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As healthcare costs continue to rise, patients are increasingly being hit with surprise medical bills. These are bills for services that they thought they had accounted for in their search for prices for care but turned out they hadn’t accounted for all the costs of their care. This can happen if you need surgery and you ask your surgeon how much it will cost. Your surgeon’s office will tell you a price, let’s say it’s $2.000. But what you don’t know, until you receive the ‘surprise bills’, is there are other costs for a surgery: facility, anesthesia, pathology, surgical assistant among others. And all of these services are generally offered by separate companies, meaning you get at least two additional bills besides your surgeon’s.
Unfortunately, many healthcare providers only disclose their fees and don’t educate the patient about the other costs associated with their care. One 2016 study found that 20% of patients who sought medical attention at an ER within their health insurance networks incurred an average surprise bill of $622.55! In most cases, everyone except the hospital is out of network so you’ll get billed by the Emergency Medicine group, pathology, imaging, and more.
To eliminate this insanity and reduce the extra burdens placed on patients,, Texas Medical Management created a new model where all the care a patient needs is bundled into one price. To do this, TMM contracts with all the other providers involved for a mutually agreed upon fee and pays them so the patients never receive a ‘surprise bill’. TMM sees healthcare from the patient’s point of view, differently than most traditional providers who often seem more concerned with who is paying than the patient. Our vision is to simplify the experience for patients and providers alike. This allows both patients and providers to focus on what’s most important, the patient’s diagnosis and treatment, also known as a patient’s health outcome. We feel so strongly about patient outcomes that we measure patient reported outcomes on every patient we care for. Our prices are published on our website because we believe that healthcare needs a dose of transparency. Not only do you see our prices, but you know you pay the same price as everyone else. No specially negotiated discounts with companies or others. Straight and simple, just like we think healthcare ought to be. Surgery is complicated, but knowing how much it costs in advance and paying for it, doesn’t have to be.
At Texas Medical Management we believe in being upfront and honest with you about your costs so that you can budget and plan for your surgery. Therefore, you need not worry about getting a huge bill you weren’t expecting. Our price includes everything you need for a surgical procedure: surgeon (pre-op, surgery and post-op), facility, anesthesia, assistant surgeon, pathology, implants, sterile supplies, and specialized equipment.
Our surgical expertise gives us knowledge on how to identify quality providers and partner with them to reduce unnecessary or low-value costs. We employ the following strategies to reduce costs and add value:
As one would expect, the people who most often work with surgeons see the results and will have the most objective opinion about quality outcomes. For that reason, surgeons, surgical nurses, surgical techs and anesthesiologists are by far the best source of information on the quality of any one surgeon. There is no substitute for first-hand knowledge. For that reason, our team is led by an orthopedic surgeon with 25 years of experience, his clinical lead is a surgical nurse with 20 years experience and our board is composed entirely of highly regarded surgeons in several different specialties. Our team’s decades of experience in surgery serve them well when vetting surgeons who want to partner with us. The vetting process involves speaking with several providers in the surgeon’s community, especially those who have first hand experience working with them, and personal interviews with the surgeon candidate. Once a surgeon has been approved, the board formally votes to admit them to our panel of highly qualified, mid-career, subspeciality focused surgeons. Our experience in surgery has taught us that a good surgeon is often the difference between a good outcome and a bad one. In fact, data indicates that the quality of the surgeon predicts the quality of the outcome 94% of the time.
This method allows us to attach a value to every minute spent during your procedure, aftercare and other aspects related to your operation. With these calculations, we are better able to pinpoint opportunities to be more resourceful. As a result, one of our main focus areas is determining the most appropriate site of service for your care. The cost of delivering care in a physician’s office, ambulatory surgery center, hospital outpatient department, surgical hospital and acute care hospital vary 100 fold. That means you might pay $500 for a physician office fee vs $5,000 for an ambulatory surgery center vs $50,000 for an acute care hospital fee. If you need the more expensive, complex site of care, that’s what your surgeon will recommend. In all cases, the surgeon will select the site that best fits your needs and doesn’t waste your money. We work with our physician partners to ensure you are in the most appropriate facility for the care you need.
Another way we remove the guesswork for our patients is through bundled prices. These present you with a single, comprehensive price that covers all of the services you use during your surgery and aftercare.
With bundled payments, we do the hard work of understanding who your surgeon needs to be involved and what care they deliver to achieve the best outcome for you. To that end, we contract with all of the providers a surgeon tells us to in advance and establish that we will pay them a fair fee and fast, often within a week of your surgery.
One way we save lots of money is by avoiding the complexities and costs associated with traditional insurance. You may not know this but surgeons spend 30% of their revenue to bill and collect from insurance companies. By eliminating costs like this from our care model, providers and patients benefit. This helps us to keep our costs low, which in turn makes our surgery prices competitive.
While we commend other healthcare providers for finally taking a step in the right direction by giving patients the level of transparency that they deserve, they still have a long way to go in mastering the concept of value-based care. For us, it is all about being patient-centered. We’re committed to providing the best possible care for you, at a price you can afford.
If you are interested in a surgical procedure without surprise bills or hidden fees then look no further. Texas Medical Management partners with board-certified surgeons, facilities and other providers to offer competitive surgery prices across a broad range of specialties including orthopedic surgery, general surgery, ENT surgery, gynecological surgery, spine surgery and more. Book your online appointment today.
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