Analysis shows 30% of recommended surgeries could be better treated with non-surgical options
Boston – June 2, 2020 – An analysis of claims data outlined in the latest White Paper from ConsumerMedical shows that 30 percent – $30 billion – of the $100 billion spent on elective surgeries in 2019 was potentially unnecessary. The findings were reported today in the White Paper entitled, Strategies to Help Manage COVID-19’s Impact on Elective Surgical Procedures. The paper also provides data showing that unnecessary surgeries, those not recommended by clinicians as following best practices, can be avoided through education and support that helps employees and health plan members make more informed healthcare choices.
ConsumerMedical, a clinical advocacy and decision support firm, covers more than four million people and works with some of the nation’s largest employers and health plans. The analysis was undertaken to help provide guidance on best practices in managing the elective surgery process for employers and payers already navigating a myriad of issues during the unprecedented COVID-19 crisis.
To arrive at data highlighting the key trends and issues related to elective surgery demand, ConsumerMedical analyzed historical data from a large database of national observed incidence rates for specific elective surgeries and average episode costs. Applying those results to the entire U.S. employee population as documented by the Bureau of Labor Statistics, the company estimated that employers spent around $100 billion in 2019 on elective surgeries for hip, knee, back, bariatric, and hysterectomy. However, based on CM’s experience with surgery avoidance rates, up to $30 billion of that spend is unnecessary and sub-optimal in terms of patient outcomes.1
“During this crisis, our goal has been to help our clients’ employees and members cope with the physical, psychological and emotional toll of surgery delays,” said David Hines, CEO and founder of ConsumerMedical. “There’s still much we don’t know about the long-term implications of COVID-19. What we do know is that taking care of people and planning for a projected surge in volume are priorities for us. Our focus is on helping patients understand their options and obtain care from the highest-quality physicians and facilities.”
ConsumerMedical’s Surgery Decision Support® (SDS) program offers personal guidance from physician and nurse clinical allies who provide education, information and support on elective surgeries by helping participants understand these common elective procedures. Of equal importance, SDS provides insights on less-invasive and lower-cost treatment options for surgery. Non-surgical options include diet and exercise, physical & behavioral therapy, steroid injections, chiropractic care, or acupuncture.
While 30 percent of surgeries may not be necessary, some 70 percent are. For members for whom surgery is appropriate, ConsumerMedical identifies and matches the patient to the highest-quality physician in their health plan network with the most experience and the best outcomes for each procedure.
Results of the program are notable. The average rate of ROI is 4:1, with per-case savings of approximately $26,125.00 from avoided surgery. Most importantly, member satisfaction rates average 98 percent.
For more information on the Surgery Decision Support program and to download the white paper visit ConsumerMedical’s Elective Surgery Support Center
1Data analysis conducted by Santa Barbara Actuaries Inc. Further details available upon request.
ConsumerMedical is a leading clinical advocacy, decision support and expert second opinion company serving over four million individuals through some of the nation’s largest employers, health plans and private exchanges. The company has been serving patients and payers for more than 24 years. As a Medical Ally, ConsumerMedical guides participants throughout their healthcare journey with compassionate, high-touch support and deep clinical expertise. ConsumerMedical offers a fully integrated suite of solutions including Medical Decision Support®, Surgery Decision Support®, Expert Medical Opinion, Claims Advocacy and more, helping individuals and families navigate the healthcare system while improving outcomes and reducing costs. ConsumerMedical’s results have been validated continuously by independent actuaries. www.consumermedical.com
Joy Scott, CEO, Scott Public Relations