Hyperparathyroidism Blog 

from the Experts at the Norman Parathyroid Center

Interesting stories of hyperparathyroidism we see every day.  Parathyroid blog published bi-weekly.

Author Archives: Dr. James Norman

Parathyroid Surgery for Medicare Patients in the US

Parathyroid Surgery for Medicare Patients in the US

Hyperparathyroidism (parathyroid disease) occurs most commonly at age 61, thus Medicare pays for thousands of parathyroid operations per year. New data shows where Medicare patients go for parathyroid surgery.

This graph shows where 100% of all parathyroid operations were performed on Medicare patients in 2012. The data was made public in April, 2014 (link to government Medicare database below). This is important to you for several reasons discussed in this article. First, you can see that Medicare wants to pay for parathyroid surgery because it makes the patients healthier. Second, you can see that there aren’t many experts in parathyroid surgery. Medicare is just the government’s insurance company, but it allows us to find out about parathyroid surgeons, where they operate, and how much experience they have.

Parathyroid surgery on Medicare patients.

Click on Medicare Parathyroid Surgery Graph to make it bigger.

Medicare cares about hyperparathyroidism because at least 3% of the population over age 65 has it and needs a parathyroid operation to treat it. Medicare also cares about hyperparathyroidism because of the other health problems it can cause if not cured. Hyperparathyroidism occurs from about age 14 up to over 100. Most commonly it is patients in their 50′s, 60′s, 70′s, and 80′s that have parathyroid surgery (we operate on somebody over 80 virtually every day).

Parathyroid surgery is covered by all insurance companies. In fact, the insurance companies know that it is cheaper in the long run for you to have a parathyroid operation than it is to treat all the bad complications that can occur if you don’t have an operation. Thus even medicare does not require a referral from any doctor to have parathyroid surgery. We often hear a patient tell us: “My doctor said that Medicare won’t pay for the operation until the calcium is higher or until I have kidney stones.” Nothing could be further from the truth. All insurances pay for parathyroid surgery, and NONE require the patient to have a calcium level at some certain level, or osteoporosis or kidney stones. In fact, Medicare allows patients to go anywhere they want to have their parathyroid operation. You do not need a referral from any doctor, and you absolutely do not need to see an endocrinologist first.

Who Operates on the Most Medicare Patients? And why do we care?

The graph above shows where Medicare patients had parathyroid surgery in 2012. Several things are quite apparent, but the most obvious is that the Norman Parathyroid Center in Tampa, FL performs far more parathyroid operations on Medicare patients than any other doctor or hospital. In fact, we perform about 10 times more than any other center.  Although not everybody can get to Tampa, Florida for their parathyroid operation, this graph is important because high-volume centers and high volume surgeons have a higher success rate and a lower complication rate.  Older patients tolerate surgery amazingly well, but they often don’t tolerate complications very well. Older patients tolerate anesthesia extremely well, but clearly they do better with less anesthesia and less time under anesthesia. The experience of your surgeon (and the entire surgery team) is important for high cure rates and low complication rates. One of the goals for Medicare (and all insurance companies) is to analyze this newly released data (April, 2014) to identify high-volume specialty centers so they can “prefer” that their patients be treated there. Ask your doctor and they will tell you: “Find the surgeon that does the most”.

What else does this Medicare Parathyroid Surgery Graph show?

There are several important points the Medicare parathyroid surgery data shows:

  1. There is one center that specializes in parathyroid surgery and performs far more than any other hospital or university.
  2. Some universities claim to be experts in parathyroid surgery, yet the data from the US government shows they do very few parathyroid operations.
  3. There are some universities (i.e., University of Miami, University of Pittsburgh, Johns Hopkins) who do very little parathyroid surgery, yet they have a fellowship in endocrine surgery to train parathyroid surgeons. How can they train parathyroid surgeons when they do so little in the first place? How does this nonsense get propagated? Who is watching the hen house?
  4. There are surgeons on the internet who claim to be experts in parathyroid surgery and have fancy websites, however many of them do not show up on this graph meaning that they aren’t doing near as many as they claim.
  5. If you think you can find an “expert” in parathyroid surgery in your home town, and you don’t live near one of the large lines on this graph, then you are probably very wrong. Parathyroid surgery is delicate and can be very challenging. It is our opinion that it is not possible for your surgeon to be an expert and him/her not be on this graph. 

This data comes from the Centers for Medicare & Medicaid Services (CMS) which released for the first time ever their data on which doctors billed for which operations and procedures. This is called the Medicare Provider Utilization and Payment Data. It is public information and you can look at it here. The data includes all surgeons who performed 11 or more procedures of any type on a Medicare patient in the calendar year 2012. For parathyroid surgery, there are two codes for parathyroid surgery: 60500 which a surgeon bills the insurance company when performing a patient’s first parathyroid operation. The second code (60502) is what a surgeon bills when performing a second, third, forth, (etc) parathyroid operation on somebody that already had their first parathyroid operation and wasn’t cured. This Medicare database does not include surgeons who billed for 10 or fewer parathyroid surgeries in 2012–but that is fine with you since you don’t want one of them as your doctor in the first place. The Medicare surgery data includes all surgeons who billed that code, and so for parathyroid surgery it can be a general surgeon or an ENT surgeon. These are the only two types of surgeons who perform parathyroid surgery (note: some general surgeons have gone on to become “endocrine surgeons”; all of the surgeons at the Norman Parathyroid Center are in this category).

Parathyroid RE-Operations. Operating After a Previously Failed Parathyroid Surgery.

Medicare Parathyroid Operation Second Surgery

Click on graph to make it bigger.

Surgeons who don’t perform parathyroid surgery every day have much lower cure rates than those who do. This has become an epidemic over the past few years now that every surgeon thinks they are an expert because they have a positive scan and can measure parathyroid hormone in the operating room while you are asleep. Unfortunately for you, this has been a boom to our business because many of these patients are not cured and they have to seek a “real” expert for their second operation. This second graph shows the Medicare data for re-operative parathyroid surgery (second time or more). All surgeons in the US are in this database if they perform 11 or more re-operative parathyroid surgeries on Medicare patients in the calendar year 2012. As you can see, there are only two hospitals in the US that are in this database. Only two hospitals performed 11 or more of these re-operative parathyroid operations. Let’s be clear on one thing: re-operative parathyroid surgery can be very hard, and an expert is a must. Experts do re-operative parathyroid surgery.

Why is this important to you? Because now you can check the publicly available Medicare database and see how many parathyroid operations your surgeon performs (or heart bypass operations, or gallbladder operations, etc). Yes it is Medicare data, but remember Medicare is just the US Government’s insurance company. Virtually 100% of surgeons of all types take Medicare because we have to since almost every disease is more prevalent in the older population. Medicare comprises about 28% of our insurance business, the rest is comprised of Blue Cross/Blue Shield, Aetna, Cigna, Wellpoint, United, etc.  Thus our total numbers for parathyroid surgery are almost 4 times higher than these graphs.

Every day we hear people tell us: “I had the best parathyroid surgeon in my hometown; he is the head of the department and he does hundreds of parathyroid operations every year.” Of course we know better, and know that there aren’t any surgeons in the world doing “hundreds” of parathyroid operations per year (except at our center because this is all we have done for 23 years). Now you, the consumer, can be smart and educated. You can look up the Medicare database and see if your surgeon is telling a fib. Or, you can just look at the graph above and see. Now that this data has been released, let’s see if the surgeons around the country will update their websites and get rid of the inflated numbers they all claim.

We applaud the release of this Medicare information from the US Government. It should have been done years ago! It is important for the best care to be given to all Americans, and this is going to occur at high-volume centers with a specialty in specific diseases. Surgery is too complex for surgeons to be “expert” at lots of things. It isn’t possible. Lower costs and higher quality is where we need to go, but this is not possible without knowing the data, and making it public for everybody to see. Let’s hope this Medicare surgery data helps us save some money, avoid poorly qualified or inexperienced surgeons, and get people cured quickly and safely!

 

  • Want to see how we can perform 11-14 parathyroid operations per day? Watch our Mini-Parathyroid Surgery Video.
  • Make sure your surgeon looks at all four parathyroid glands. Be careful of the “one and done” approach to parathyroid surgery where the surgeon will take out the one gland shown on a scan and then quit–you may not be cured and then you will end up on our second graph–the graph of the re-do’s. We operate every day on patients who’s first surgeon took out one parathyroid tumor and quit the operation because “the hormone fell by more than 50%”. Folks, if it worked, we would do it–and we do not.
  • About 18-20% of the parathyroid operations we perform on Medicare patients are on people that were operated on somewhere else on the first graph above and they were not cured, then they show up at our center and become part of the second graph. Read more about these Failed Parathyroid Surgery cases. Be smart and pick your surgeon wisely! Ask tough questions. And if he/she says they do “hundreds” per year, show them this graph and ask them where they are on the graph!

 

Canadian Patients Traveling to Florida for Parathyroid Surgery Continues to Increase.

Canadian Patients Traveling to Florida for Parathyroid Surgery Continues to Increase.

Canadians with hyperparathyroidism claim expertise in parathyroid surgery and long wait times as the reasons for traveling to Tampa for surgery. On April 6, 2014, the Calgary Herald published an article about the dramatic increase in the number of Canadians traveling to Tampa, Florida for their parathyroid surgery. This is a great article and shouldContinue Reading

Intra-Operative PTH Assay: Exposing the Problems with Measuring PTH in the Operating Room.

Intra-Operative PTH Assay: Exposing the Problems with Measuring PTH in the Operating Room.

Measuring parathyroid hormone (PTH) in the operating room has some theoretical benefits, but in real life, the intra-operative PTH assay (io-PTH testing) doesn’t really help and may hurt. Measuring parathyroid hormone in the operating room cannot determine if a patient is cured of hyperparathyroidism. Intra-operative PTH Assay: The theory of measuring PTH in the operatingContinue Reading

Failed Parathyroid Surgery: Yesterday’s Three Unsuccessful Parathyroid Cases.

Failed Parathyroid Surgery: Yesterday’s Three Unsuccessful Parathyroid Cases.

Parathyroid surgery can be tricky which is why all your doctors will tell you “get the most experienced parathyroid surgeon you can” or you can have a failed parathyroid surgery or a bad complication. The fact that we have a business that is exclusively parathyroid surgery is evidence that this is not always a simpleContinue Reading

Vocal Cord Nerve Damage During Parathyroid Surgery is Increased with Nerve Monitoring

Vocal Cord Nerve Damage During Parathyroid Surgery is Increased with Nerve Monitoring

Thyroid and parathyroid surgeons have been told that monitoring vocal cord laryngeal nerves during surgery may decrease the incidence of vocal cord nerve injury, but the data shows vocal cord nerve monitoring dramatically increases nerve damage. Surgeons don’t like hurting their patients. We will do anything, it seems, to prevent injuring our patients while theyContinue Reading

A Doctor With Hyperparathyroidism: How Parathyroid Surgery Changed Me in One Month.

A Doctor With Hyperparathyroidism: How Parathyroid Surgery Changed Me in One Month.

Hyperparathyroidism sneaked up on me. I was feeling tired and old. I’m a family practice doctor so my job is to take care of other people–to make them feel better. Yet I was miserable myself. My name is  Ashok Goyal MD and this is my story. I found myself not enjoying my job like I usedContinue Reading

Is Your Surgeon Cheating During Your Parathyroid Operation?

Is Your Surgeon Cheating During Your Parathyroid Operation?

The internet is full of surgeons who claim to be experts at parathyroid surgery. But are they really doing expert work, or are they cheating and doing a simple operation that any joe-blow surgeon could do? Parathyroid surgery can be very tricky for a number of reasons.  First, there are four parathyroid glands and aContinue Reading

Sexual Dysfunction and Loss of Sexual Desire due to Hyperparathyroidism

Sexual Dysfunction and Loss of Sexual Desire due to Hyperparathyroidism

Sexual dysfunction and loss of sexual desire and interest in sex is common in patients with high blood calcium and hyperparathyroidism.  Both women and men have a nice benefit to their sex lives from parathyroid surgery and cure of the high blood calcium / hyperparathyroidism. We have known for years that people with primary hyperparathyroidismContinue Reading

Diagnosing Hyperparathyroidism: Top 10 Mistakes Doctors Make Diagnosing Parathyroid Problems.

Diagnosing Hyperparathyroidism: Top 10 Mistakes Doctors Make Diagnosing Parathyroid Problems.

Hyperparathyroidism should be easy to diagnose in about 95% of cases. Unfortunately many doctors and endocrinologists don’t have much experience diagnosing parathyroid problems and thus it takes too long and too many tests are performed.  How do we diagnose hyperparathyroidism when many doctors don’t know how? Parathyroid problems (hyperparathyroidism) affect about 1% of all womenContinue Reading

Don’t Break That Parathyroid Adenoma! The Parathyroid Tumor Will Grow Anywhere!

Don’t Break That Parathyroid Adenoma! The Parathyroid Tumor Will Grow Anywhere!

A broken parathyroid tumor can be a devastating complication of parathyroid surgery. Parathyroid tumor cells will grow almost anywhere, so they must not be broken during surgery! Parathyroid tumor implants are very hard to cure. Today’s story illustrates one of the most important rules of parathyroid surgery — “do not break the parathyroid adenoma; itContinue Reading

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About Dr. James Norman

Dr. James Norman

James (Jim) Norman, MD, FACS, FACE, is recognized as one of the world's foremost expert on parathyroid disease and hyperparathyroidism and has treated far more parathyroid patients than any other doctor in the world. He is the founder of the Norman Parathyroid Center in Tampa, Florida, the world's leading center for the diagnosis and treatment of hyperparathyroidism. Dr Norman has made numerous contributions to to the understanding of parathyroid disease and is credited with dramatically changing the way parathyroid surgery is performed. He is a fellow of the American College of Surgeons (FACS) and also a Fellow of the American College of Endocrinology (FACE). He is recognized in the top 1% of all surgeons by US News and World Reports in addition to dozens of other awards and Best Surgeon accolades. He has published over 250 peer-reviewed journal articles. Dr Norman and his partners perform more than 2600 parathyroid operations annually on patients from all over the world.

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