Monday, January 7, 2019

Stem Cell vs Joint Replacement Worksheet

What is the Real Cost of Joint Replacement Vs. Stem Cell Therapy?
By: Edward G. Loniewski, DO, FACOS, FAOAO

Have you ever wondered what the real cost to your personal bottom line would be if you were scheduled for a joint replacement?   What if the same time you were given the option to consider a stem cell procedure for that same knee?  Although the joint replacement is a covered benefit of many insurance plans, everyone knows that there are always some part of the procedure not covered and you have to plan for lost wages.  Thus, we have developed a simple exercise below to help you work out that difference in cost between the two options.   To complete this exercise, you will need a copy of your health insurance plan to find out your deductibles and it would be helpful to have your employer benefits so you can find out if you have paid time off and your current balance in your health spending account.

Are you ready to do some real Jethro Bodine ciphering?   Get out a pencil and some of your health insurance information.

Circle  the total number of joints you need replaced:
 1 2 3 4

We need to determine your potential lost wages since this is an actual cost of the procedure.    Are you currently working?
Yes
No
If yes, What Category of Work are you employed ?
Sedentary - clerical
Moderate -  lifting under 30 lbs. , occasional squat or kneel
High-  walking 8 hrs a day,  constant stairs, squatting, kneeling  and lifting over 30 lbs. 

Not working - 0 weeks off work 
Sedentary - 6 weeks off work for joint replacement 
Moderate - 8 weeks off work for joint replacement
High- 12 weeks off  work for joint replacement
Subtract 1 week to reconcile to a stem cell procedure ( ie  sedentary 6 weeks -1 week = 5 weeks off).  It normally takes a patient upto one week to recover after a stem cell procedure, although most patients can return to work the next day. 

Write that number here: ___________________________

Select your rough estimate of income per week:
$500 to $1000
$1000 to $3000
$3,000 to $5000
Over $5,000
Multiply the income per week by the level of work number ( ie $1,000 x 5= $5,000)
This is the amount of wages lost if you had your joint replaced.   If you need two or more joints replaced, multiply this number by the number of joints ( ie $5,000 x 2 = $10,000) 
 LINE A:    TOTAL INCOME LOST ______________________
Note- the above line may be reduced if you have paid time off or if you have some income replacement insurance.  Please contact your human resource office for details.

Now lets calculate the insurance cost of the joint replacement.
What is your total maximum out of pocket deductible per year on your health insurance?
0-$500
$500-$1000
$1,000- $2,000
$2,000- $4,000
$4,000- $5,000 (most common)
$6,000- $7500
$7,500 to $12,500
$12,500 or over
I do not know my maximum.
Write the Maximum Out of Pocket amount here:  _____________________

If you do not know the maximum, we can get an idea by answering the following questions:
What is your annual deductible on your health insurance?
$0
$500- $1,000
$1,000- $2,000
$2,000- $4,000
$4,000- $6,000
$6,000- $8,000
$8,000- $12,500
If you have co-insurance what is percentage ratio? The cost of a total joint is approximately $35,000
I have no co-insurance
90/10 (meaning the insurance pays 90% and you pay 10%)
80/20 - (*most common )
50/50
What are the co-pays for  each physical therapy or doctor visit?
$0-  none
$30- $40
$40-$50
Add up each above and write down the estimated maximum here: _________

LINE B:  Total Costs Not Covered :  __________________________
If you have Medicare without secondary insurance, place in $7,000 since this is 20% of $35,000 .

Now let's find out if you can get reimbursed for any of these costs.
What is the amount in your yearly Health Spending Account (HSA)?  Maximum is $3450 for individuals and $6,900 for families.  If over 55, add in another $1,000.
I do not have an HSA
$1000- $2,000
$2,000- $3,000 (most common)
$3,000- $5,000
$5,000- $7,000
$7,000- $9,000

LINE C:  Total reimbursable in your HSA:    ______________________

Your Total Cost of a total joint is determined with the following formula:

Line A + Line B - Line C = Total Cost of Joint Replacement

Example:   Johnny Joint has two bad knees which need to be replaced.   He works at the local city government in the maintenance department and his job is high demand.   He earns $750 per week in gross wages and he has a total maximum out of pocket cost of $3,000 and has a health spending account of $2,500 but he already spent $500 on medications.   What would Johnny’s cost be for replacing his joints this year :

Line A= $750 x 11= $9,000 lost wages
Line B= $3,000 max out of pocket costs
Line C = $2,000 HSA

Johnny Joint Cost for his single knee replacement this year = $9,000 + $3,000 - $2,000= $10,000

If Johnny has both knees replaced he might get lucky and have this done within the same year.  Most patients have the other knee done after one year.   But, even if he did have this done in the same year, the cost would be the following:
Line A = $9,000
Line B = $0
Line C = $0
The total cost would be : $9,000 +$0 - $0 = $9,000
Johnny’s total cost for both knee replacements would be $19,000

Compare this to the cost of a stem cell procedure which would be the following.

Stem Cell Procedure  cost example :
The average cost for a stem cell procedure for both knees is $6,000
Most health spending accounts allow reimbursements for procedures deemed medically necessary and thus, Johnny could deduct $2,000 from this total to bring the cost down to $4,000

The net difference between Johnny having both knees replaced vs a stem cell procedure would be :

$19,000 - $4,000 = $15,000!   and “you can take that to the bank” as Jethro would say to Mr. Drysdale.

Do Some Cipering Yourself

Cost of Joint Replacement = 

Line A _________ +   Line B _________   -  Line C ___________

Cost of Stem Cell Procedure (advanced level of cell therapy)  =
$4,000 for one joint
$6,000 for two joints - Line C________________

Write Total Joint Cost Here: ____________________________

Write Stem Cell Cost Here:  ____________________________

Subtract Total Joint Cost from Stem Cell to find how much you may save and

 write this amount Here: _____________________________________

This amount may change depending upon a few circumstances such as the choice of our ultimate plan;  the need for an arthroscopic procedure; or the desire for a general anaesthetic at a local surgical center.

If you would like a face to face conversation with Dr. Loniewski, call 810-299-8552 for an appointment. 

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