Neuromonitoring for Arthroscopy? Let’s Monitor For Lightning Strikes

I had yet another conversation with a neuromonitoring company recently.  The explosion of these companies is not tied to their medical necessity but rather financial gain and greed.  The chance of a nerve injury in a shoulder, knee, or hip arthroscopy is 0.01% to 0.03% (https://www.ncbi.nlm.nih.gov/pubmed/19620828) and yet there are salespeople that approach me nearly every week to monitor my cases for this 1 in 10,000 occurrence!   I might as well hire them to monitor me for being struck by lightning which has the same 1 in 10,000 chance!

The rise in kickback deals with doctors using neuromonitoring in exchange for money is just starting to be appreciated and prosecuted.  Google “neuromonitoring fraud” to see recent actions in Texas and by insurance companies to shut down yet another example of corrupt people trying to make money in health care.

Below is the full text of my recent conversation showing how far down the path of ridiculousness a salesperson will go….because the financial gain is tremendous…. A neuromonitoring company billing as out of network will make more than the surgeon and usually more than the hospital for the surgery!              _____________________________________

Dr. Buford, my name is XXX XXXXX and I work for XXX Neuromonitoring.

I ran across your information while searching for Orthopedic surgeons in the Dallas area.

I think you’d be a great fit for our Intraoperative Neuromonitoring Services.

Can I schedule a brief appointment with you to discuss?

I only do shoulder and knee arthroscopy….is there a need for intraoperative

monitoring for those types of cases?

Absolutely, we monitor both, and shoulder arthroscopies are one of the most

common procedures we monitor for Ortho Surgeons. Inraoperative Neuromonitoring

protects you in that a neurodiagnostic professional is in the room during surgery and

you are alerted when in the vicinity of a nerve. Patients also appreciate the extra precaution.

The service is also at no cost to you, or the patient. We simply bill insurance.

I haven’t had a nerve problem in a scope in 18 years….at least 4000 cases?

I am just not sure the added expense is of any benefit for routine arthroscopies.

Thats awesome Dr. Buford, everyone isn’t as fortunate. IONM is an added measure of precaution,

and please keep in mind that it is of no expense to you or the patient. We bill insurance, and

our company covers the portion that they don’t. We even monitor Medicare cases as a courtesy to you.

I at least wanted to give you information on our company if you become interested at some point.

Right….but since the procedure cost per case goes up…. I might even get “dinged” and

won’t qualify for some of the insurance networks if my average cost per rotator cuff repair (for example)

goes up $500 per case. Insurance companies won’t “certify” me as a good doctor if my cases are

more expensive. What do you bill insurance companies to neuromonitor a 1 hour

arthroscopic rotator cuff repair? Are you in network with all of the big insurance companies?

And actually, everyone is kinda as fortunate The reported nerve complication rate for knee and shoulder

arthroscopy is below 1% (actually well below)

Nerve injury occurs at a rate of 0.03% after hip arthroplasty, 0.01% after knee arthroplasty,

and 0.02% within 3 mos of arthroscopic knee surgery. …

https://www.ncbi.nlm.nih.gov/pubmed/19620828

I just hate charging anybody for something with a 0.01% chance of happening…you catch my drift I hope

I don’t have that exact figure off-hand, however, we are in network with most commercial plans. All we would need

is the pre-authorization code for billing a few days prior to the surgery. I would love to meet you for lunch and have a few

minutes of your time to discuss more in depth. Is that possible this week with the exception of Wednesday?

XXXXX, in my opinion it just isn’t appropriate for primary shoulder knee and hip arthroscopies based on

the published evidence …..nobody (doctors, patients, hospitals, medicare, insurance companies) should buy

neuromonitoring for a 1 out of 10,000 chance of a temporary neuropraxia. And since I can’t even know what

the charge is to the insurance company I am definitely not interested.

I understand your opinion. I don’t have the figure but can get the information for you.

So for a partial menisectomy(CPT: 29881) as a knee example or for a rotator cuff repair as a

shoulder example (CPT: 29827)

I will find out and get back with you ASAP!

Dr. Buford, I followed up with my team, and unfortunately I am not at liberty to give a dollar amount of how much we bill for insurance.

What I can tell you is that we don’t bill the surgeon or the facility, only the patient’s insurance, and we don’t balance bill. Does it sound like something you’d want us to come in and discuss?

Ok, Unfortunately I can’t proceed. All of my implant vendors, for suture anchors, allografts, capital equipment, etc.

are transparent with their pricing and it is curious to me why your company is not.

In addition to the lack of medical necessity, the lack of price transparency is another huge red flag for me….best wishes