Each year, a new record for outpatient and inpatient surgeries is set. And employers feel the pain, in the form of costs being passed along in premium hikes.

U.S. doctors will perform an estimated 75.5 million elective surgeries this year. Some 35.5 million are outpatient surgeries, while another 40 million require a hospital stay of at least 24 hours. Odds are at least one employee on your health plan will go under the knife at some point in the next two years.

Reimbursing hospitals and surgery centers has become a major strain on insurance companies. As such, the costs are passed along to plan sponsors. Those with high utilization of surgical services get clobbered  when it comes time for policy renewal.

To some extent, there’s no way for plan sponsors to avoid taking the hit. After all, that’s why health coverage is such a valuable benefit to employees in the first place. When there’s a medical need for surgery — and if surgery can correct a health problem – it’s a justified expense. 

The problem is that some doctors are quick to recommend surgery to patients. Beyond that, improvements in diagnosis technologies have also served to increase the number of surgeries that get performed. As a plan sponsor, you have a couple of options to help mitigate these effects.

Second surgical opinions (SSOs)

If your health plan doesn’t require second surgical opinions (SSOs) prior to certain procedures, you may want to add this policy. With proper employee education, an SSO gives employees and their dependents an incentive to make sure the surgery is medically necessary.

Example: Patients who don’t get an SSO before the surgery may have to pay half (rather than, say, 20%) of the cost of surgery and anesthesia. But with an SSO, the plan may even waive the 20% coinsurance requirement.

The key: Make sure employees understand what elective surgery means. SSO lists often include serious operations like knee surgery, spinal surgery and hysterectomies. Many people don’t realize these are elective surgeries, even if one doc recommends it.

Eliminating dubious pre-op tests

Evidence-based medicine has become a buzz phrase in this era of consumer-driven healthcare. But what does it mean in real-life terms?

Where surgeries are concerned, it means there’s an opportunity for your plan to eliminate certain questionable pre-op tests before outpatient cases. According to Outpatient Surgery Magazine, these tests usually do little but drive up costs and cause the employee to miss work a day or two before surgery:

• chest X-rays and heart rhythm tests
• urinalysis, and
• blood testing.

Unless an employee’s medical history indicates that these tests are needed, many medical experts say they can be done away with.

The same thing goes for anesthesia care.Anesthesia-related costs can be held down if your company’s health plan favors lower-cost care that typically works just as well as higher-cost options.

For example, if someone isn’t at high-risk of post-op nausea and vomiting (PONV) there may not be a need to routinely cover use of high-cost PONV drugs.Young, female non-smokers are generally the highest PONV risk group, along with those who’ve had past histories of getting sick after surgery.