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Doctors told to cut back on joint replacements

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The Winnipeg Regional Health Authority has told orthopedic surgeons at Concordia Hospital for the second consecutive year to rein in the number of hip and knee replacements they're performing to stay within budget.

Manitoba has had some of the longest waits in the country for such surgeries, although its performance has improved recently.

A source at the hospital -- one of two in the city that perform joint replacements -- said surgeons have been asked "to cut back and slow down."

Some scheduled surgeries have been postponed as a result, the source said.

Concordia Hospital was on pace last fall to perform 1,650 hip and knee replacements by March 31 (when its fiscal year ends), but had a budget to carry out only 1,500. It begged to do more and the WRHA scraped together the cash for another 71. It wound up performing 1,611.

So this year, the hospital's surgical team was authorized initially to do 1,460 joint replacements -- the normal 1,500 minus the 40 over-budgeted surgeries it did the previous year.

The Concordia team, operating in a state-of-the-art facility that opened in 2009, is once again on pace to exceed its target.

"The region is watching our numbers very closely, and we are already ahead of ourselves," the source said.

Through June 30, the latest period for which statistics are available, Concordia had performed 417 joint replacements, putting it on a pace to reach 1,668 in the current fiscal year. (That projection may be a tad high since surgeries tend to slow down a bit during the summer vacation period.) Grace General Hospital, meanwhile, had performed 392 joint replacements in the first three months of the fiscal year, putting it on a pace to do 1,568. It's budgeted to do 1,500.

Dr. Brock Wright, senior vice-president and chief medical officer of the Winnipeg Regional Health Authority, acknowledged Concordia's original budget called for fewer than its normal 1,500 procedures.

When the hospital informed the region late last year it would exceed the revised target of 1,571 replacements, officials had a choice of cancelling surgeries or forging ahead, Wright said. They agreed not to cancel the procedures and instead charge the additional 40 to the new budget year.

When the number of surgeries this year began to track substantially higher than budgeted, he met Concordia's leadership two weeks ago to discuss the situation. The region gave the go-ahead to raise the target to 1,500 replacements.

"I left the door open that there may be a possibility to go beyond 1,500, but I'm still in those discussions and we're still doing that analysis," Wright said.

One of the factors the region is weighing 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, 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't dramatically exceed its budget at the expense of other health services.

larry.kusch@freepress.mb.ca

Republished from the Winnipeg Free Press print edition August 30, 2014 A9

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