surgeons.

Health Care Greed

2/22/13: Health Care Greed: The high cost of health care in America is easily explained in recent Time magazine article.  This article is worthy of one’s time.  Read more: While most critics point to the doctors as the problem, the doctors account for 17% of the health care dollar.  Doctors do contribute to the high expense by practicing defensive medicine; ordering laboratory and radiological tests.  Doctors also contribute by performing unnecessary procedures which is well established in other publications. So who and what else contributes to the high cost.  Where is the rest of the money going or where is it being spent. The Time publication points out the so called non-profit hospitals make large profits.  The administrators make millions in wages, far more than the doctor’s incomes.  The American Hospital Association spent $1,859,041 on lobbyists in 2012 and this is just the federal level.  The trail lawyers’ lobby makes sure there is no tort reform. Independently, I learned with an initiative I made to reduce health care costs in Michigan, that the insurance company is not interested.  You might think insurance companies have an interest in reduced premiums, but that is not so since the get a percentage of premiums.  Higher premiums mean increased income to the insurance company. Perhaps the take home message of the Time article is to learn what the hospital calls their “chargemaster list prices” and that if you are hit with these unjustifiable costs, there are advocates mentioned in the article whose business it is to help negotiate such.

References: Presidential Guest Speaker Lecture. International Society for Hip Arthroscopy

References: Presidential Guest Speaker Lecture International Society Hip Arthroscopy Boston,MA September 28, 2012 Johnson LL. Arthroscopic Surgical Principles and Pracatice: C.V. Mosby. 1986 McCarroll, H. Relton. Unexpected Roads to Greatness. J Bone Joint Surg Am. 1959;41:546-552. Johnson, L. L.: Needlescope. In Symposium on Arthroscopy and Arthrography of the Knee, pp. 36-43.St. Louis, C. V. Mosby, 1978. Johnson, L. L.: Joints Other than the Knee. In Symposium on Arthroscopy and Arthrography of the Knee, pp. 249-260.St. Louis, C. V. Mosby, 1978. Johnson, L. L., Becker, R. L.: Role of the Assistant in Arthroscopy. In Symposium on Arthroscopy and Arthrography of the Knee, pp. 274-281.St. Louis, C. V. Mosby, 1978. Johnson, L. L.: Comprehensive Arthroscopy of the Knee.St. Louis, C. V. Mosby, 1977. Johnson, L. L.: Diagnostic and Surgical Arthroscopy of the Shoulder.St. Louis, C. V. Mosby, 1993. Detrisac, D. A., Johnson, L. L.: Arthroscopic Shoulder Capsulorrhaphy using Metal Staples. Arthroscopy and Related Surgery, 1993; 24(1):71-88. Johnson, L. L.: Sports & Medicine – Who is Influencing Whom? 1990 John C. Kennedy Lecture. Am. J. Sports Med., 649-654, 1990. Johnson, LL. Arthroscopic Abrasion Arthroplasty: A Review. Clin Orthop. 2001: 391S; S306-S317. Johnson, L.L. The Outcome of a Free Autogenous Semitendinosus Tendon Graft in Human Anterior Cruciate Reconstructive Surgery: A Histological Study.  Arthroscopy 1993;9(2):131-142. Johnson, L. L.: A Rationale for Systematized Record Keeping and Improved Documentation, “Twenty Years at the Bed Side, Doc”.  Arthroscopy 1987; 3:258-264. Johnson LL, JohnsonAL, Colquitt JA, Simmering MJ, Pittsley AW. Is it possible to make an accurate diagnosis based only on a medical history? A pilot study on women’s knee joints. Arthroscopy 1996; 12:709-714. Johnson, L. L., Becker, R. L.: An Alternative Health Care Reimbursement System-Application of Arthroscopy and Financial Warranty-Results of a Two Year Pilot Study. Arthroscopy. 1994;10(4):462-470. Johnson, L. L.: Arthroscopic Abrasion Arthroplasty Historical and Pathological Perspective:  Present Status.  Arthroscopy Journal, 2:54-69, 1986. VanDyk GE, Dejardin LM, Flo G, Johnson, LL. Cancellous Bone Grafting of Large Osteochondral Defects: An Experimental Study in Dogs. Arthroscopy 1998;14:311-320 LIVING IN THE PRESENT Johnson LL, Delano MC, Spector M, Jeng L, Pittsley A, Gottschalk A. The biological response following autogenous bone grafting for large defects of the knee: Index surgery through 12-21 years’ followup. cartilage. 3 (1) Jan; 85-98. First published on August 16, 2011 as doi:10.1177/1947603511413568. Johnson LL, Verioti C, Gelber J, Spector M, D’Lima D, Pittsley A. Pathology of the end-stage osteoarthritic lesion of the knee: Potential role in cartilage repair.  Knee. 2010; 18(6). 402-406.   Guyton GP, Brand RA. Apparent spontaneous joint restoration in hip osteoarthritis.  Clin Ortho Rel Res 2002, #404;pp.302-307. Zhang D, Johnson L, Hsu, H-P, Spector, M. Cartilaginous Deposits in Subchondral Bone in Regions of Exposed Bone in Osteoarthritis of the Human Knee:  Histomorphometric Study of PRG4 Distribution in Osteoarthritic Cartilage. J Ortho Res. 2007; 873-883. Milgram JW: Morphologic alterations of the subchondral bone in advanced degenerative arthritis. Clin Orthop 173:293-312, 1983. EYE TO THE FUTURE Chen H, Sun J, Hoemann CD, Lascau-Coman V, Ouyang W, McKee MD, Shive MS, Buschmann MD. Drilling and Microfracture Lead to Different Bone Structure and Necrosis during Bone-Marrow Stimulation for Cartilage Repair. J Orthop Res. 2009 Nov;27(11):1432-8. Garg AK: The use of platelet rich plasma to enhance the success of bone grafts around dental implants. Dent Implantol Update 11:17, 2000. Reeves KD, Hassanein K: Randomized prospective double blind placebo controlled study of dextrose prolotherapy of knee osteoarthritis with and without ACL laxity. Alt Ther Hlth Med 2000;6(2):37-46. Reeves KD, Hassanein K: Randomized prospective double blind placebo controlled study of dextrose prolotherapy of osteoarthritic thumbs and finger (DIP, PIP and trapeziometacarpal joints) Evidence of Clinical Efficacy. Jnl Alt Compl Med 2000;6(4):311-320. Reeves KD, Hassanein K: Long term effects of dextrose prolotherapy for anterior cruciate ligament laxity: A prospective and consecutive patient study. Alt Ther Hlth Med 2003;9(3)58-62. Dumais R, Benoit C, Dumais A, Babin L, Bordage R, deArcos C, Allard J, Belanger. Effect of Regenerative Injection Therapy on Function and Pain in Patients with Knee Osteoarthritis: A Randomized Crossover Study. Pain Medicine  2012 Jul 3. doi: 10.1111/j.1526-4637.2012.01422.x. [Epub ahead of print] Jayaprakasam B,VareedSK, Olson LK, Nair MG. Insulin secretion by bioactive anthocyanins and anthocyanidins present in fruits. J Agric Food Chem. 2005 Jan 12:53(1):28-31 Johnson LL, vanDyk, GE, Green JR III, Pittsley AW, Bays B, Gully SM, Phillips JM. Clinical Assessment of Asymptomatic Knees: Comparison of Men and Women. Arthroscopy 1998:14(4):347-359. Johnson LL, JohnsonAL, Colquitt JA, Simmering MJ, Pittsley AW. Is it possible to make an accurate diagnosis based only on a medical history? A pilot study on women’s knee joints. Arthroscopy 1996; 12:709-714.   Gray CL.  Battle for America’s Future. Healthcare, the culture war and the future of freedom.