I've heard that if I wait to have my carpal tunnel surgery done until I'm on Medicare, it will cost less. That's two years away. Is it worth the wait?

With health care costs soaring, everyone is looking for ways to trim the budget. Financial experts are taking common problems like carpal tunnel syndrome (CTS) and doing a cost analysis between operative and nonoperative treatment to help patients and surgeons in the decision-making process.

For years, its been recommended that anyone with carpal tunnel symptoms start with conservative (nonoperative) care first. But the results of new studies suggest just the opposite. It looks like surgery may be the new standard of care for anyone with electrodiagnostically proven carpal tunnel syndrome.

That phrase electrodiagnostically proven is the important key. Symptoms of wrist pain and numbness of the thumb, first two fingers, and half of the ring finger come with carpal tunnel syndrome. But unless electrodiagnostic tests are done, the patient does not have a confirmed, proven case of carpal tunnel syndrome.

What tests are we talking about? Several tests are available to see how well the median nerve is functioning, including the nerve conduction velocity (NCV) test and an electromyogram (EMG). The NCV test measures how fast nerve impulses move through the nerve. Slow or absent impulses is a sign that the nerve is not firing properly.

The EMG is done by testing the muscles of the forearm and wrist that are controlled by the median nerve to determine if they are working properly. If the test shows a problem with the muscle, the nerve that goes to the muscle might not be working correctly. This is similar to checking whether the wiring in a lamp is working. If the light still doesn't work after you've put in a new bulb, you can begin to tell if there's a problem in the wiring.

Knowing that nerve function is affected helps steer patients to surgery right away because this is not something that responds well to treatment with splinting or hand therapy. Rather than spending money on conservative care and still ending up with surgery, costs can be cut up front by beginning with surgery first. Waiting too long when there is known nerve damage could affect your results in a negative way with worse outcomes than if you had treatment sooner than later.

One thing to be aware of: there's a difference between actual charges and reimbursement received for services. Charges are made for surgeons' services, anesthesia, operating room costs, splints, therapists, injections, and testing. But costs paid out as reimbursement (the amount actually paid for those services) comes through one of three sources: Medicare, private insurance, and Workers' Compensation.

Cost of care varies depending on who was paying for it. Costs are typically the highest for Workers' Compensation patients and lowest for Medicare patients. Remember, these figures aren't based on what was charged for services. These dollars paid reflect what the various organizations would pay for the services (i.e., reimbursement). Anyone who takes Medicare patients agrees to accept the reimbursement rate set by the government without charging the patient out-of-pocket for the difference between what was charged and what was paid. If you have a secondary insurance carrier, they usually pay the remaining unpaid portion billed for by doctors, therapists, and others.

For the best results, your decision should really be based on the results of electrodiagnostic tests. If you have a confirmed case of carpal tunnel syndrome from nerve entrapment, evidence suggests surgical treatment now, not two years from now. Some patients with mild symptoms do respond to conservative care, but they report less than optimal results. They say the painful symptoms don't go away completely and that over time, all symptoms gradually come back. Many of these patients end up having surgery anyway. And waiting too long can compromise nerve function from unrelieved compressive forces.

Finding out what's best for your health as well as what works for your pocket book can be a challenge. Talk with your surgeon about your test results and your best options. If surgery is needed now, most surgeons will work out a payment plan that patient's can afford.

Reference: 

Jay Pomerance, MD, et al. The Cost-Effectiveness of Nonsurgical Versus Surgical Treatment for Carpal Tunnel Syndrome. In The Journal of Hand Surgery. September 2009. Vol. 34. No. 7. Pp. 1193-1200.

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