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Avera offers options for state employees

Avera Medical Group announced Tuesday a plan to limit travel time for state employees seeking certain medical procedures after changes to the state's health plan that took effect earlier this month.

The changes classify certain medical procedures as "Tier 1," and limits the most affordable options for those procedures to specific providers and facilities, many of which are only available in Sioux Falls. It was a move made by the state in an effort to reduce spending on health care.

Patients within Avera's system have expressed concern at having to travel great distances to receive certain types of care, said Tad Jacobs, Avera Medical Group's chief medical officer, during a Tuesday conference call with reporters.

Cardiac procedures, such as heart bypass surgery, orthopedic procedures, such as hip or knee replacement, and bariatric procedures, such as weight reduction surgery, are only available at Sanford facilities under the state's new plan. Gastroenterological procedures, such as colonoscopies or hernia repair, are only available at the Sioux Falls Specialty Hospital.

To receive any of those treatments anywhere else but an approved facility would mean a significantly increased out-of-pocket cost for patients, and added travel costs.

"We just don't think that's right," Jacobs said.

In a letter sent Monday by Avera to about 10,000 state employees, Avera agreed to provide those procedures at its facilities at the same cost as if the procedure was performed at an approved Tier 1 facility.

"They will still have to pay their co-pay or deductible, but any other cost will be the same as if they went to a Tier 1 facility," Jacobs said.

Jacobs said Avera has been in talks with the state since the changes to the plan were announced to discuss different options, and decided this was the best choice for patients.