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Cost, fear of taking time off have many patients pushing surgery to back burner

Philip G. Pavely | Tribune-Review - A Butler Memorial Hospital operating room is set up on Thursday, Nov. 7, 2013. While hospitals nationwide have seen a decrease in surgical procedures, Butler Health System has recorded an increase as a result of tnew neurosurgical doctors and cardiology outreach programs, officials said.
<div style='float:right;width:100%;' align='right'><em>Philip G. Pavely | Tribune-Review</em></div>A Butler Memorial Hospital operating room is set up on Thursday, Nov. 7, 2013. While hospitals nationwide have seen a decrease in surgical procedures, Butler Health System has recorded an increase as a result of tnew neurosurgical doctors and cardiology outreach programs, officials said.
Philip G. Pavely | Tribune-Review - Nursing assistant Alex Calhoun sets up an operating room on Thursday, Nov. 7, 2013, in Butler Memorial Hospital.
<div style='float:right;width:100%;' align='right'><em>Philip G. Pavely | Tribune-Review</em></div>Nursing assistant Alex Calhoun sets up an operating room on Thursday, Nov. 7, 2013, in Butler Memorial Hospital.
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Monday, Nov. 11, 2013, 1:31 a.m.

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.”

Rick Wills is a staff writer for Trib Total Media.

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