For the second consecutive year the Winnipeg (Canada) Regional Health Authority (WHRA) has told orthopedic surgeons at Concordia Hospital to slow down the number of hip and knee replacements they are performing to stay within budget. The Concordia team, which operates in a state-of-the-art facility that opened in 2009, is once again on schedule to exceed its target.
In the fall of 2013 Concordia Hospital’s surgical team found itself about to perform 1, 650 hip and knee replacements by March 31 when its fiscal year ends. The problem was that the hospital was budgeted to carry out only 1, 500, according to Larry Kusch, writing for the Winnipeg Free Press. The hospital leadership pleaded to be allowed to do more and the WRHA funded another 71. The hospital ended up performing 1, 611 joint replacement surgeries.
This year the regulators authorized the hospital’s surgical team to do 1, 460 joint replacements—the normal 1, 500 minus the 40 over-budgeted surgeries it did the previous year. Concordia is now on a pace to reach 1, 668 in the current fiscal year. “The region is watching our numbers very closely, and we are already ahead of ourselves, ” a hospital source told Kusch.
When, in 2013, the hospital informed the regional health authority that it would exceed the revised target, officials had a choice of cancelling surgeries or forging ahead. The authority agreed not to cancel the procedures and instead charged the additional 40 to the new budget year.
When the number of surgeries this year began to track substantially higher than budgeted, Brock Wright, M.D., senior vice-president and chief medical officer of the Winnipeg Regional Health Authority, met with Concordia’s leadership to discuss the situation. The region then gave the go-ahead to raise the target to 1, 500 replacements.
One of the factors the region is weighing, according to Kusch, is the impact of a new trend to perform full hip replacements—instead of partial ones—in the case of fractures. Not every patient needs a full joint replacement under these circumstances, Wright noted, but some do. The WRHA wants to ensure the change in practice is medically warranted and wants to study the impact on its budgets. Wright said he understands there is a high demand for hip and knee replacements, but one program can not dramatically exceed its budget at the expense of other health services.
