Dr. Jon Wagner is a man on a mission. The associate professor at the University of New Mexico bought a $30,000 rapid-prototyping machine for his office. He's convinced he can improve surgical outcomes by practicing on accurate physical models before stepping into an OR. By his own estimates, the resulting reconstructive surgeries are about 25 to 33% shorter, saving up to an hour in some cases. What's more, the prep halves the number of secondary surgeries occasionally needed to correct particularly severe trauma. But here's the rub.

Medicare and insurance companies don't seem to care about more efficient surgeries and so provide no reimbursement for the equipment and models. You might expect such short sightedness from Medicare, but not insurance companies. You'd think they would be open to new ideas and encourage other surgeons to follow suit if the benefits are what Wagner claims.

To be sure, Medicare and insurance companies can't reimburse unproven procedures. Wagner acknowledges he must document the savings and advantages and then present them to Medicare committees as an ROI study. But he's not asking for a handout, just a hearing.

Wagner outlines a typical surgical scenario like this: Suppose a kid comes into the OR with a face that met a hard line drive. An MRI scan reveals bone fractures, fragment locations, and more. Computers can clean up the data to show just the skull with the bone fragments out of position. Within six hours, the RP machine builds a full-size skull model reflecting the damage.

With model in hand, Wagner can size braces and screws to hold broken bones in place. Without the RP model, he'd only work from X-rays and do the work in the OR, around soft tissue that covers the boy's face. That would take place while the patient is under anesthesia, thereby lengthening the surgery.

Wagner and others like Andy Christensen, president of Medical Modeling LLC, Golden, Colo., say the next step toward letting the technology benefit a wider audience is proper coding for Medicare billing. Christensen says he knows of no one who has solved the reimbursement puzzle. He admits there are ways to get modest reimbursement, but when he charges $750 to $2500 for a model, gleaning a few dollars seems pointless. There are insurance codes for 3D imaging in radiology and a 3D RP model is something of a radiograph. It's also possible to bundle the model with corrective surgical procedures.

Christensen hasn't yet published his ROI data but says it supports findings from other countries. He says a group from Australia has been lobbying for medical codes and government funding there and has had a difficult time as well.

Lest you think this is just an issue for wealthy doctors, suppose you're the parent of that injured Little Leaguer. Would you want the surgeon to build a 3D skull model for practice and a clearer picture of what he's facing, or just do things the old fashioned way?

What really ticks you off?

As we begin planning for the second half of 2005, we'd like to slate a few spot-on Web casts and articles dealing with design and manufacturing issues that are the biggest thorns in your side. We'd like to know:

• What design problem has turned you into an insomniac?
• What software do you think might reveal more insight to your products?
• Or, what is your biggest gripe working with suppliers?

To get at the root of these problems, we invite you to answer these questions and several others at survey.medicaldesign.com.

Tell us what really bugs you.