Joint Surgeons of Sacramento

Joint Effort Newsletter
Surgery in China SutterGold Club Patient Billing Radiological Studies Staff Profile Patient Concerns Volume 1, Issue 1 Volume 2, Issue 1 Volume 2, Issue 2 Volume 6, Issue 1 Volume 7, Issue 1 JOINT SURGEONS OF SACRAMENTO 1020 29th Street Suite 450 Sacramento, CA 95816 Ph: (916) 733-5066 Fx: (916) 733-8705 RELATED ITEMS Meet Our Doctors Map and Directions Take a Tour of Our Office HIP & KNEE INFO Total Hip Replacement Total Knee Replacement NEWSLETTER Sign Up Now!		Volume III, Issue 1 Winter 1992 Journey to the East: Orthopedic Surgery in China By Dr. Jeffrey K. Taylor During late September and early October of this year, I had the opportunity to visit Mainland China. We made the trek at the invitation of relatives who have been posted to the U.S. Embassy in Beijing, as well as to visit with an old friend who is the Dean of the Peking Union Medical College. In addition, I had been invited to give a seminar to the orthopaedic surgeons in Beijing, sponsored by the China-Japan Friendship Hospital. China is a country a little larger than the continental United States with a population of over one billion people. From a standpoint of industrialization it is still a developing nation yet it has a rich culture, stretching back continuously for nearly five thousand years. My impression of China was formed through the course of a four thousand mile, circuit around China by airplane, riverboat, bus and train. The great accomplishment of their past, such as the construction of the Great Wall, and the splendid culture demonstrated in the Forbidden City of Ching Emperors, stand in contrast with China’s difficult struggle into the modern age. Every where we went, we found the people to be gracious, friendly and extremely hard working. Despite frequent government propaganda critical of the United States, the people tend to hold Americans in high esteem. The contrast of traditional Chinese culture, blended with the ongoing struggle for modernization that we saw throughout China, was also quite apparent in medical care and in the practice of orthopaedic surgery. While in Beijing, I spent an entire day at the China-Japan Friendship Hospital. This is the largest and most modern medical facility in the Chinese capitol. It was built seven years ago with financing from Japan, and houses over 1500 patients. When it was built, its Japanese sponsors outfitted it with the most modern diagnostic and treatment technology available and it represents one of the finest medical facilities in all of China. Nevertheless, the funds for continued upgrade of equipment are extremely limited and physicians are often forced to make do with older equipment and techniques. I spent the day meeting with hospital officials, touring the hospital and rounding with the orthopedic surgeons on staff there. Nearly one-half of the medical specialties represented in the hospital were based on traditional Chinese medicines such as herbal treatments and acupuncture. The remainder were founded in Western medical disciplines. Various types of arthritis presented in much the same patterns as they do in the west. Before being considered as a candidate for reconstructive surgery or total joint replacement, patients will be treated with both traditional Chinese and Western methods. My hosts felt that acupuncture did not offer significant prolonged relief from the symptoms of advanced arthritis of the hips or knees, but was often helpful in treating chronic low back pain and muscle strains. Traditional herbal remedies, as well as Western medicines are employed as anti-inflammatory agents to treat the early signs and symptoms of degenerative joint disease. Some of these traditional preparations have been found to contain naturally occurring chemical cousins of the anti-inflammatory drugs such as Ibuprofen and Indomethacin that are employed in Western medicine. Many Chinese will also use traditional exercise techniques such as Tai Chi to maintain flexibility and strength, in the face of advancing arthritis. In all cases, conservative means of treating arthritis are employed extensively, and a patient is not considered a candidate for surgery until he has failed these treatments. Chinese orthopaedic surgeons have two different total hip prosthetic systems (both manufactured in China) available for implantation. The first is modeled after the traditional cemented Charnley prosthesis and is used most extensively in China. As a model, variations on the Charnley design have proved to be among the most successful of cemented hip replacements and Chinese surgeons are also having excellent success with this design in patients who are candidates for cemented arthroplasty. With patients who are younger, or at high risk for other reasons, the Chinese have begun to employ titanium porous-coated prostheses for cementless, biological fixation, joint replacement. This represents a relatively new technology available to Chinese surgeons and they are still gaining experience with it. On the afternoon of my visit, I presented a two-hour seminar on joint replacement and reconstruction to about 75 orthopaedic surgeons who had gathered from the major teaching hospitals in Beijing. This developed into a wonderful exchange of ideas and experiences with the difficult problems of joint reconstruction. My hosts were extremely anxious to hear about the new developments in areas such as CT-based custom total joint replacement and surgical robotics. As skilled surgeons and diligent researchers, our Chinese colleagues were anxious to adopt and explore the most advanced techniques in orthopaedic surgery, but they are hindered by limited resources, in terms of both new technologies and advanced materials. Return to top SutterGold Club Sutter Health provides various services for over 10,000 members of the SutterGold Club. This is a free program for mature adults (over 50). Some of the benefits of membership include free cholesterol and blood pressure tests, educational seminars, volunteer opportunity with the SutterGold Time Exchange Program (STEP), discounts, benefits when hospitalized, assistance with insurance claim forms, and the quarter SutterGold Club News. For more information or an application for the free membership, call (916) 733-3084. Return to top Patient Billing In an effort to avoid confusion and reiterate the information you received as a new patient, we feel it is important to summarize our billing procedure. After any visits to the office, we bill all primary insurance carriers, which we have done since inception. For those patients that have private insurance, we do this as a courtesy. For patients with Medicare coverage whose check is received at the patient’s home, we ask that you forward that check, or if you prefer, your own check to our office. Should you want us to bill your secondary or supplemental insurance, we must have the Medicare Explanation of Benefits (EOMB) that accompanies your Medicare check. No secondary insurance company accepts bills without the EOMB. We will then bill your supplemental insurance as a courtesy. It is very important to remember that if after 30-45 days from an office visit you have not received a Medicare check to notify our office. We bill electronically and sometimes claims are not received by the Medicare carrier therefore we would need to re-bill the claim. Surgery billings generally take longer for payment because in most cases documentation must be sent with the claim form. Each month we send out a monthly statement of your account. These monthly statements serve two purposes. It notifies you that your insurance carrier has been billed. The statement also reflects any payments received by an insurance carrier, or by the patient and what balance remains for the patient to pay. Each insurance company has its yearly deductibles and these are also your responsibility to pay. The statement also lists the days and times best suited for inquires. Remember, if your employer pays the insurance premiums, any questions or concerns regarding your claims, as well as your benefits, should be directed to them. We welcome your payment at any time. We understand that medical costs can sometimes become a burden. Please don’t ignore bills that you are having difficulty in paying. We are willing to work with you to set up a payment plan. If this is necessary, please contact the office manager or the billing clerk. Another important item to remember is to keep the office informed of any changes in your insurance coverage. This can be done at the time of your office visit. Return to top Some General Information About Radiological Studies often Ordered by Drs. Bargar and Taylor These up to date methods of imaging are used by many specialties other than orthopaedics Normally, one cannot simply walk in without an appointment for these tests. Because the scanning machines are highly utilized, it usually takes about a week to get an appointment for these studies. MRI – Magnetic Resonance Imagining, does not use ionizing radiation (X-rays), nor does it require the use of injected or swallowed contrast agents to enhance images of the body’s organs. Instead, a powerful magnet, and radio waves are used. The procedure offers improved images of soft tissue like cartilage and ligaments, as well as, blood flow to bone. MRI helps in the detection of central nervous system disease, tumors and other diseases affecting the body’s organs. No special preparation is required by the patient prior to the test. Because of the magnet you will be asked to remove all metal objects that might be affected. The scan takes approximately 45 minutes to one hour. MRIs do not emit any radiation. CT Scan – Computerized Tomography Scan is generally used by our office for the manufacturing of total joints or models used by the doctors for preoperative planning. It is a computerized X-ray that allows three-dimensional measurement of bones and soft tissues. No preparation is required by the patient. After being properly positioned, you’ll be secured with soft straps to keep you as still as possible during the scan. The scan takes approximately one hour. A CT scan emits approximately the same amount of radiation as a chest X-ray. BONE Scan – A bone scan is usually ordered to help rule out loosening and infection in the bone around the prosthesis. No preparation is required by the patient prior to the scan. After arriving for the scan the patient is injected with a liquid called a radioactive element, Technecium-99. The agent is injected into a vein, usually in the arm. After the injection, the patient must wait three hours before they can be scanned. During that time the patient is free to leave the building. The scan itself then takes approximately one hour. INDIUM Scan – This scan shows bone and soft tissue, it is used in conjunction with the bone scan to rule out infection. For this scan a small amount of the patient’s blood is drawn from a vein in the arm. The blood is then sent to a lab where it is spun down and the white cells are removed. A radioactive element, Indium-111, is added to the white cells to circulate throughout the body. The patient must then return to the scan center the next day to have the actual scan done. The test takes approximately one and a half hours to complete. Radiation exposure in a bone or indium scan is less than a series of back X-rays or a barium enema. Staff Profile Born in Hackensack, New Jersey; Mary moved to California at the age of 12. She has been working in the medical field for the last 8 years. She has been married to Jim Minix since November 1988. While working for a medical billing service she met Anna Amos. Mary accepted a full time position with Dr. Bargar in January 1987. During the summer of that year she went back to school to become a limited X-ray technologist under Dr. Bargar’s direction. Mary then decided to continue her studies, and in August of 1991 she received her Certified Medical Assistant license. At your next appointment you’ll notice that she has switched positions with Betty Lowe. Betty, who is also an X-ray technologist, is now taking X-rays and Mary will be the medical assistant. This is due to Mary’s anticipated birth of her first child in May of 1992. When not at work, Mary enjoys time with her family, most of who live in the area. She also enjoys snow skiing, art and trips to Tahoe. She and her husband have also been busy preparing their home for the new arrival. Return to top Patient Concerns Q: Why was I advised to stop taking aspirin prior to my operation? A: Aspirin contains a chemical called salicylate, which inhibits platelet activity thereby interfering with the clotting mechanism of blood. During an operation every effort is made to reduce blood loss by the surgeon and undue bleeding can occur if the patient has salicylate in their systems. At the time the decision to have surgery (any type) is made the doctor will want to know about all the medicines you are currently taking, so it is very important to name all the medicine, even over the counter drugs. The following is a partial list of medications affecting platelet action: All arthritis medications commonly grouped as NSAID (Non Steroidal Anti-Inflammatory) include Ibuprofen, Advil, Motrin, Nuprin, B7fferin, Anacin, Bayer, Ecotrin, Niacin, Coricidin, Darvon, Empirin, Norgesic, Percodan, Roboxin, Sudafed, vitamin E, fish oil, Pepto Bismol, Naprosyn, Feldene, Clinoril, Voltaren, Lodine. These are only a few commonly used medications one should avoid prior to any surgical procedure. For aspirin or aspirin containing products, we recommend stopping the medication two weeks prior to the procedure. For other NSAIDs, 48 hours before surgery is sufficient. Return to top

Joint Effort Newsletter

   Surgery in China
   SutterGold Club
   Patient Billing
   Radiological Studies
   Staff Profile
   Patient Concerns

   Volume 1, Issue 1
   Volume 2, Issue 1
   Volume 2, Issue 2
   Volume 6, Issue 1
   Volume 7, Issue 1

JOINT SURGEONS
OF SACRAMENTO
1020 29th Street
Suite 450
Sacramento, CA 95816
Ph: (916) 733-5066
Fx: (916) 733-8705

RELATED ITEMS
Meet Our Doctors
Map and Directions
Take a Tour of Our Office

HIP & KNEE INFO
Total Hip Replacement
Total Knee Replacement

NEWSLETTER
Sign Up Now!

Volume III, Issue 1
Winter 1992

Journey to the East: Orthopedic Surgery in China
By Dr. Jeffrey K. Taylor
During late September and early October of this year, I had the opportunity to visit Mainland China. We made the trek at the invitation of relatives who have been posted to the U.S. Embassy in Beijing, as well as to visit with an old friend who is the Dean of the Peking Union Medical College. In addition, I had been invited to give a seminar to the orthopaedic surgeons in Beijing, sponsored by the China-Japan Friendship Hospital.

China is a country a little larger than the continental United States with a population of over one billion people. From a standpoint of industrialization it is still a developing nation yet it has a rich culture, stretching back continuously for nearly five thousand years. My impression of China was formed through the course of a four thousand mile, circuit around China by airplane, riverboat, bus and train. The great accomplishment of their past, such as the construction of the Great Wall, and the splendid culture demonstrated in the Forbidden City of Ching Emperors, stand in contrast with China’s difficult struggle into the modern age. Every where we went, we found the people to be gracious, friendly and extremely hard working. Despite frequent government propaganda critical of the United States, the people tend to hold Americans in high esteem.

The contrast of traditional Chinese culture, blended with the ongoing struggle for modernization that we saw throughout China, was also quite apparent in medical care and in the practice of orthopaedic surgery. While in Beijing, I spent an entire day at the China-Japan Friendship Hospital. This is the largest and most modern medical facility in the Chinese capitol. It was built seven years ago with financing from Japan, and houses over 1500 patients. When it was built, its Japanese sponsors outfitted it with the most modern diagnostic and treatment technology available and it represents one of the finest medical facilities in all of China. Nevertheless, the funds for continued upgrade of equipment are extremely limited and physicians are often forced to make do with older equipment and techniques.

I spent the day meeting with hospital officials, touring the hospital and rounding with the orthopedic surgeons on staff there. Nearly one-half of the medical specialties represented in the hospital were based on traditional Chinese medicines such as herbal treatments and acupuncture. The remainder were founded in Western medical disciplines.

Various types of arthritis presented in much the same patterns as they do in the west. Before being considered as a candidate for reconstructive surgery or total joint replacement, patients will be treated with both traditional Chinese and Western methods. My hosts felt that acupuncture did not offer significant prolonged relief from the symptoms of advanced arthritis of the hips or knees, but was often helpful in treating chronic low back pain and muscle strains. Traditional herbal remedies, as well as Western medicines are employed as anti-inflammatory agents to treat the early signs and symptoms of degenerative joint disease. Some of these traditional preparations have been found to contain naturally occurring chemical cousins of the anti-inflammatory drugs such as Ibuprofen and Indomethacin that are employed in Western medicine. Many Chinese will also use traditional exercise techniques such as Tai Chi to maintain flexibility and strength, in the face of advancing arthritis. In all cases, conservative means of treating arthritis are employed extensively, and a patient is not considered a candidate for surgery until he has failed these treatments.

Chinese orthopaedic surgeons have two different total hip prosthetic systems (both manufactured in China) available for implantation. The first is modeled after the traditional cemented Charnley prosthesis and is used most extensively in China. As a model, variations on the Charnley design have proved to be among the most successful of cemented hip replacements and Chinese surgeons are also having excellent success with this design in patients who are candidates for cemented arthroplasty. With patients who are younger, or at high risk for other reasons, the Chinese have begun to employ titanium porous-coated prostheses for cementless, biological fixation, joint replacement. This represents a relatively new technology available to Chinese surgeons and they are still gaining experience with it.

On the afternoon of my visit, I presented a two-hour seminar on joint replacement and reconstruction to about 75 orthopaedic surgeons who had gathered from the major teaching hospitals in Beijing. This developed into a wonderful exchange of ideas and experiences with the difficult problems of joint reconstruction. My hosts were extremely anxious to hear about the new developments in areas such as CT-based custom total joint replacement and surgical robotics. As skilled surgeons and diligent researchers, our Chinese colleagues were anxious to adopt and explore the most advanced techniques in orthopaedic surgery, but they are hindered by limited resources, in terms of both new technologies and advanced materials.

Return to top

SutterGold Club
Sutter Health provides various services for over 10,000 members of the SutterGold Club. This is a free program for mature adults (over 50). Some of the benefits of membership include free cholesterol and blood pressure tests, educational seminars, volunteer opportunity with the SutterGold Time Exchange Program (STEP), discounts, benefits when hospitalized, assistance with insurance claim forms, and the quarter SutterGold Club News.
For more information or an application for the free membership, call (916) 733-3084.

Return to top

Patient Billing
In an effort to avoid confusion and reiterate the information you received as a new patient, we feel it is important to summarize our billing procedure.

After any visits to the office, we bill all primary insurance carriers, which we have done since inception. For those patients that have private insurance, we do this as a courtesy.

For patients with Medicare coverage whose check is received at the patient’s home, we ask that you forward that check, or if you prefer, your own check to our office. Should you want us to bill your secondary or supplemental insurance, we must have the Medicare Explanation of Benefits (EOMB) that accompanies your Medicare check. No secondary insurance company accepts bills without the EOMB.

We will then bill your supplemental insurance as a courtesy. It is very important to remember that if after 30-45 days from an office visit you have not received a Medicare check to notify our office. We bill electronically and sometimes claims are not received by the Medicare carrier therefore we would need to re-bill the claim. Surgery billings generally take longer for payment because in most cases documentation must be sent with the claim form. Each month we send out a monthly statement of your account. These monthly statements serve two purposes. It notifies you that your insurance carrier has been billed. The statement also reflects any payments received by an insurance carrier, or by the patient and what balance remains for the patient to pay. Each insurance company has its yearly deductibles and these are also your responsibility to pay. The statement also lists the days and times best suited for inquires.

Remember, if your employer pays the insurance premiums, any questions or concerns regarding your claims, as well as your benefits, should be directed to them.

We welcome your payment at any time. We understand that medical costs can sometimes become a burden. Please don’t ignore bills that you are having difficulty in paying. We are willing to work with you to set up a payment plan. If this is necessary, please contact the office manager or the billing clerk.

Another important item to remember is to keep the office informed of any changes in your insurance coverage. This can be done at the time of your office visit.

Return to top

Some General Information About Radiological Studies
often Ordered by Drs. Bargar and Taylor
These up to date methods of imaging are used by many specialties other than orthopaedics Normally, one cannot simply walk in without an appointment for these tests. Because the scanning machines are highly utilized, it usually takes about a week to get an appointment for these studies.

MRI – Magnetic Resonance Imagining, does not use ionizing radiation (X-rays), nor does it require the use of injected or swallowed contrast agents to enhance images of the body’s organs. Instead, a powerful magnet, and radio waves are used. The procedure offers improved images of soft tissue like cartilage and ligaments, as well as, blood flow to bone. MRI helps in the detection of central nervous system disease, tumors and other diseases affecting the body’s organs. No special preparation is required by the patient prior to the test. Because of the magnet you will be asked to remove all metal objects that might be affected. The scan takes approximately 45 minutes to one hour. MRIs do not emit any radiation.

CT Scan – Computerized Tomography Scan is generally used by our office for the manufacturing of total joints or models used by the doctors for preoperative planning. It is a computerized X-ray that allows three-dimensional measurement of bones and soft tissues. No preparation is required by the patient. After being properly positioned, you’ll be secured with soft straps to keep you as still as possible during the scan. The scan takes approximately one hour. A CT scan emits approximately the same amount of radiation as a chest X-ray.

BONE Scan – A bone scan is usually ordered to help rule out loosening and infection in the bone around the prosthesis. No preparation is required by the patient prior to the scan. After arriving for the scan the patient is injected with a liquid called a radioactive element, Technecium-99. The agent is injected into a vein, usually in the arm. After the injection, the patient must wait three hours before they can be scanned. During that time the patient is free to leave the building. The scan itself then takes approximately one hour.

INDIUM Scan – This scan shows bone and soft tissue, it is used in conjunction with the bone scan to rule out infection. For this scan a small amount of the patient’s blood is drawn from a vein in the arm. The blood is then sent to a lab where it is spun down and the white cells are removed. A radioactive element, Indium-111, is added to the white cells to circulate throughout the body. The patient must then return to the scan center the next day to have the actual scan done. The test takes approximately one and a half hours to complete. Radiation exposure in a bone or indium scan is less than a series of back X-rays or a barium enema.

Staff Profile
Born in Hackensack, New Jersey; Mary moved to California at the age of 12. She has been working in the medical field for the last 8 years. She has been married to Jim Minix since November 1988.

While working for a medical billing service she met Anna Amos. Mary accepted a full time position with Dr. Bargar in January 1987. During the summer of that year she went back to school to become a limited X-ray technologist under Dr. Bargar’s direction. Mary then decided to continue her studies, and in August of 1991 she received her Certified Medical Assistant license. At your next appointment you’ll notice that she has switched positions with Betty Lowe. Betty, who is also an X-ray technologist, is now taking X-rays and Mary will be the medical assistant. This is due to Mary’s anticipated birth of her first child in May of 1992.

When not at work, Mary enjoys time with her family, most of who live in the area. She also enjoys snow skiing, art and trips to Tahoe. She and her husband have also been busy preparing their home for the new arrival.

Return to top

Patient Concerns
Q: Why was I advised to stop taking aspirin prior to my operation?

A: Aspirin contains a chemical called salicylate, which inhibits platelet activity thereby interfering with the clotting mechanism of blood. During an operation every effort is made to reduce blood loss by the surgeon and undue bleeding can occur if the patient has salicylate in their systems.

At the time the decision to have surgery (any type) is made the doctor will want to know about all the medicines you are currently taking, so it is very important to name all the medicine, even over the counter drugs. The following is a partial list of medications affecting platelet action:

All arthritis medications commonly grouped as NSAID (Non Steroidal Anti-Inflammatory) include Ibuprofen, Advil, Motrin, Nuprin, B7fferin, Anacin, Bayer, Ecotrin, Niacin, Coricidin, Darvon, Empirin, Norgesic, Percodan, Roboxin, Sudafed, vitamin E, fish oil, Pepto Bismol, Naprosyn, Feldene, Clinoril, Voltaren, Lodine.
These are only a few commonly used medications one should avoid prior to any surgical procedure. For aspirin or aspirin containing products, we recommend stopping the medication two weeks prior to the procedure. For other NSAIDs, 48 hours before surgery is sufficient.

Return to top