SNS 기사보내기
As the government's restructuring program for tertiary general hospitals gets underway, medical professionals are concerned that orthopedic treatment and surgeries are declining due to overly rigid severity classifications.
While the severity classification standards remain the same, tertiary hospitals that must increase the proportion of severe patients are doing so by reducing the share of mild patients, putting orthopedic departments at a disadvantage,
On Wednesday, the Korean Orthopedic Association (KOA) held a news conference at the Korea Press Center, calling for improving severity classification standards as part of the restructuring project of tertiary general hospitals.
The Korean Orthopedic Association urged the government to improve the severity classification criteria for the restructuring project of tertiary general hospitals at a news conference on Wednesday. (KBR photo)
The Korean Orthopedic Association urged the government to improve the severity classification criteria for the restructuring project of tertiary general hospitals at a news conference on Wednesday. (KBR photo)
The association noted that orthopedic disease codes lack sufficient subdivisions, causing severe cases to be misclassified as mild, which downplays their severity.
According to KOA, the share of Group A surgeries, which are classified as severe diseases, is less than 1 percent on average among surgeries performed in orthopedic departments of tertiary general hospitals.
“Orthopedics has been hit by the pilot project to restructure tertiary general hospitals,” KOA President Han Seung-beom (Korea University Anam Hospital) said. “Some 70 percent of orthopedic patients are classified as non-serious because the classification of disease and surgery names is immature. The United States has about 2,000 classifications of musculoskeletal diseases, but Korea has only 200. Spinal conditions are not categorized based on reoperations or specific nodal issues.”
Lee Jae-chuol (Soon Chun Hyang University Hospital Seoul), who chairs KOA’s Public Relations Committee, said, “The disease code is not subdivided. So, they divide all as Group C (not-serious) diseases, whether it is a single-joint spine surgery or a six-joint surgery. If you perform Group C spine surgery, the severity of the university hospital will be lowered.”
Lee pointed out that this problem occurs because the severity classification is based on frequency, not surgical difficulty.
“This leads to the downsizing of orthopedic surgery. Already, some hospitals have downsized orthopedic operating rooms and anesthesiology staff, leaving vacancies unfilled when senior faculty retire. In some cases, hospitalization quotas are being reduced in orthopedics to maintain overall severity,” he added.
In the future, he said, even if some patients need a difficult surgery, including reoperation, tertiary hospitals will send them back to primary or secondary medical institutions.
“Patients don't think of themselves as having a mild disease. They are often referred to tertiary hospitals after treatment fails at lower institutions, and they still prefer university hospitals,” Lee said. “We have to send patients back to lower-level hospitals, but it is difficult to persuade them. If a patient is already receiving internal medicine treatment at a university hospital, they may be reluctant to undergo orthopedic surgery at a primary or secondary hospital.”
Lee pointed out that the argument that major orthopedic surgeries, such as fusions, artificial joints, and fractures, should only be performed in neighborhood clinics or secondary hospitals ignores patient choice and safety.
KOA emphasized the urgency of overhauling the severity classification system as the pilot project for restructuring tertiary general hospitals has already begun. It also expressed frustration that the issue is being discussed by the Special Committee on Healthcare Reform but has been stalled by the government-doctor conflict.
“The special committee is discussing severity classifications,” KOA President Han said. “The Ministry of Health and Welfare is also talking about revising the severity classification, but the ministry is unable to touch the severity classification system because it is in a hurry to resolve the prolonged conflict as medical students’ returns are being delayed and trainee doctors are not coming back.”
"This is a case of putting the cart before the horse," Han said. "Instead of this haphazard approach, we should have developed a long-term plan, created a healthcare reform blueprint, and first addressed severity classification."
Professor Lee Bong-gun of the Department of Orthopedic Surgery at Hanyang University Hospital said, “The place in charge of the severe disease group classification is the special committee, but it does not have the ability to reorganize it in a short period. The current severity classification system for evaluating the designation of a tertiary general hospital was also created over several years through outsourcing.”
“I am worried that the pilot project will become established as it is. It is difficult to solve the problem the moment it is established. It will take several years to reorganize the severity classification system, and if the pilot project is over, orthopedics will be devastated,” he said. “The direction of healthcare reform is good, but it should have started with the correct classification of patients.”
tweet
Related articles
[Interview] Netflix drama ‘The Trauma Code’ is fiction. The real crisis in Korea’s ERs is worse.
Trauma specialist reflects on Netflix drama 'The Trauma Code' amid budget crisis
Tertiary hospitals face tough transition amid restructuring to prioritize critical care
J&J MedTech opens Seoul training center for orthopedic and cardiovascular technologies
Kim Eun-young key@docdocdoc.co.kr
See Other Articles
Copyright © KBR Unauthorized reproduction, redistribution prohibited