Costs and Care Choices – Virtua versus Surgery in the office

Pain after surgery is something we want to minimize.  As a surgeon the concept of a medication that dramatically reduces pain after surgery is a great idea!

Exparel is liposomal bupivicaine, or a time release version of numbing medication that can be used in surgery patients to decrease postoperative pain.   I began using it in abdominoplasty surgeries in early 2012 after the FDA approved the product for other surgeries.  Many plastic surgeons have started using this throughout the country as it makes sense to use this medication if it reduces pain and improves/shortens recovery.  The difference I have seen between my patients using this medication from prior to 2012 is dramatic.

When I operate at the hospital instead of my AAAASF operating room I am unable to use Exparel since it is not on formulary.  I asked the hospital to get the medication and was informed of the lengthy process, paperwork, and hours of work involved in getting this considered.

It took me almost a year to get to the point where I could present this medication to the Virtua committee.  After the meeting they decided that they would not approve the medication.

I am very disappointed about this.  I do not believe it was a good decision as I have seen such wonderful outcomes with this medication.  At the end of the day, Virtua disagreed.  I believe it was mostly a cost-based decision since in one of my initial emails their pharmacist replied From a patient comfort perspective, and from a Virtua service standpoint, an argument could be made in favor of the liposomal preparation. However, the cost / benefit ratio would be a real tough sell.”

When patients ask me should they have their surgery in my facility or at the hospital, this is one more reason.

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