The government could stop tens of thousands of needless surgical operations and save more than $150 million if Medicaid and Medicare patients were required to get a second opinion before surgery, a Department of Health and Human Services report concluded.
The report, by HHS Inspector General Richard Kusserow, disagreed with the HHS agency responsible for programs in the area--the Health Care Financing Administration (HCFA).
"I am convinced," Kusserow said, "that further delay in implementing a mandatory second-surgical-opinion program can only result in more health-care funds wasted . . . . I recommend that this matter be included in the department's" next budget. HCFA has maintained that, even though it appears a program requiring second opinions would save money, years more study are needed.
Kusserow estimated that more than $157 million could be saved in Medicaid and Medicare, even if only nine kinds of elective operations were counted. He said that in Medicare alone, patients could be spared more than 37,000 needless operations each year.
Kusserow said that money would be saved not only when a second doctor concluded surgery was unnecessary, but also when the first doctor consulted used extra caution because he knew a second opinion would be coming.
The government already has a program encouraging Medicare and Medicaid patients to seek a second opinion. But Kusserow wrote, "individuals simply do not voluntarily seek second opinions."
In states that have adopted mandatory programs--Massachusetts, Michigan, and Wisconsin--elective surgery cases have dropped between 20 and 35 percent and each state has saved an estimated $1 million to $3.7 million annually, the report said. Surgery that is elective and that experts say is often needless includes repair of hernias or vericose veins, hysterectomies, and cataract removal.
Opponents of the mandatory plan say that a second opinion would cause the surgery rate to rise in some cases. A spokesman for Blue Cross-Blue Shield said a patient advised by one doctor to have an operation often will refuse, but a second, confirming opinion will convince the patient to have surgery.