QC: Why Finding In-Network Endometriosis Specialists Is So Difficult

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0:00

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host,
Alana,
and
it's
time
to
connect.
Dr.
Errington
is
not
only
an
expert
in
advanced
minimally
invasive
gynecologic
surgery,
but
also
a
fierce
advocate
for
endometriosis
patients,
both
in
and
out
of
the
operating
room.
Known
for
his
compassionate
approach
and
relentless
dedication,
Dr.
Errington
has
made
it
his
mission
to
give
hope
to
patients
who've
been
told
their
cases
are
hopeless.
With
over
two
decades
of
surgical
experience
and
a
steadfast
belief
in
excision
as
the
best
treatment
for
endometriosis,
Dr.
Errington
has
helped
patients
worldwide
reclaim
their
quality
of
life
through
meticulous
care,
cutting-edge
techniques,
and
a
deep
understanding
of
the
physical
and
emotional
toll
of
this
disease.
Beyond
the
OR,
he's
a
sought-after
speaker,
educator,
and
advocate,
bringing
attention
to
the
complexities
of
endometriosis
and
the
importance
of
individualized,
informed
care.
Please
help
me
in
welcoming
Dr.
Jeff

nderstanding Insurance and RVUs

SPEAKER_00
1:40

Errington.
A
lot
of
us
with
endometriosis
are
struggling
to
navigate
the
insurance
piece
of
endometriosis.
Can
you
give
us
a
sense
of
what
this
is
like
to
try
to
have
insurance
as
a
provider
for
endometriosis
so
that
we
understand
why
a
lot
of
providers
cannot
afford
to
be
an
in-network
provider
for
insurance?

SPEAKER_01
2:01

Within
the
healthcare
system,
the
way
that
it's
structured,
and
this
is
all
geared
really
toward
CMS,
which
is
the
national
uh
Medicare
system,
they
they
really
set
up
the
underlying
pay
scale
or
fee
scale
or
value
scale
of
everything
we
do
in
medicine.
And
then
all
the
private
health
insurers,
they
use
that
to
set
their
own
values
to
procedures.
The
way
that
works
is
they
look
at
they
look
at
everything,
and
it's
each
procedure,
each
office
visit,
everything
we
do
is
given
what's
called
an
RVU
or
relative
value
unit.
And
you
know,
the
base,
the
ultimate
base
level
of
an
RVU
would
be
one.
And
let's
say
that's
just
the
simplest
thing,
just
a
simple,
straightforward
office
visit.
And
then
everything
else
we
do
is
compared
to
that
level,
you
know,
that
one
RVU
scale.
And
they
determine
is
that
is
it
easier
than
that?
Is
it
harder
than
that?
If
it
is
harder
than
that,
how
much
harder?
And
they
give
a
relative
value
compared
to
that
one
single,
you
know,
RVU
value.
Uh
so
certainly,
you
know,
an
endometriosis
surgery
is
far
more
complex
than
just
a
routine
quick
in
and
out,
you
know,
office
visit.
So
if
the
routine
visit
is
given,
say,
an
RVU
of
one,
an
endometriosis
surgery
may
be
given
an
RVU
value
of,
say,
12.
Cardiothoracic
surgery
and
neurosurgery,
it'd
probably
be
given
an
RVU
value
of
2530.
I
have
no
idea
what
the
number
is,
but
it
gives
you
an
idea
of
how
they
look
at
things.
And
interestingly,
within
that
RVU
system,
everything
is
in
a
single
pie.
So
if
they
if
they
want
to
increase
an
RVU
for
a
particular
specialty
or
procedure,
that
increase
has
to
be
matched
by
a
decrease
somewhere
else.
And
it
doesn't
even
have
to
be
in
the
same
specialty.
So
there's
there's
a
finite
in
the
government,
for
some
reason
they've
determined
there's
a
finite
piece
of
pie.
And
every
time
somebody
gets
a
bigger
piece
of
the
pie,
somebody
else
gets
a
smaller
piece
of
the
pie.
So
it's
all
configured
around
that
part
of
it.
Now,
within
the
RVU,
so
relative
value
unit,
they
typically
have
three
components
that
apply
to
doctors.
And
they
look
at
the
the
amount
of
work
that's
involved
in
providing
the
care.
So
for
surgery,
they're
looking
at
the
pre-operative
visit,
they're
looking
at
the
surgery
itself,
the
incisions,
the
entry,
the
procedure,
the
closure.
And
then
it
also
takes
into
account
an
appropriate
period
of
time
of
post-operative
care.
Usually
for
laparoscopy,
I
think
that's
about
six
weeks
for
most
procedures,
that
that's
all
included
in
the
work
that's
around
the
procedure.
They
also
have
a
portion
of
the
RVU
that
takes
into
account
the
malpractice
risk.
So,
you
know,
within
a
medical
practice,
malpractice
can
be
super
expensive
in
the
US.
So
the
more
risky
a
procedure
is,
the
higher
the
component
of
the
malpractice
portion
of
the
RVU.
And
that
becomes
important.
And
then
the
final
piece
of
that
RVU
puzzle,
the
third
piece,
is
the
geography,
basically
the
location
of
the
procedure.
So
clearly
throughout
the
country,
practicing
in
California,
practicing
in
New
York,
medical
care
is
far
more
expensive
in
those
states
and
those
areas
than
it
is,
say
in
Utah.
So
if
you
take
an
equivalent
level
of
care
from
Utah,
transfer
that
into
New
York
or
California,
big
cities,
wherever,
the
cost
of
that
same
care
is
going
to
be
far
higher,
partly
because
of
the
geographic
location
and
just
the
cost
of
living
and
cost
of
practice.
Does
that
make
sense?
Yeah.

ow Insurance Fails Endo Patients

SPEAKER_01
5:34

So
going
back
to
the
malpractice
side
of
things,
when
we
look
at
advanced
endometriosis
care,
even
within
a,
say,
a
laparoscopy
for
endometriosis,
there
is
far
more
complexity
to
really
doing
good
endometriosis
work,
doing
the
dissections,
separating
the
adhesion,
separating
the
bowel,
working
around
the
ureters,
than
somebody
that
goes
in
and
says,
oh,
that
endometriosis
directly
over
the
ureter.
I
very
carefully
just
touched
cottery
to
it
so
I
didn't
damage
the
ureter.
Instead
of
doing
the
appropriate
dissection
and
separating
the
disease
out,
or
if
they
go
in
and
see
some
bowel
endometriosis
to
maybe
just
very
easily,
carefully,
safely
burn
across
the
surface,
but
not
really
treat
it,
the
risk
of
that
is
far
less
than
a
doctor
actually
going
in
and
cutting
the
disease
out
and
repairing
the
bowel
or
dissecting
the
ureter
out.
The
thing
where
that
comes
into
play
when
insurance
companies
look
at
that
RVU
for
laparoscopy,
they
don't
make
any
adjustments
on
the
complexity
risk
between
superficial
ablation
and
excision
of
disease.
To
the
insurance
companies
and
to
that
CAMS
RVU
system,
it's
all
the
same.
And,
you
know,
and
that
that's
just
the
malpractice
side
of
things.
Certainly
the
work
involved,
you
know,
taking
10,
15
minutes
to
quickly
burn
a
few
places
rather
than
two
or
three
hours
to
cut
disease
out,
they
have
zero
accounting
for
the
extra
work
involved
and
the
tedious
work
involved
in
full
excision
rather
than
just,
you
know,
spot
burning
a
couple
places
and
saying
that's
the
best
I
can
do.
Right.
So
when
when
we
look
at
the
way
that
insurance
looks
at
things,
they
consider
a
superficial,
you
know,
let's
say
somebody
gets
in
and
they
and
there's
just
endometriosis
everywhere,
but
no
adhesions.
Right.
Unless
unless
you
say
that
it,
you
know,
there
is
some
depth
to
the
disease,
but
there's
no
bowel
involvement,
no
ureter
dissections,
but
really
widespread
endometriosis
with
some
depth
to
the
to
the
tissues,
to
the
side
of
the
rectum.
Going
in
and
cutting
that
out,
you
know,
can
take
uh
hour
and
a
half,
a
couple
hours
sometimes
compared
to
a
doc
just
going
in
and
saying,
oh,
here's
a
few
spots,
let's
burn
those,
and
then
leaving
everything
else
untreated
and
untouched.
We're
talking
a
10,
15
minute
surgery
versus
an
hour
and
a
half
surgery,
and
the
compensation,
the
RVU
value
for
those
procedures
is
exactly
the
same.

SPEAKER_00
7:47

That's
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wrap
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quick

pisode Closing and Contact Info

SPEAKER_00
7:49

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