April 1 was an important day for many in Michigan. It was the day nearly half a million people in our state became newly eligible for the expanded Medicaid program.
Since then, more than 300,000 people have enrolled. Many have not seen a physician for a long time. Or, they have relied on emergency rooms for their medical care.
As revealed in a study published in the medical journal JAMA Surgery, there's good news and challenging news in all of this.
Certainly it's good that patients will be able to turn to a physician for medical care.
But the challenge is the overall poor health of many of these patients, especially surgical patients, and that has many implications – to the patients, to the hospitals and to the surgeons treating them.
Chief Medical Officer of the University of Michigan Health System, Dr. Darrell Campbell, Junior, talked about the study on Stateside.
Campbell analyzed data on 14,000 patients who had operations in 52 hospitals in Michigan from July 2012 to June 2013. The study looked at the Medicaid population and compared them to people with private insurance but were around the same age. The study analyzed the condition those patients were in prior to their surgical procedure.
“What we found was that they weren’t in very good shape,” Campbell said. “And that has consequences for the results after they have surgery, not only in terms of how well they do from physical point of view but also the cost and resources that are used afterwards.”
Campbell said there was a significant difference in surgical outcome and mortality between the two groups. Medicaid-insured patients had twice the number of complications as privately insured people and two-thirds as many for serious complications, and more than twice the chance of dying.
“I think the more we more we can get people into a structured medical system, the more we can interact and intervene to make their health a little bit better prior to a big surgical procedure,” Campbell said.
Campbell added that there are a number of things that can be done to make sure a patient's health is better before an operation, by quitting smoking, making sure they are on the right medications, treating diabetes, and training them to walk several miles a day.
Blue Cross Blue Shield of Michigan partnered with the University of Michigan Health System to try to improve surgical care. Together they created the Michigan Surgical Quality Collaborative. There are now 70 hospitals in the state connected electronically. They get together every three months to discuss how to improve surgical care.
They also created a pre-habilitation, which is basically a tune-up for patients.
“We put them through a boot camp prior to a big operation,” Campbell said. “It’s a very patient-centric approach. ‘Help me to do a good job on your surgery by getting in the best shape you could possibly get into prior to surgery.’”
Campbell believes that the state medical society should start making this happen throughout the state. Surgical costs adds a lot to the total bill to medical care in state, especially if the results are not good.
“If you improve the results in surgery, you cut costs; they go together,” Campbell said. “Better quality, lower cost.”
*Listen to full interview above.