Surgery News - January 2008 - (Page 1) VOL. 4 • NO. 1 • JANUARY 2008 Congress Delivers T 6-Month Reprieve 20/20 V From 10% Pay Cut Crisis Continues INSIDE HE ISION COURTESY DR. PATRICK J. OFFNER Slight increase effective through June. B Y M A RY E L L E N SCHNEIDER A new study says 73% of U.S. emergency departments have inadequate on-call coverage. • 4 Else vier Global Medical Ne ws Ventilator bundles must be revised and made more relevant to trauma/surgical patients, said Dr. Patrick J. Offner. I Outcomes Imply Flaws In Ventilator Bundle BY BRUCE JANCIN Else vier Global Medical Ne ws C O L O R A D O S P R I N G S — Implementation of a widely advocated bundle of evidence-based practices aimed at reducing ventilator-associated pneumonia had the desired effect in a busy medical ICU but not in the same hospital’s level I trauma/surgical ICU, Dr. Patrick J. Offner reported at the annual meeting of the Western Surgical Association. “I think ventilator-associated pneumonia prevention is an important goal in our patients. However, the ventilator bundle as implemented by us was ineffective in reducing the ventilator-associated pneumonia rate in our trauma ICU,” observed Dr. Offner, an ACS Fellow with St. Anthony Central Hospital, Denver. The explanation for the disparate outcomes is unclear. Compliance with all four elements of the ventilator bundle— elevation of the head of the bed to an angle of 30-45 degrees, daily interruption of sedation to assess readiness for extubation, deep venous thrombosis prophylaxis, and prophylaxis against peptic ulcer disease—was about 85% in both the medical and surgical ICUs in this prospective study, Dr. Offner said. One thing is clear, however: If implementation of standardized ventilator bundles is going to be incorporated in pay-for-perforSee Ventilator • page 10 n what has become a yearend tradition, last-minute congressional action has once again staved off deep cuts to the Medicare physician fee schedule. The 2007 version means surgeons won’t feel the pinch of a 10.1% pay cut under Medicare; instead, they will get a 0.5% increase through June 30, 2008, thanks to House and Senate passage of S. 2499. At press time, President Bush was expected to sign the legislation. Unless Congress acts again this year, even deeper cuts in payments to physicians will occur at midyear. “We stopped the cut, but we will have to revisit the issue in earnest after the first of the year, or physicians will be confronting a payment cut of 10.6% on July 1,” said Cynthia Brown, director of the Ameri- can College of Surgeons’ (ACS) Division of Advocacy and Health Policy. “This is not the outcome we were looking for. Financing issues got in the way of our proposal to establish six separate fee schedule expenditure targets and conversion factors,” she said, adding that the College would be bringing the proposal back to the table once Congress reconvenes in January. At the urging of ACS Executive Director Thomas R. Russell, about 3,500 Fellows of the College indicated that they telephoned their legislators— the best response the ACS has ever received to a request urging its members to take action, according to Ms. Brown. Officials at the American Medical Association also expressed disappointment with the legislation. “We strongly urge Congress to break the tradition of shortSee Pay Cut • page 2 Thoracic Hearty Applause An FDA panel unanimously voted to approve a left ventricular assist device.• 6 News From the College Testimonials An ACS statement offers guidelines for physicians as expert witnesses. • 1 2 Breast Preference for Prophylaxis The proportion of breast cancer patients opting for bilateral mastectomy more than doubled from 1998 to 2003. • 2 2 Fellowships Lure Chief Residents B Y J E F F E VA N S Else vier Global Medical Ne ws VITAL SIGNS Groups With the Largest Increase In Surgical Fellowship Rates 1993 2005 Programs 76% 54% 57% 78% 55% Surgeons 77% 58% ELSEVIER GLOBAL MEDICAL NEWS 75% Small Community U.S. medical graduates Women Note: Based on a survey of the intentions of 11,080 PGY-5 chief residents. Source: Dr. Karen Borman H O T S P R I N G S , VA . — The proportion of general surgery chief residents who are choosing to do a surgical fellowship rather than becoming a general surgeon is increasing overall and in divergent ways in a variety of demographic groups, Dr. Karen Borman reported at the annual meeting of the Southern Surgical Association. She and her colleagues compiled survey answers from 11,080 PGY-5 chief residents who took the American Board of Surgery In-Training Examination during 1993-2005. This examination provides a unique chance to obtain nationwide data on the plans of all PGY-5 general surgery residents with a set of standardized survey ques- tions, according to Dr. Borman, professor of surgery and vice chair for surgical education at the University of Mississippi, Jackson. The exam comprised the same exit survey questions every year of the 13-year period. “We wanted to have the chief residents—that is, those individuals in their final year of training—because they would be less than 6 months from finishing and presumably have firm SURGERY NEWS fellowship plans,” Dr. Borman explained. If a resident had taken multiple ABS in-training exams as a PGY-5, Dr. Borman and her associates used the “final, most recent exam in an attempt to try and capture the chief residents, that is, people who wouldn’t be answering what they hoped to do as a fellow but what they See Fellowships • page 2 Presorted Standard U.S. Postage PAID Permit No. 384 Lebanon Jct. KY 60 Columbia Rd., Bldg. B Morristown, NJ 07960 CHANGE SERVICE REQUESTED
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.