Report Shows Drop in Surgeries for Elderly

The number of prostate and gall bladder removals and hysterectomies decreased in California’s elderly in recent years, suggesting that some unnecessary surgeries are being avoided, according to a report being released today.

The report was prepared by California Medical Review Inc. of San Francisco, which is hired by the federal government to oversee the Medicare program in the state. Its first “annual summary of operations” documents efforts to save the government money while assuring that the elderly and disabled who are insured through the Medicare program receive quality medical care.

The firm, which has an annual budget of $22 million, said that it had saved the federal government $114 million between April, 1989, and March, 1990, by reviewing individual cases and refusing payment for unnecessary surgeries and other care.

It also confirmed 437 quality-of-care problems among Medicare patients in the state, including 60 problems with “serious adverse effects on the patient,” such as readmission to the hospital, permanent disability or death.

“Overall, the quality of care that is delivered in California hospitals is good,” said Jo Ellen H. Ross, the organization’s chief executive officer.

The report did not name the hospitals where quality-of-care problems were most frequently identified. It also did not name the two physicians who were recommended for federal sanctions, in one instance exclusion from the Medicare program for 10 years and in the other a fine.

The organization focused attention on four common surgical procedures in California’s elderly, which significantly decreased between 1988 and 1989.

* Transurethral prostatectomies, the removal of a male gland that surrounds the urethra, decreased from 21,752 to 18,162.

* Cholecystectomies, or gall bladder removals, decreased from 11,299 to 9,871.

* Major artery bypass surgeries decreased from 6,031 to 5,422.

* Hysterectomies decreased from 5,257 to 4,862.

Under a “prior authorization” program, physicians must obtain advance permission to perform these surgeries and six others.

The statistics document “the overall effectiveness of our prior authorization program,” Ross said. “While the number of these surgeries decreased, we did not observe a single case where someone who should have had one of these surgeries did not receive it.”

In other findings:

* The number of Medicare beneficiaries in California increased from 3 million in 1987 to 3.1 million in 1989. But the number of Medicare hospital admissions decreased from 855,351 to 809,917 over the same time period. These trends reflect increased outpatient care and decreased surgery rates.

* Hospital lengths of stay for common surgeries have decreased as well as the number of surgeries. For example, the typical length of stay for a hysterectomy patient decreased from 6.47 days in 1988 to 6.04 days in 1989.

Later this year, Ross said, California Medical Review plans to release some hospital specific data on quality of care and unnecessary surgeries. Such data would be released along with explanatory comments prepared by individual hospitals.