BOSTON--(BUSINESS WIRE)--The latest data analysis from ConsumerMedical shows that elective surgeries declined by 65 percent from March to April of 2020 compared to the same period in 2019, at the early phases of the COVID-19 pandemic. During that time, there was also a 35 percent decrease in physical therapy visits, 30 percent fewer office visits for surgery-related conditions, and 41 percent fewer injections to manage pain.1
The findings highlight two issues that will impact employers and health plans in the coming months: 1) thousands of patients have not received the care and support needed to alleviate pain and address an injury or condition, and 2) hospitals and surgery centers will be looking for ways to recoup losses from postponed elective surgeries. These factors create the perfect storm for driving a surge in incidence rates and costs for employers, payers and patients.
ConsumerMedical provides decision support and clinical advocacy services through some of the nation’s largest employers and health plans to more than 4 million people nationwide. The elective surgery analysis included a review of nearly 200,000 surgery claims covering more than 400 employer groups nationwide.
The company’s analysis of claims also highlights other information of interest to employers and payers, including:
- More than 30 percent of elective surgeries don’t follow best practice protocols
- Between 5 and 10 percent of patients are misdiagnosed
- More than 60 percent of patients receive an incorrect treatment plan
“The realities of elective surgery today highlight the value of ConsumerMedical’s Surgery Decision Support program,” said Randy Hawkins, MD, FACHE, Chief Medical Officer & Executive Vice President, Health Analytics. “As the pandemic persists, and delays in elective surgeries continue, employers, and insurers will need programs that help employees and members make informed decisions regarding treatment plans and elective surgical procedures.”
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 treatment options for surgery that also support clinically recognized best practices. Non-surgical options include diet and exercise, physical & behavioral therapy, steroid injections, chiropractic care, or acupuncture.
Overall, companies participating in an SDS program have seen 30 percent of patients changing to a best practice treatment and 20 percent switching to providers with more successful surgery track records, resulting in 37 percent of employees and members avoiding unnecessary surgery altogether. The overall ROI for participating in ConsumerMedical SDS programs is 4:1. Participant satisfaction rates for the program are over 96 percent.
ConsumerMedical has developed an infographic for further information on trends and issues affecting elective surgery. For more information on the Surgery Decision Support program and to download the white paper and infographic visit ConsumerMedical’s Elective Surgery Support Center here.
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 continuously validated by independent actuaries. www.consumermedical.com