Sunday, March 15, 2009

Bad Economy Leads Patients To Put Off Surgery, or Rush It - NYTimes.com

As the recession deepens, doctors and hospitals are reporting that hard-pressed patients are deferring elective surgery, like knee replacements and nose jobs, even as others are speeding up non-urgent procedures out of fear that they may soon lose their jobs and health insurance.

With unemployment still rising, there are wide variations by region and type of surgery. That means that highly regarded orthopedic surgeons in Chicago may be as busy as ever, while gastroenterologists in Atlanta are scrambling to fill cancellations.

But even those whose operating rooms are booked months in advance say they anticipate a slowdown later this year.

Delaying elective procedures can have serious medical consequences, as when a detectable polyp develops into a tumor because a patient skips a colonoscopy. Some hospitals said their emergency rooms were already seeing patients with dire conditions that could have been avoided had they not deferred surgery for economic reasons.

"We're probably seeing five or six of those a day at each of our hospitals," said Zeff Ross, a senior vice president at Memorial Healthcare System, which operates six hospitals in South Florida. "Someone gets an attack of diverticulitis, but they wait. They get it a second time and the doctor tells them to get the surgery done now, but they still wait. The third time, it perforates and that's a much tougher surgery, much more dangerous for the patient and with a longer length of stay."

The slowdown is likely to have significant financial repercussions. Elective operations are typically covered by private insurance plans that tend to reimburse hospitals and doctors at higher rates than government insurance programs like Medicare and Medicaid. As those payments dwindle, so do hospital profit margins and the resources to provide charity care to a growing number of uninsured.

"Elective admissions could represent only 9 or 10 percent of a hospital's admissions and yet represent 25 percent of its bottom line," said Michael A. Sachs, chief executive of Sg2, a health care consulting firm. "They're the patients that subsidize the underfunding associated with Medicaid and Medicare patients and uncompensated care."

The loss of revenue and growth in uncompensated care is conspiring with other byproducts of the recession — declining philanthropy, battered investments and tight credit — to force many hospitals to lay off workers, postpone expansions and cancel equipment purchases.

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http://www.nytimes.com/2009/03/14/us/14surgery.html?pagewanted=print