Teaching Hospitals Struggle With Inpatient Surgery ‘Boom’

Inpatient surgery volume is "booming" at Massachusetts' top teaching hospitals, sometimes leading to long waits for elective surgeries, the Boston Globe reports. The rise in inpatient surgeries is surprising to some industry experts who, in the early 1990s, predicted that cost constraints under managed care and new technologies would drive down inpatient surgery volumes and shift outpatient procedures to smaller community hospitals and physicians' offices. Heeding advice from consultants, many hospitals closed beds to reduce costs; at Massachusetts facilities, the number of beds dropped from 19,918 in 1994 to 16,493 in 1998. But with technological advances, more patients are now eligible for a variety of operations. Additionally, physicians are beginning to feel more comfortable operating on older, frailer patients. At Massachusetts General Hospital, for example, the average age of heart surgery patients is 70 years old, compared with 62 in 1985. Furthermore, technology has expanded the range of elective surgeries, which baby boomers have "wasted no time requesting," the Globe notes. At the same time, new technology has also meant that operations that used to require overnight stays now can take only a few hours, so hospitals have scrambled to schedule more patients. Minimally invasive surgery techniques have had a "dramatic" impact on operations -- between 1990 to 1997, outpatient surgery in the U.S. "zoomed" up 32%, according to the Globe.

As a result of surgical advances, Massachusetts hospitals are facing a crunch in their operating rooms. Most insurance companies in the state allow patients to choose where to go for medical care, and many are electing to go to the top teaching facilities, overcrowding ORs. The problem is compounded by many hospitals' economic turnaround plans: according to Boston Medical Center's head of surgery, the hospital focused on expanding surgery programs because "that's where the money is." Surgeries at Brigham and Women's Hospital have increased 25% across the last five years -- during which time the hospital closed more than 130 beds -- and the waiting time for an elective joint replacement can be as long as two months, even though the hospital has 36 ORs. To combat the crunch, Brigham and Women's has partnered with Faulkner Hospital; Brigham performed 1,609 surgeries there last fiscal year, and is currently adding an eighth operating room at Faulkner. BMC, where "aggressive" recruitment of 25 new surgeons led to a 20% growth in day surgery last year, is now taking overflow to Quincy Medical Center. And Tufts Health Plan hospitals have seen a 17% increase in outpatient surgeries in the last four years, while New England Medical Center added 30 beds last year after a 5.5% surgery volume increase. However, hospitals in the "financially struggling" CareGroup are among the few where surgery has declined, dropping 2% last year (Kowalczyk, Boston Globe, 11/20).