The Surgery Business: The Financial Incentives Behind the Operating Table and the Accountability Gap That Protects Everyone Except the Patient (Paperback) (ISBN-13: 9798181936225)

Every year, American surgeons perform approximately fifty million inpatient surgical procedures. The research on those procedures - conducted by the RAND Corporation, the Dartmouth Atlas of Health Care, and peer-reviewed academic medical centers across four decades of study - consistently finds that between ten and thirty percent of the most commonly performed elective surgeries are unnecessary. That means the patient who received them would have had equivalent or better outcomes without going under the knife.

The Surgery Business exposes the financial architecture behind every surgical recommendation Americans receive - and why that architecture is designed to point toward the operating room regardless of what the evidence says about the patient's condition.

Surgeons are paid per procedure. Hospitals earn tens of thousands of dollars per surgical admission through operating room fees, anesthesia billing, device markups, and post-surgical care. Device manufacturers pay hundreds of millions of dollars annually to the surgeons who select their implants - payments now publicly searchable in the federal Open Payments database. The fee-for-service reimbursement system that governs American surgical practice does not pay surgeons for recommending watchful waiting. It does not compensate the physician who sends a patient to physical therapy instead of the operating room. It pays for procedures.

This book examines the specific procedures where the gap between industry promotion and clinical evidence is widest: lumbar spinal fusion, whose randomized controlled trial evidence consistently finds that structured rehabilitation produces comparable outcomes for most patients; cardiac stenting in stable patients, which the landmark COURAGE trial found produces no survival advantage over optimal medication management; hysterectomy, performed at rates two to three times higher in the United States than in comparable countries for the same benign conditions; and knee and hip replacement, where device industry financial relationships with surgeons have been prosecuted by the Department of Justice and litigated in billion-dollar product liability cases.

When surgery goes wrong, the accountability system reveals its true priorities. The malpractice system compensates fewer than three percent of patients injured by surgical negligence. Medical boards discipline physicians at rates researchers have characterized as inadequate for patient protection since the 1980s. Hospital credentialing processes are systematically compromised by the institutional financial interest in maintaining surgical volume. Informed consent forms are written at reading levels that exceed the health literacy of most patients who sign them.

The Surgery Business gives readers the tools to engage this system as informed participants: how to search the Open Payments database for surgeon financial relationships, how to use the Choosing Wisely campaign's specialty society recommendations to evaluate whether a proposed procedure has adequate evidence behind it, how to obtain a genuine second opinion, what questions to ask before signing a consent form, and what the randomized controlled trial evidence actually shows about the most commonly recommended surgical procedures.

The financial architecture of American surgical medicine has never been designed to produce genuinely informed patients. This book was.