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Sending patients Outside doesn't cut it

Nancy Salois

Medical care Outside to "save money" is an oxymoron. This concept brings to mind many, many concerns -- here are a few of mine:

• If the insurance company's contracted surgeons are following accepted protocol for their billing practices, then the surgery price includes 90 days of follow-up visits. Will the insurance companies put patients in hotels for 90 days? If not, who does the follow up on these "outside operated" patients?

If patients develop complications post-op and need to be seen, who sees them? The emergency department? How is that cost savings? If the insurance companies expect local surgeons to see them, they need to consider that the patient will be an emergency patient with possible post-op complications, not a routine patient. They will require an extended visit with surgical records review from the operating surgeon (if they can even get those records from out of state) and then treatment and follow-up will have to be undertaken. There will be charges for these services by the local surgeon because they weren't paid the initial surgical fee.

The local surgeon will be working with a full schedule of his/her own patients and will have to work in a possible emergency to treat someone else's patient. How is that serving anyone?

• The Daily News story of Sept. 2 mentioned knee replacements. It is generally medically recommended that patients do not fly for at least four weeks after major lower extremity joint replacements because of the increased risk for deep vein thrombosis or pulmonary embolus (blood clots). Will the insurance company put these people in hotels for those four weeks, paying all of their expenses? Most general anesthesia patients are required to have someone stay with them for the first 24 hours after surgery. When does the "companion" get sent back to Alaska?

• The federal government defines reasonable prices for Alaska surgeries. If a surgeon charges more than "reasonable and customary," the patient has the right to choose another surgeon. Surgical fees include 90 days of follow-up with a recommended number of visits within these 90 days. Some patients may require more visits than others and if they need to be seen 10 times or 20 times post-op in those 90 days, they are, usually at no additional charge.

Does the insurance company plan to fly these Outside patients back and forth for their post-op rechecks, since the surgical fee paid to the Outside surgeon included payment for these visits? Someone has to take care of these patients post-op. Who is going to do that?

These are just a few of my questions. There are many more things to be considered with Outside options for medical care.

Insurance companies don't see patients as people, they see them as financial drains. What is good for their bottom line is not necessarily in anyone's best interest. One post-op complication due to early travel or lack of follow-up can cost far more than an initial surgical fee charged by a local Alaska surgeon who is here, on call, to detect and treat post-op complications in a timely manner.

This policy may look good on paper but it is a disaster waiting to happen. I work in orthopedics and have for 26 years. I am all for cutting costs for medical care but this is a bad idea from every angle except the bottom line for the insurance companies -- and even then, I think it will prove to be more expensive in the long run, in more ways than monetary.

One last thought: If the patient is being "sent Outside" for cheaper medical care, do they also get to pay "Outside" insurance premiums, which I assume are cheaper than here in expensive Alaska?

Nancy Salois is a licensed practical nurse with more than 30 years experience, 26 of those in orthopedics. She lives in Anchorage.


By NANCY SALOIS