Yesterday through Rumor Control, I heard, according to at least one orthopedic surgeon, that WMHS is now putting restrictions on patients in need of orthopedic surgery. I can assure you that any restrictions are not from WMHS –they are from those who eventually pay the bill for the surgery. The payors, particularly Medicare, want to make sure that less invasive treatment and therapy are occurring before the surgeon and the hospital jump right to surgery. Our orthopedic surgeons have always approached surgery very conservatively. However, in order to show a robust demonstration of compliance, we now have to document medical necessity prior to surgery through a preoperative checklist. We have to make sure that conservative treatments were tried and failed for at least 3 months before surgery is scheduled. Again, this is a requirement of Medicare, not the WMHS administration.
With all of the changes occurring in healthcare, we at WMHS have to do a better job of educating our physicians and staff as well as our patients. There are now so many restrictions that are being leveled at hospitals and physicians by the various payors that we need full-time staff just to track the ever changing requirements, such as the medical necessity checklist for hip and knee surgery.
I continue to be amazed at the ways in which the payors, especially Medicare, try to avoid paying providers for care that is delivered. There are many changes initiated by Medicare that have improved the delivery of care, but there are some that haven't. Stay tuned.
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