Posted on 11/11/2013 1:39:18 AM PST by Cincinatus' Wife
For decades, health care was considered a recession-proof business.
It's time to rethink that, some health and business experts say. The industry's stability no longer can be taken for granted.
More than half of people surveyed, 57 percent, report they put off or skipped some form of health care in the past year because of cost, according to a September report by the Kaiser Family Health Foundation.
One specialty taking a hit is surgery, doctors and medical experts say, and not just because patients worry about money. They worry, too, that recovery time will keep them out of the office and jeopardize their jobs in a weak economy.
“I have never seen people as afraid of losing their jobs as they are now, and that's why so many delay surgery,” said Dr. David Cooper, a knee specialist from Wilkes-Barre and spokesman for the Pennsylvania chapter of the American Academy of Orthopedic Surgeons.
‘Universal' declines
The number of surgeries performed each year has declined nationally since the 2008 economic downturn.
A study by the Health Care Cost Institute in Washington found that the number of inpatient surgeries in American hospitals dropped more than 5 percent each year from 2009 to 2012.
“We are seeing a reduction in the number of hospitalizations. At the same time, there has been no real increase in outpatient procedures,” said Carolina-Nicole S. Herrera, director of research at the institute.
According to a survey of 58 hospitals by the Hospital Council of Western Pennsylvania, inpatient surgeries decreased by 4.13 percent, or by 6,713, from June 30, 2012, to this June. Outpatient procedures declined by 10,643, or 3.45 percent.
“It is pretty much universal that we are seeing declines. A lot of that has to do with high deductibles. They are a problem for the hospitals,” said Dennis Lukes, council vice president.
When the number of surgeries drops, it hurts the bottom line of hospitals and health care conglomerates, said Yaa Akosa Antwi, a health care economist at Indiana University in Bloomington, Ind.
“Surgeries are an important part of hospital revenue, even though the cost varies between procedures and at different hospitals,” Antwi said.
Last month, Indiana University Health hospitals laid off 800 of its 36,000 employees.
“A decline in admissions and surgeries were one of the reasons they cited for the layoffs,” Antwi said.
Megan Neuburger, an analyst at Fitch Ratings in New York, said the drop in surgeries is reflected in the flat or poor earnings of many for-profit hospitals and medical device companies she tracks.
“There's a hangover from the weak economy. There are still many people out of work. Many people who do work are nervous about being out of work for a long time for surgery,” she said.
Price to pay for delay
Cooper, who has performed knee surgeries in Wilkes Barre for 30 years, estimates there has been a 30 percent increase in the number of his patients who delay surgery. That means patients often are in worse shape when they finally undergo an operation.
He recalled a 38-year-old stone mason who put off knee surgery to repair torn cartilage for nearly a year.
“It got so bad that he could not even straighten his knee. He finally got operated on. But, as a result of waiting for surgery, he now has traumatic arthritis. That's a condition that will never go away,” Cooper said.
In 2008, Allegheny Health System performed nearly 6,000 inpatient surgeries. Last year, it recorded 4,462 inpatient surgeries. In July, the Allegheny Health Network laid off 262 workers and eliminated 200 open positions to match staffing levels to lower patient volume.
“We think that our reduction in surgeries was mostly due to the partial shutdown of West Penn Hospital,” said Stephanie Waite, a spokeswoman for the health system.
West Penn's emergency room was closed in 2011 and part of 2012.
UPMC, the region's largest hospital system, performed 174,000 surgeries last year, according to its website. Spokeswoman Susan Manko said she did not have numbers for other years.
The Butler Health System has added services and about 30 off-site locations since the late 1990s, including four urgent care centers. The hospital has a partnership with the Benbrook Medical Center in Butler Township, an outpatient surgery center.
“While most facilities report a decrease in surgical procedures, we are experiencing a slight increase due to our new neurosurgical doctors and our cardiology outreach strategy,” said Karen Allen, Butler Heath System's chief nursing officer.
Cash crunch
Pat Rafaelle, vice president of the Hospital Council of Western Pennsylvania, said more employers and individuals are buying insurance plans with high deductibles to keep rates down.
“Often, people might not have the thousands of dollars they need to pay for a surgery. Everyone — individuals and employers — winds up paying more,” Rafaelle said.
Before 2009, insurance claims were rising 7 percent to 8 percent each year, according to Phil Neubauer, a spokesman for Highmark, which insures 5.5 million people in Western Pennsylvania.
“For the last few years, that's fallen to 2 to 4 percent,” he said.
Dr. Jim McCormick, a colorectal surgeon in Allegheny General Hospital and president of the Southwest Pennsylvania Chapter of the American College of Surgeons, said he has noticed for about four years that delays are more likely to happen in ophthalmology and orthopedics.
“But every once in a while, I'll have a patient delay cancer treatment because they are between jobs and don't have coverage,” he said.
McCormick said some patients skip MRI and CT scans because of large co-payments. Deductibles for such tests can be as much as $500, he said.
“People will call the office and say, ‘I just can't have this test done.' Access to health care is an issue for many of these people,” he said.
Some elective surgeries, such as plastic surgery, are not medically necessary, and some cardiac surgeries and most orthopedic procedures can be delayed, doctors said.
“These conditions are not like cancer or something that really has to be dealt with immediately,” Cooper said. “Many of these people manage by taking narcotic painkillers. Some of them get hooked.”
I’ll be honest - my job woes started in the days of Bush, thanks to H1B visas.
Obama and Obamacare make it worse, but the constant influx of foreign slave labor, along with their non-American outlook on life, has been a bi-partisan nightmare project from both parties.
Also, this disaster is ALSO of the health-care system’s making. For decades now, there have been no effective price controls - patient’s insurance plans pay for everything, creating no patient-level consumer incentive for the price to be made reasonable.
Has some great health-care technology come out of this? Yes. Is it available at a price that one can pay off on their own in a reasonable time (like car payments)? No.
So, in many respects, Obamacare is exposing many faults in our system that existed before it. Maybe, in forcing things back to square one, these flaws will get fixed - but by this manner, at the cost of many lives.
They delay surgery any longer, and it’ll be even more expensive under ObamaCrapCare.
Hospitals should be avoided, if at all possible. The number of deaths that result from hospital-caused infections is staggering. Only as a last resort should anyone check into these MRSA breeding grounds.
You ain’t seen nothing yet, with Obungacare deductibles, society will look like the Limping Dead.
We’re postponing anything we possibly can. $12k/yr policy with $6000 deductible. We’ll get close to the deductible if we don’t hit it.
And this is before commie care hits. Can’t wait.
I learned yesterday that a good friend became infected with MRSA at the site on his shoulder of his flu shot injection......... given in the Doctor’s office!
His free flu shot ended up costing over $150 for the surgery, medication and Doctor’s visits resulting from the MRSA infection
I go to the same medical group offices but different doctor......not a pleasant thought
You have to differentiate between the healthcare system and the healthcare delivery system. What is good and bad about our healthcare system and what is good and bad about our delivery systems. How does the healthcare system affect the delivery systems and vice-versa
Obamacare is simply an additional delivery system added to the pre-existing delivery systems and it is supposed to give insurance to those who couldn't afford insurance or who could afford only inadequate insurance, or who couldn't get insurance because of pre-existing conditions.
Most people will continue to get their healthcare delivered thru their employer based insurance and Medicare. And if you work in retail or food, your employer insurance is probably not very good.
"Has some great health-care technology come out of this?"
This article talks about reductions of inpatient surgery and one of the main reasons for that is advances in micro-surgery which means more outpatient surgery. Used to be a hernia operation required 3 days, now 3 hours.
Good points.
Lawsuits drive up health costs (patients are required to undergo all sorts of tests for CYA and to protect the "delivery system"). We need lawsuit abuse reform and the sale of healthcare ins across state lines.
I’m expediting my surgery because it will soon be considere an “elective” luxury, like getting a nose job. Even though I can’t lift a small cat over my head with my left arm. You see, I don’t NEED to lift up a cat for my job, so how would fixing the problem help The State?
Access denied comrade! Next!
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