Are Hospital Denials On Requested Surgical Products Intruding Upon The Patient-Physician Relationship?

Patrick DeHeer DPM FACFAS

Many physicians have long considered enemy #1 to be the almighty insurance company. Having insurance giants dictate patient care is often too much to take. While the insurance companies remain thorns in our sides, some of us are taking notice of another challenge on the horizon, equally repugnant in its intrusion of the patient-physician relationship.

Hospitals have become more of an enemy and less of an ally for physicians. I have experienced several cases in which hospitals have denied the use of requested products for surgical cases. It always comes down to the cost of the product we are using. Sometimes, hospitals present an alternative and sometimes they flat out refuse the product.

The hospital never takes on the additional liability with alteration of a surgeon’s operative plan. Of course, the patient often gets left out of this process and potentially suffers from it. Another ignored factor in this is the additional stress on the surgeon by alteration of the operative plan.

Clearly, the costs of healthcare must be reined in and some of that responsibility falls on the physician. Should a surgeon take cost into account for similar products when deciding what to use on a case? I believe we should and think the system would be much better if more surgeons actually knew what some of this stuff costs. The expense of some of these products borders on criminal in my opinion and it does affect my decision-making process.

What is wrong with the system is when an insurance company is altering my surgical plan, for example with the use of subtalar implants. What is intolerable with the system is when a hospital alters my surgical plan without regard for the patient outcome and bases its decision solely on dollars and cents.

How does this play out in the future when pay for performance launches? If I want to use an amniotic membrane for a tarsal tunnel release and either the hospital or insurance company denies its use, what happens when my patient develops scar tissue and subsequent symptom recurrence? Am I penalized or will the hospital or insurance company take the penalty? I think it is pretty clear what will take place: the patient will suffer and the physician will be penalized.

This problem with both insurance companies and hospitals dictating to surgeons will only get worse. Evidence-based medicine will be critical to combat specific instances but ultimately, it will be the customer who will have to find a voice. I believe the customers — the patients — will protect the doctor-patient relationship on all levels, including letting me choose which locking plate I think is best for their first metatarsophalangeal joint fusion.

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