End of the year brings a crush of surgeries

  • Article by: CHEN MAY YEE , Star Tribune
  • Updated: December 24, 2009 - 8:52 PM

Patients who have hit their high insurance deductibles hurry to cram in elective procedures before Jan. 1.

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Dr. Jonathan Braman, right, assisted by resident Kate Pico, marked Jeffrey Scott for shoulder surgery Thursday at TRIA Orthopaedic Center in Bloomington.

Photo: Glen Stubbe, Star Tribune

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It's the season for fixing hips and knees, shoulders and elbows.

People slip on ice and snow. College kids come home for the holidays -- and elective surgeries. And, given the choice, most Minnesotans prefer to be in a sling in winter rather than summer.

Now add a new reason to repair that achy joint this holiday season: the high-deductible factor.

People with insurance deductibles tend to put off medical care early in the year because they have to pay out of pocket. Some then burn through their deductibles anyway because of unexpected doctor visits or a trip to the emergency room. Anything else they get done this year is covered by insurance so they're trying to cram in procedures before Jan. 1.

That's how Jeffrey Scott Buswell ended up at TRIA Orthopaedic Center in Bloomington recently, in a hospital gown and blue puffy cap, getting prepped for shoulder surgery.

Buswell, 52, had hernia surgery earlier this year, which helped him hit his $3,400 deductible. That prompted him to get his right shoulder repaired in September, rush through physical therapy, then come back in December for his left shoulder.

"I don't know if I would have fixed either one this year if I hadn't hit the deductible," said Buswell, a rock concert producer from St. Louis Park.

For Buswell and others like him, making the year-end deadline can mean a difference of several thousand dollars. Buswell's surgeon, Dr. Jonathan Braman, is booked solid from Nov. 1 through the end of December, despite adding hours.

"It's brutal," Braman said. "Space on the sched becomes a commodity."

Worsening problem

It's a problem that's only going to get worse as more people get insurance with high deductibles.

About 13 percent of insured Minnesotans -- or 550,000 people -- now have high-deductible health plans paired with health savings accounts. These plans, which have been around since 2004, have deductibles of $1,150 and up for single coverage and $2,300 and up for family coverage.

Even those with traditional plans are facing higher deductibles. Blue Cross and Blue Shield of Minnesota's Personal Blue policies, for example, have deductibles of $1,500 to $4,500.

Doctors report that deductibles do affect patient behavior. Many patients now ask about price. If in the past they demanded a costly MRI, now they'll question whether they need one. The plans' advocates say this sort of engagement is a first step to curbing the nation's runaway health costs.

But once the deductible is met, "they go right back to their old behavior," said Maureen Swan, a principal at health care consultancy MedTrend Inc. The incentive then is to use as many medical services as possible at little or no extra charge before the new year.

Of course, nothing is free in health care, and these extra procedures can translate into higher future premiums. But that doesn't stop people from viewing them as an early gift from Santa.

To be sure, not every provider is enjoying a year-end boom during what's been a tough period for health care.

Officials at HealthEast Care System, which has clinics and hospitals in the east metro, have not noticed an increase in elective procedures. In fact, volumes dipped at St. John's Hospital in Maplewood.

A year-end crush of surgeries

But many others are staffing up and adding hours to cope with a year-end rush.

At Fairview Ridges Hospital in Burnsville, doctors are set to do 900 surgeries of all types in December, compared with an average of 800 in other months.

At Abbott Northwestern Hospital in Minneapolis, overall surgery volumes have topped 100 a day for the past six weeks, up from the usual 80 a day. Patients are coming in for all kinds of surgeries --podiatry, bariatrics, c-sections and yes, orthopedics.

Hospital officials speculate that the weak economy also has played a part in the year-end crush. Some who had been putting things off because of the economy simply can't wait any longer. Others are afraid of losing their jobs and want to use their insurance while they still have it.

"We really try to accommodate these guys," said Dr. Scott Anseth, medical director of Abbott Northwestern's joint replacement program. "But we've probably lost some patients because we don't have enough time."

At TRIA, one of the biggest orthopedic centers in the Twin Cities, surgery volumes in November hit a record. The center, owned by Park Nicollet Health Services, the Orthopaedic Center and University of Minnesota Physicians, has chalked up almost 6,000 procedures so far this year, up 7 percent from last year.

Irked by perverse incentives

But the perverse incentives at play irritates some doctors.

"You could not design a less intelligent system," Braman said. He thinks insurance companies should re-set the deductible on a patient's birthday, so as to spread the volume out across the year.

Recently, Braman's neighbor begged him to get her in to remove a lipoma -- a benign tumor -- from her elbow. He created a spot for her where none existed before: 6:30 a.m. on New Year's Eve.

Until then, no place is safe for an orthopedic surgeon.

Dr. Alan Markman was enjoying a holiday party for Dartmouth alumni at Gluek's Restaurant and Bar in downtown Minneapolis when a friend approached. "My knee's killing me," the friend said. Could he get in before Jan. 1?

The surgeon, who has been fixing joints for 25 years, likes to take a few days off between Christmas and New Year's.

"Not this year," he said.

Chen May Yee • 612-673-7434

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