Second opinions for elective surgery. The mandatory medicaid program in Massachusetts

Area of Science:

• Health Services Research
• Medical Policy
• Surgical Outcomes

Background:

• Massachusetts mandated second surgical opinions for Medicaid recipients in 1977.
• This policy aimed to control costs and improve healthcare quality for elective procedures.

Purpose of the Study:

• To evaluate the initial year's outcomes of the mandatory second surgical opinion program in metropolitan Boston.
• To assess the impact on Medicaid expenditures and healthcare quality.

Main Methods:

• Analysis of consultants' reports and patient surveys.
• Tracking participation rates and outcomes for elective surgeries under the program.

Main Results:

• 77.2% of eligible Medicaid patients participated in the second opinion program.
• 88.7% of participants received a second opinion favoring surgery; 11.3% were advised against it.
• Only 7.7% of participating patients ultimately had surgery rejected by a second or third opinion.

Conclusions:

• The program identified honest disagreements in surgical indications, with many negative second opinions reversed by third consultations.
• While direct Medicaid savings were modest, the program likely enhanced healthcare quality for recipients.