Self-insured employers: how many of your employees get surgeries they don’t need? Evidence suggests the number might be higher than you think.

Physicians say that as much as 11.1% of all surgical procedures are given inappropriately.

Each year, 500,000 patients get heart stents, and 700,000 patients get meniscus knee surgeries that show next to no clinical benefits.

Aside from the risks these unneeded procedures pose to patients, they also come at outrageous prices. The annual cost of unnecessary surgery for every 1,000 employees in your company — about $250,000.

Clearly, inappropriate surgeries are a problem you can’t afford to ignore. But what can your company do about them?

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On its surface, ‘Centers of Excellence’ looks like an intelligent strategy.

Self-insured employers, pursuing cost-efficiencies and streamlined care for employees, select certain hospitals to become provider-partners. They label these partners ‘Centers of Excellence’, and design their benefits packages around them.

But this model only works if employers rigorously scrutinize the provider’s quality of care. Unfortunately, their due diligence sometimes falls short. MPIRICA’s analysis has found that employers frequently select hospitals that may not have the strongest track record for surgical success.

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The term “Center of Excellence” (CoE)  is a powerful distinction. Self-insured employers have begun to apply this label to hospitals they partner with to deliver high-ticket, high-volume surgeries — like total knee replacements — to their employees.

For employers, the bundled pricing that CoEs offer (in exchange for a volume of patients) is an attractive prospect. But for the employees, the label means much more.

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