Starting Jan. 1, Walmart Inc. will require employees needing spinal surgeries to travel at the company's expense to one of eight designated hospitals for the operations. Walmart, which is self-insured, says the program that has been voluntary since 2013 has cut down on unnecessary procedures.
The Bentonville retailer will pick up the tab for the surgeries and all related travel expenses for patients on the company's health insurance plan, including a caregiver.
The mandate is a change to a program that until now was completely voluntary. Under the program, covered employees may choose to have a number of procedures, including transplants, heart surgeries and knee and hip replacements, at one of the approved hospitals with all expenses paid. Participation in the program will still be voluntary for these other types of surgery.
Walmart spokesman Justin Rushing said the retailer chose to mandate travel for spinal surgeries after finding that about half of those who chose that option learned they didn't need surgery after all. He said the decision wasn't based on trying to save money on health care costs, but rather on ensuring that participants get appropriate care at the nation's top medical facilities.
"The ability for people to receive this kind of care is invaluable, and far outweighs any potential cost savings downstream," Rushing said.
According to the Mayo Clinic's website, surgery can help relieve some causes of back pain but is rarely necessary. Back pain typically resolves on its own, and most back problems respond well to nonsurgical treatments such as anti-inflammatory medications and physical therapy, the website said.
If conservative treatments fail to relieve back pain or it becomes disabling, then such procedures as removal of a herniated disk, implantation of artificial disks or spinal fusion may be necessary, according to the website.
Walmart's approved medical centers for spinal surgeries are the Mayo Clinic's three locations -- in Rochester, Minn., Jacksonville, Fla., and Phoenix; Mercy Hospital Springfield in Missouri; Memorial Hermann Health System in Houston; Emory Healthcare in Atlanta; Virginia Mason Health System in Seattle; and Geisinger Medical Center in Danville, Penn.
These facilities, known in health care as designated "centers of excellence," were chosen "for their demonstrated expertise in high-risk procedures," Rushing said.
Dr. Joe Thompson, president and chief executive officer of the Arkansas Center for Health Improvement in Little Rock, said Walmart "has been one of if not the leading large employer to turn toward these centers of excellence ... for select conditions."
It's all part of a broader shift in the U.S. health care system away from the traditional fee-for-service model of treatment to what is termed a value-based model, Thompson said. The latter rewards health care providers financially for positive patient outcomes, he said, while the former gives providers incentive to perform more tests and treatments.
These may not only be unnecessary, Thompson said, but may actually harm the patient. Examples include false positives and false negatives in test results, and complications that may arise from surgery.
The federal and state governments, insurance companies and self-insured companies like Walmart are all moving toward a value-based system of care, Thompson said.
As to whether paying for an employee's travel to and treatment at designated hospitals is cost effective, Thompson said, "I think you'd have to ask the company, but from my perspective, I've never seen Walmart do something that wasn't good for the bottom line."
Business on 12/01/2018