Acquired Spondylolisthesis; Right L5 Radicular Syndrome of lower legs (with subtle right foot drop); Lumbar Foraminal Stenosis; Polyneuropathy; Hip Pain; Leg Pain; Lower Back pain; History of L4-L5 hardware removal, instrumentation and fusion on July 29th 2013; History of L4-L5 fusion


The client was referred to Case Management on February 2013. He had an EMG showing evidence of right L4-L5 radiculopathy with both acute and chronic features with a subtle right foot drop. Surgery was initially scheduled for March 2013, but had been delayed for further evaluation after inconsistent findings. The client was not comfortable with undergoing surgery if there is a possibility that symptoms would not be resolved.

The client was unable to carry out activities of daily living without being in significant pain, and could no longer drive his car due to pain; he was not working. In July 2013, it was determined the client would undergo bilateral foraminotomy, fusion and decompression. The surgery was completed on July 2013, however, the client continued to have pain and discomfort without improvement. The client was referred to Central Peninsula Hospital to have adjustments or repairs made to hardware screws that were used in a prior surgery. Diagnostic testing indicated at least a portion of the hardware was interfering in some way with the spinal nerve; therefore, a procedure was necessary to move the piece of hardware off the nerve in anticipation of relieving this patient’s painful symptoms.

Cost Savings:

1. The MRC Nurse consultant completed a line-by-line review of the hospital bill.

• Hospital Charges: $ 82,317

• Discounted Charges: $ 74,006

Cost Savings: $ 8,311

2. The MRC Nurse Consultant assisted the client in avoiding at least one emergency room visit for post-surgical pain, at least two office visits for increased complications of healing and recovery, and at least one additional medication to assist the client with pain management.

• Average cost of an ER visit for intractable pain: $ 1,289

• Average cost of an ER physician visit: $ 282

• Average cost of an outpatient visit for established patient (x2): $ 252

Fees Avoided: $ 1,823

3. The MRC Nurse Consultant negotiated a direct agreement with the surgeon’s office on their surgical fees.

• Surgeon Fees: $ 57,549

• Negotiated Fees: $ 47,766

Cost Savings: $ 9,783

Total Cost Savings: $ 19,917