At the urging of a medical device maker, employers are considering whether to promote a less costly form of surgery that may reduce the time people take off work.
Experts say minimally invasive procedures known as laparoscopic surgeries are less costly in the long run compared with traditional open surgery. Using a laparoscope to look inside the body via a video monitor, the surgeries—if done without complications—are less traumatic to the body, resulting in reduced hospital stays and returning people to work faster.
While minimally invasive surgery using laparoscopes has been around for years, it is being applied to a growing number of surgeries, from gastric bypass to hysterectomy. Concerns remain that some doctors may not have the skills or experience to perform these procedures.
Instrumental in this growing discussion among employers is medical device maker Ethicon Endo-Surgery, which has met with employers to talk about the potential benefits of minimally invasive procedures.
“The whole gist of what we do is to simply educate,” says Matt Moore, director of health care policy and economics for Ethicon, a subsidiary of Johnson & Johnson.
If done right, minimally invasive procedures promise employers greater value for their health care dollars, says A. Mark Fendrick, director of the University of Michigan Center for Value-Based Insurance Design, which is funded with support from Johnson & Johnson.
A maker of products used in minimally invasive surgeries, Ethicon has met with employers and employer groups since fall 2006, when it sponsored a meeting for employer members of the Midwest Business Group on Health in Chicago. Ethicon presented case studies that showed how minimally invasive procedures allowed patients to return to work more quickly.
The Knoxville, Tennessee-based HealthCare 21 Business Coalition also made a presentation on how benefit design could encourage the use of minimally invasive surgeries.
“Ethicon wanted to see whether benefit design covered this kind of surgery,” says Larry Boress, president and CEO of the Midwest Business Group on Health. “If it’s not built into the benefit design, then they have real problems getting doctors to invest in it.”
Moore says Cincinnati-based Ethicon does not tell employers whether to cover minimally invasive procedures or to create incentives for employees to choose them over open surgery.
“The whole point of this is to deliver appropriate information around minimally invasive procedures.”
Jerry Reeves, chief medical officer for the Hotel Employees and Restaurant Employees International Union in Las Vegas, formed a group to study minimally invasive procedures after receiving medical journal publications from an Ethicon salesman and seeing an increase in the procedures being paid for by other health plans. One concern is that patients will go to doctors who may not be adept at the procedure.
"We’re trying to evaluate the medical and health outcomes of advanced minimally invasive procedures, whether they generally offer significantly more value than open procedures, and how to identify hospitals and surgeons with the team skills and experience resulting in superior outcomes from these surgeries,” he says, “rather than just opening up coverage for a bunch of less experienced surgeons with poor outcomes who may be practicing these new techniques on unsuspecting patients for the first time.”
Likewise, to avoid the health and economic costs of complications from surgeries, SC Johnson & Son, a maker of cleaning products in Racine, Wisconsin, developed a network of hospitals whose doctors were evaluated as providing high-quality minimally invasive care, according to the company. Patients who go to these centers pay half the out-of-pocket cost they would pay elsewhere.
—Jeremy Smerd
