Saum Sutaria, M.D.

And in that setting, you may use the operating room. You may stay in a hospital bed for three days. You may be in the ICU for a day. You may be given a bunch of drugs and medications that are important for that. All of that cost goes into one bundle called the hospital DRG.

And in that setting, you may use the operating room. You may stay in a hospital bed for three days. You may be in the ICU for a day. You may be given a bunch of drugs and medications that are important for that. All of that cost goes into one bundle called the hospital DRG.

In general, the reimbursement system, which used to fragment all that stuff, has moved into an element of single reimbursement called a DRG, diagnosis-related group. By the way, a government innovation from Medicare that applies in much of the commercial world today. And you get paid a fee for all that stuff.

In general, the reimbursement system, which used to fragment all that stuff, has moved into an element of single reimbursement called a DRG, diagnosis-related group. By the way, a government innovation from Medicare that applies in much of the commercial world today. And you get paid a fee for all that stuff.

Now, we make our lives a little bit complex because we often send patients confusing bills that lists everything that they had in that DRG and an individual price for each one of those things, even though at the end of the day, what's going to get adjudicated is one payment, very simple, and one copay if it even exists.

Now, we make our lives a little bit complex because we often send patients confusing bills that lists everything that they had in that DRG and an individual price for each one of those things, even though at the end of the day, what's going to get adjudicated is one payment, very simple, and one copay if it even exists.

But we make it very complicated by sending this entire list of everything you had, which you can imagine as a patient who's just coming out of and recovering from heart surgery, the last thing you want to see is a line item of 60 different things that you had done and what the cost of those were, especially when those costs bear no connection to what your insurance company or Medicare may have actually paid.

But we make it very complicated by sending this entire list of everything you had, which you can imagine as a patient who's just coming out of and recovering from heart surgery, the last thing you want to see is a line item of 60 different things that you had done and what the cost of those were, especially when those costs bear no connection to what your insurance company or Medicare may have actually paid.

It's a complicated system.

It's a complicated system.

Oh, it's highly, highly variable.

Oh, it's highly, highly variable.

Medicare, somebody is going to reimburse, let's say 20 something thousand, some number for that hospitalization.

Medicare, somebody is going to reimburse, let's say 20 something thousand, some number for that hospitalization.

Well, the pro fees, like I said, that's US the hospital fee. The pro fee may be separate. I mean, what a physician gets paid to do that could be 750 or $1,000, let's say.

Well, the pro fees, like I said, that's US the hospital fee. The pro fee may be separate. I mean, what a physician gets paid to do that could be 750 or $1,000, let's say.

I mean, again, the number could be higher with other insurance companies and whatnot. But the point is, yeah, there's a big difference.

I mean, again, the number could be higher with other insurance companies and whatnot. But the point is, yeah, there's a big difference.

People can't fathom that.

People can't fathom that.