KY surgeons, surgery center provide free operations for underinsured
KY surgeons, surgery center provide free operations for underinsured
Physician: 'This is the work I went to medical school to do'
Ann Latty was facing a bleak situation. Diagnosed with a cataract that needed immediate surgery, but without money or insurance to cover the operation, she wasn't sure her vision could be preserved.
Then she learned about Surgery on Sunday, a Lexington, KY-based nonprofit founded by plastic surgeon Andrew Moore, MD, who devised a way to eliminate the barriers keeping uninsured people from the surgeries they need.
Surgery on Sunday brings together all-volunteer surgical teams, uses donated operating rooms, and performs operations on people who otherwise would go without or would be forced to wait until their conditions became emergent.
Surgeons, surgical nurses, and other operating room staff who volunteer their time with Surgery on Sunday get the opportunity to provide truly free procedures — difficult because even when staff volunteer, free operating space can be impossible to find.
"We all occasionally see a patient who needs surgery, and we'd be glad to give it to them, but we had trouble getting the facilities," Moore says. "This takes that part of it out of the picture."
Surgical space often goes unused on Sundays, however — hence the name. With HealthSouth Corp. donating surgical space on Sundays, Surgery on Sunday launched in late summer 2005, and in its first year performed 160 surgeries, operating one Sunday a month.
Patients no longer fall through the cracks
Moore says Surgery on Sunday was created with the working poor in mind — those who can't afford insurance but are not eligible for federal or state health insurance programs. Whereas the working poor can usually receive primary care, surgery is a more difficult problem, Moore says. They find Surgery on Sunday by referral from community organizations and are evaluated based on need. General surgery, dental surgery, eye surgery, and reconstructive procedures are covered.
HealthSouth promised Moore the space and free surgical supplies if he could put together the program, and a two-year grant from Catholic Health Initiatives provided seed money. The volunteer medical workers are insured against malpractice claims by a federal program that covers health care providers who provide free care to the poor. Local hospitals have agreed to take any patients that might need to be transferred during or after surgery.
The program is much more than just free care for patients, Moore says. The savings to taxpayers and local health care resources can be tremendous when surgeries are performed early.
"If someone has gallstones and can't afford surgery, and they wait until they come into the emergency department and they're septic and maybe have pancreatitis, you have someone who is so much sicker and eats up far more resources of the health care system than if they had had laparoscopic surgery done sooner," he explains.
A recent Surgery on Sunday patient, a 45-year-old construction worker who damaged knee cartilage on the job, was uninsured and denied government disability.
"He couldn't get disability, and couldn't afford the surgery, so would likely end up on [public assistance] and never be able to work again," Moore says. "He had the surgery, and now, six weeks later, he is back at work, where he wants to be."
According to the Centers for Disease Control and Prevention in Atlanta, just more than 41 million people in the United States — about 14% of the total population — in 2005 did not have health insurance.
"We did 160 free surgeries last year, and that's just a drop in the bucket; but if there are 150 centers around the country doing 160 surgeries, that's more than a drop," says Moore. That projection might be realized. Moore says because the Lexington program has been such a success, HealthSouth has agreed to a similar arrangement in Louisville and is studying the idea of expanding it company-wide around the country.
'I get to do the medicine I went to school to do'
Chris Marek, MD, is a plastic surgeon who goes to Ecuador once a year as a medical missionary, to perform surgery on people who can't obtain it otherwise. It's satisfying work, free of the quagmire of billing and paperwork, and he says participating in Surgery on Sunday allows him to do the same work for people in his own community.
"I get to do the medicine I went to school to do," says Marek. "It's been a great thing."
Moore says the program reenergizes the medical professionals who volunteer, because it lets them spend their time helping patients instead of completing paperwork.
"Health care providers, in general, are very generous, warm-hearted people who are looking to help people. That's why we were attracted to medicine in the first place," he explains. "This lets you have that warm, fuzzy feeling of taking care of someone who otherwise wouldn't get taken care of."
The patient population "knows you're doing this out of the kindness of your heart, and they thank you a million times," he adds.
But Surgery on Sunday patients aren't treated like charity cases, says Latty, who not only had the cataract surgery she needed, but also what she considers extensive follow-up care because of swelling and bleeding complications. Her surgery was successful, and now, six months later, she is still receiving follow-up calls and office visits with her ophthalmologist.
"I couldn't have asked to have been treated any better. Nobody acted like I was getting a freebie," says Latty. "They treated me like anybody else, and I am sure that I had to have more return appointments than most people would. But they were all just very, very supportive. I can't say enough about about it."
Moore says that in addition to getting the satisfaction of helping patients who need his care, he has gained an unexpected new appreciation for the surgical staff he works with.
"One of the amazing things, to me, has been that as a surgeon I walk in and everything's ready for me," he explains. "Until [I organized Surgery on Sunday], I never realized how many people it takes to get me there."
While he was putting the program together, Moore says he met with a social worker at a local health department who offered to volunteer.
"I said 'thanks,' but I wondered what I would need with social workers," he says, laughing. "Now I know they are one of the very foundations of the program. They make sure patients know when their appointments are, make sure they can get to their appointments, solve problems with medications. We have a fairly significant Hispanic population, so they help arrange interpreters.
"So there's no question that while a lot of the spotlight is on the surgeons, there is a huge number of people who work to make this happen — people who are there to greet patients, a church that makes lunch for us on Sundays, a local university that is involved. It has brought our community together."
Plans in works to expand
Blue Cross and Blue Shield of Kentucky and HealthSouth are working with providers to expand Surgery on Sunday into the Louisville, KY, area, and Moore hopes that HealthSouth will make the program a corporate project that can spring up wherever HealthSouth has surgical centers.
"We hope to develop a template for other communities to use," says Moore. "All communities are different, and they have to have a [surgical] facility, get malpractice insurance, make sure you're licensed, and all those sorts of things."
The original Lexington program may grow. Demand has created a waiting period of several months in some cases, a situation Moore hopes to resolve with more volunteers and perhaps with an additional Sunday added to each month's schedule.
Sources
For more information, contact:
- Andrew Moore, MD, 1401 Harrodsburg Road, Lexington, KY 40504. Phone: (859) 276-3883.
- Surgery on Sunday Inc., 525 Waller Avenue, Suite 146, Lexington, KY 40588. Phone: (859) 246-0046. E-mail: [email protected]. On the Web at www.surgeryonsunday.org.
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