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The Cost of Cutting: A Surgeon Reveals the Truth Behind a Multibillion-Dollar Industry

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Why is surgery so expensive?   Surgeon Paul A. Ruggieri reveals little-known truths about his profession—and the hidden flaws of our healthcare system—in this compelling and troubling account of real patients, real doctors, and how money influences medical decisions behind the scenes. Even many well-informed patients have no idea what may be contributing to the cost of their Why is surgery so expensive?   Surgeon Paul A. Ruggieri reveals little-known truths about his profession—and the hidden flaws of our healthcare system—in this compelling and troubling account of real patients, real doctors, and how money influences medical decisions behind the scenes. Even many well-informed patients have no idea what may be contributing to the cost of their surgery. With up-to-date research and stories from his practice, Ruggieri shows how business arrangements among hospitals, insurance companies, and surgeons affect who gets treatment—and whether they get the right treatment. Pulling back the curtain from the hospital bed, he explains how to safeguard one’s own health (and finances), and how America can make surgery more affordable for all without sacrificing quality care.


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Why is surgery so expensive?   Surgeon Paul A. Ruggieri reveals little-known truths about his profession—and the hidden flaws of our healthcare system—in this compelling and troubling account of real patients, real doctors, and how money influences medical decisions behind the scenes. Even many well-informed patients have no idea what may be contributing to the cost of their Why is surgery so expensive?   Surgeon Paul A. Ruggieri reveals little-known truths about his profession—and the hidden flaws of our healthcare system—in this compelling and troubling account of real patients, real doctors, and how money influences medical decisions behind the scenes. Even many well-informed patients have no idea what may be contributing to the cost of their surgery. With up-to-date research and stories from his practice, Ruggieri shows how business arrangements among hospitals, insurance companies, and surgeons affect who gets treatment—and whether they get the right treatment. Pulling back the curtain from the hospital bed, he explains how to safeguard one’s own health (and finances), and how America can make surgery more affordable for all without sacrificing quality care.

30 review for The Cost of Cutting: A Surgeon Reveals the Truth Behind a Multibillion-Dollar Industry

  1. 4 out of 5

    India M. Clamp

    Ruggeri is pertinacious and reticulates a factual tale of virtue elucidating a patina colored tutelary advancing the practice of surgery today. Brace yourself for being included in the journey of unnecessary procedures, testing and how a revenue source is a living, breathing soul enraptured with a myth that may induce “Delirium tremens.” Reading “The Cost of Cutting: A Surgeon Reveals the Truth Behind a Multibillion-Dollar Industry” on Kindle engenders questions like, what is the rationale for e Ruggeri is pertinacious and reticulates a factual tale of virtue elucidating a patina colored tutelary advancing the practice of surgery today. Brace yourself for being included in the journey of unnecessary procedures, testing and how a revenue source is a living, breathing soul enraptured with a myth that may induce “Delirium tremens.” Reading “The Cost of Cutting: A Surgeon Reveals the Truth Behind a Multibillion-Dollar Industry” on Kindle engenders questions like, what is the rationale for each hospital charging a different amount for the same surgery? Dr. Ruggeri follows the finances delineating the 150-billion-dollar industry from his scientific tableau. “The line between operating for love and operating for money isn’t as distinct as it once was. The reality is that some surgeons (and hospitals) are more motivated by money than by the Hippocratic oath they promised to uphold.” ---Paul A. Ruggieri, MD A phrase coming to mind is “Paucite paucarum diffunfere crimen in omnes” and we ask who is responsible, as an aside comes to mind from the movie Wall Street and Geckos quote “greed is good.” Well is it? Within Dr. Ruggeri’s hands he gently guides us to the answer. Advocating (Per Dr. Ruggieri) for pay based on favorable patient outcomes is wise. Buy.

  2. 4 out of 5

    Kyle Wendy Skultety (gimmethatbook.com)

    This review originally appeared on my blog www.gimmethatbook.com. The Cost of Cutting was a book I picked up for a pleasure read from the library. Ruggieri also wrote Confessions of a Surgeon, which I enjoyed very much. The difference between the two books is that Cost is mostly about the money, and directly blames healthcare/insurance/government for the woes of doctors, and Confessions is mostly about activity in the hospital; more medicine oriented. Cost will preface each chapter with a medical This review originally appeared on my blog www.gimmethatbook.com. The Cost of Cutting was a book I picked up for a pleasure read from the library. Ruggieri also wrote Confessions of a Surgeon, which I enjoyed very much. The difference between the two books is that Cost is mostly about the money, and directly blames healthcare/insurance/government for the woes of doctors, and Confessions is mostly about activity in the hospital; more medicine oriented. Cost will preface each chapter with a medical case and then peel away layers, explaining what the patient needs, how he is supposed to pay for it, how much profit the hospital will make (or not), and then Ruggieri ultimately rails against the system. I found this style of writing to be both good and bad. I’ll admit, I picked this book up to gain some insight into hospitals and learn more about medical billing. There were a lot more facts and figures about healthcare than surgery, and this made for a rather flat book at times. That being said, I did learn a lot of interesting and scary things, such as: medical equipment sales reps may be INSIDE the surgery suite, guiding the surgeon as he uses robotic arms or the DaVinci system for the first time! Also: Medicare and Medicaid pays such small amounts for hospital stays that doctors can “cherry pick” which cases they will take…or not. The needs of the patient fall by the wayside if that person has no insurance at all, and with the passing of the Obamacare /Affordable Health Act, hospitals are forced to give up profits to handle cases, thereby forcing doctors in turn to take cases regardless of patient needs or wants. For example: A woman needs surgery, and her doctor sends her to a specialist. The specialist has operating privileges at 2 hospitals. The hospital accountants/powers that be are pushing more surgeries towards Hospital One for profit. thus the surgeon tells the patient she will be going to Hospital One. This woman is upset because she heard bad things about the place, a friend of hers got awful care, and refuses to go there. The surgeon is caught in the middle between his patient’s wish and his boss. In the book, the patient wants to go to her preferred place, Hospital Two, and the surgeon gets upbraided for it. He strongly advises thw woman to choose Hospital One, and she does, reluctantly. I’ll let you read how things work out yourself…no spoilers! This is not how I’d like my surgery/medical care to be handled–would you? And let’s not even get started on hospital billing–how obscure codes control how things are handled by the insurance. Medical billing is a lucrative practice, a long cry from the “old days” when a doctor would give you a handwritten bill. We have all heard about the $300 aspirin or $1000 bandage billed to someone who has been in the hospital. Ruggieri offers up solutions on how to make things better, and explains why hospitals are all about profits instead of medicine. Even if you have no interest in medical stories, I urge you to read this, simply to gain more awareness of how to protect yourself should you need surgery. Leave everything in the doctor’s hands? The implications are truly frightening.

  3. 4 out of 5

    Alexys

    overall this was a good book, and worth reading. as a family physician though, I took issue with his stepping out if his lane, using a primary care example incorrectly to explain the potential danger and inconvenience of the so-called death panels (last chapter, the seventy or eighty yeast old woman who can't get her pap smear -- bad example, as it isn't indicated anyway; the seventy-some year old "hero" unable to get his colonoscopy without a specified other indication like history of colon can overall this was a good book, and worth reading. as a family physician though, I took issue with his stepping out if his lane, using a primary care example incorrectly to explain the potential danger and inconvenience of the so-called death panels (last chapter, the seventy or eighty yeast old woman who can't get her pap smear -- bad example, as it isn't indicated anyway; the seventy-some year old "hero" unable to get his colonoscopy without a specified other indication like history of colon cancer, is similarly, presumably, not indicated). I admit that I am not a surgeon, but this wandering outside of official recommendations makes me wonder if there was anything else he might have mistakenly cited our used as an example. Generally, though, his point is well taken, and the underlying message holds true -- patients and doctors alike need to learn what is going on with healthcare so we can more effectively control costs and get the best outcomes.

  4. 5 out of 5

    Xing Chen

    Overall, an enjoyable and enlightening read, providing insights into the many factors that influence the delivery of patient care- ranging from the surgeon’s affiliation with a particular practice or medical device company, investment in or ownership of businesses, insurance reimbursements and government policies, and competition for patients. His sources span medical literature, popular articles in the news media, and personal experience, to form a detailed and fascinating picture of the surgic Overall, an enjoyable and enlightening read, providing insights into the many factors that influence the delivery of patient care- ranging from the surgeon’s affiliation with a particular practice or medical device company, investment in or ownership of businesses, insurance reimbursements and government policies, and competition for patients. His sources span medical literature, popular articles in the news media, and personal experience, to form a detailed and fascinating picture of the surgical profession in the US. The quality of the writing is uneven- some chapters read smoothly and fluently, whereas others are repetitive, employ an abundance of mixed metaphors, and could be shortened. The author’s personal opinion features prominently and comes across as fairly ‘old school’- his concerns include decreases in continuity and quality of patient care when physicians work in shifts, instead of being available all round the clock; compromises in patient care due to financial constraints; and the decline of independent surgical practitioners. His points of view are repeated numerous times, paraphrased in various ways within each chapter, with the unfortunate effect of making his perspective seem rather narrow and subjective (perhaps unfairly so). A discerning reader would likely find his arguments more convincing if they were simply stated once. From early on in the book, I was very sceptical of his judgments, as he made several assertions that seem virtually unverifiable. For example, at one point, he claimed that another physician's decision to reject treatment of a patient was purely financial. On another occasion, he claimed that a patient had been referred to a particular surgeon for financial reasons, that the limited experience of this surgeon led to a complication, and that ultimately this was a conclusive example of the detrimental effects of cost-cutting, which I thought was absurd as he was not directly involved in the situation, and could not possibly justify any of those assumptions. I continued through the book, taking his words with a pinch of salt and reading between the lines. Ruggieri is at turns self-critical and defensive, at times taking pains to describe his objectivity in decision-making and zeal in putting patients first. One wonders whether some of these paragraphs were added on the advice of legal or image consultants, during the manuscript editing process. One of his discussions focuses on the often-cited statistic of the disproportionately high cost of medical treatment in the final year of life- and what this implies. I found it extremely intriguing that researchers have proposed ways of calculating patients’ ten-year survival rates (Cruz, 2013) using a ‘mortality index’ that is based on a scoring of 12 items, ranging from age to difficulty bathing to difficulty in managing finances. I wonder whether the final-year splurge is indicative of the amount of energy and resources that society is willing to invest in a person’s healthcare, before we can comfortably declare, ‘Enough is enough, we have done as much as reasonably possible- we should now allow nature to take its course.’ Perhaps, before we cross this threshold of expenditure, we are plagued by a form of guilt which prevents us from giving up before that point. Financial considerations aside, is this in part a modern manifestation of the elaborate rituals that have historically accompanied death, attempting to place a value on life- perhaps exaggerated all the more due to a diminished belief in the after-life? In summary, despite the uneven editing and entrenched perspectives, I found The Cost of Cutting informative and thought-provoking, fueling my desire to hear the perspectives of other professionals in the healthcare industry.

  5. 5 out of 5

    Jim Quinnan

    I'm not sure if this is the best book to learn about how the health insurance and surgery business works in the U.S., but it does give a LOT to think about. Some important lessons about fee for service models and how it motivates hospitals and doctors to do things not in the best interest of the patient. One big example--surgical quality is not a top priority because error-free surgery with good outcomes actually is less rewarding to hospitals than surgery with complications for which treatment c I'm not sure if this is the best book to learn about how the health insurance and surgery business works in the U.S., but it does give a LOT to think about. Some important lessons about fee for service models and how it motivates hospitals and doctors to do things not in the best interest of the patient. One big example--surgical quality is not a top priority because error-free surgery with good outcomes actually is less rewarding to hospitals than surgery with complications for which treatment can also be billed. Other examples are more predictable. Medical tests lead to ancillary findings that could be treated profitably but probably don't have to be. And the risks of treatment are often underestimated. I recommend reading this or another book on the subject--this is our life and health we are talking about!

  6. 4 out of 5

    Peter Low

    A good perspective from being a surgeon in the US healthcare system.

  7. 5 out of 5

    Katie Rees

    Interesting discussion regarding the monetary aspects of surgery. Also quality concerns and the future of healthcare. Published in 2014 so not totally up to date but still informative.

  8. 5 out of 5

    Selina Adams

    This is a great book! I learned a lot about the OR which is helpful since I have clinicals in the Operating room. His other book is also good: “Confessions of a Surgeon”

  9. 4 out of 5

    Ren Bedasbad

    Incredibly informative and very well written. Dr. Ruggieri discusses all the monetary motivations behind surgeries and it's effects on surgeons, hospitals, politics, and the patients. He discusses it from multiple different levels and relates the pros and cons of certain systems that are already in place. He occasionally gives cases to make the implications of money in surgery more real. He will repeat many things over and over, which at times became tedious, but was mostly very helpful for stic Incredibly informative and very well written. Dr. Ruggieri discusses all the monetary motivations behind surgeries and it's effects on surgeons, hospitals, politics, and the patients. He discusses it from multiple different levels and relates the pros and cons of certain systems that are already in place. He occasionally gives cases to make the implications of money in surgery more real. He will repeat many things over and over, which at times became tedious, but was mostly very helpful for sticking the information in your head.

  10. 5 out of 5

    Khalid Almazmi

    An insight into the American health system and what factors influence the decision to operate . Despite the advances over the years greater challenges await to be tackled , a must read

  11. 5 out of 5

    Joe

    Quite scathing.

  12. 5 out of 5

    Andrea

  13. 5 out of 5

    Raymond

  14. 4 out of 5

    Michael S

  15. 4 out of 5

    almarie cabredo

  16. 5 out of 5

    Ofer Ben-Shachar

  17. 5 out of 5

    Daniel

  18. 5 out of 5

    Alex Ment

  19. 5 out of 5

    Joseph Rivers

  20. 5 out of 5

    Martina

  21. 4 out of 5

    Hannah Kokes

  22. 5 out of 5

    Andy Rivera

  23. 5 out of 5

    Tammy Heitmeyer

  24. 4 out of 5

    Sue

  25. 5 out of 5

    Karen

  26. 4 out of 5

    Sami

  27. 5 out of 5

    Alex

  28. 4 out of 5

    Ben

  29. 4 out of 5

    Tony Zheng

  30. 4 out of 5

    Grant Wilhelm

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