Surgery News - April 2008 - (Page 6)

S U R G E R Y NEWS • A P R I L 2 0 0 8 THE VISION Evolutionary Changes in Surgical Practice Health Care Costs to Hit States Look Inward to Pay Mounting Health Tabs $4.3 Trillion by 2017 B Y M A RY E L L E N S C H N E I D E R 20/20 Else vier Global Medical Ne ws ealth care spending in the United States is projected to consume nearly 20% of the gross domestic product by 2017, according to estimates from economists at the Centers for Medicare and Medicaid Services. Health care spending growth is expected to remain steady at about 6.7% a year through 2017, with spending estimated to nearly double to $4.3 trillion by 2017, the CMS analysts said in a report published online in the journal Health Affairs. The 10-year projections come from the National Health Statistics Group, part of the CMS Office of the Actuary, and are based on historical trends, projected economic conditions, and provisions of current law. The analysts project that spending for private sector health care will slow toward the end of the projection period, while spending in the public sector, including Medicare and Medicaid, will increase. Much of the increase will be fueled by the first wave of baby boomers entering Medicare in 2011, which is projected to H add 2.9% to growth in Medicare spending by 2017, according to the report. The CMS economists projected that growth in spending on physician services would average about 5.9% per year through 2017, compared with 6.6% from 1995 to 2006. These projections are based on current law, which calls for steep cuts to physician payments under Medicare over the next several years. If Congress were to provide a 0% update over the next decade, the average annual growth from 2007 to 2017 would rise to 6.2%, according to the report. On the hospital side, growth in spending is projected to accelerate at the beginning of the projection period because of higher Medicaid payments but to slow toward the end as a result of projected lower growth in income. Home health care will likely be one of the fastest growing sectors in health care from 2007 through 2017, with an average annual spending growth rate of 7.7%. Growth in prescription drug spending is expected to accelerate overall through 2017, because of increased utilization, new drugs entering the market, and a leveling-off of the growth in generics. B Y A L I C I A A U LT Else vier Global Medical Ne ws WA S H I N G T O N — With health care expenses accounting for the single largest expense in their budget, states are increasingly looking for solutions from within, not from the federal government, according to an annual accounting of state legislative trends compiled by the Blue Cross and Blue Shield Association. “Health care spending represented nearly one-third of total state expenditures last fiscal year,” said Susan Laudicina, BCBSA director for state research and policy at a briefing for reporters. She noted that as the economy weakens, health care costs will continue to rise, while tax revenues will fall. “The challenge for state lawmakers is how to avoid cutting existing programs like Medicaid and the State Children’s Health Insurance Program while also finding new ways to cover the uninsured and contain costs,” said Ms. Laudicina. About half of the state legislatures debated universal coverage or expan- sion programs for children in fiscal 2007. Mandates requiring individuals to buy insurance were introduced in 12 states but failed, largely because they are controversial, said Ms. Laudicina. Connecticut and New York expanded eligibility for SCHIP to 400% of the federal poverty level and seven other states raised eligibility to 300%, but those efforts are threatened by a rule change issued by the Department of Health and Human Services last August that ostensibly caps eligibility at 250% of the federal poverty level. Eight states—Connecticut, Indiana, Kansas, Louisiana, Maryland, New York, Texas, and Washington—created programs using public funds to subsidize private employer-sponsored health insurance to Medicaid-eligible workers. “Transparency” initiatives—proposals requiring hospitals (and, in some cases, physicians) to publicly share information on adverse events, quality data, and pricing—are gaining ground. Transparency bills were enacted in Arkansas, Delaware, Georgia, Indiana, Minnesota, New Jersey, Orgeon, Pennsylvania, Texas, and Washington. Broader Range of Skills Blurs Boundaries, Improves Patient Care BY JANE ANDERSON Else vier Global Medical Ne ws o provide the best possible patient care, Tareas surgeons increasingly need skills in that traditionally have been the purview of other specialties, and they must work closely with other specialists to take advantage of new technologies. The bottom line, according to surgeons who are expert in using technologies such as imaging and irradiation, is that the scope of practice in most surgical subspecialties is changing and expanding rapidly. “Ten years ago, we used to do open vascular surgery and nothing else,” said Dr. Peter Gloviczki, professor of surgery and chairman of the division of vascular surgery at the Mayo Clinic, Rochester, Minn., and director of the multispecialty Gonda Vascular Center. “We have expanded our practice to include procedures not traditionally performed by open vascular surgeons.” Education in the specialty has changed in tandem with the changes in practice, said Dr. Gloviczki, an ACS Fellow. “Even as you’re practicing, you retrain, and then you retrain,” he said, adding that there’s strong support from the Society for Vascular Surgery to train practicing there is a continuous expansion of minimally invasive procedures. The growth is vascular surgeons in new procedures. The Mayo Clinic’s history of group clearly in endovascular procedures [such practice led naturally to its multidisci- as balloon angioplasty, stenting, and stent plinary vascular surgery center, which grafts],” he said. For example, aortic opened in the early 1990s but took its aneurysms “used to all be repaired with open surgery, but now at least current form in 2002, Dr. half are repaired with stent Gloviczki said. grafts,” he said. Gonda, which has 38 physiOf course, vascular surcians and 105 allied health staff geons must recognize that inmembers, encompasses deterventional radiologists and partments of vascular medicardiologists also are percine, vascular surgery, vascular forming many of these carradiology, cardiology, diagdiovascular procedures, Dr. nostic radiology, dermatology, Gloviczki said. Depending on physical medicine, rheumalocal customs, vascular surtology, and thrombosis. Our practice has geons might collaborate with “We are able to see a huge expanded to volume of patients with vas- include procedures physicians in these other specialties to perform these procular disease,” Dr. Gloviczki not traditionally cedures, he said. said. A much smaller group done by open “The key is to be able to made up only of vascular sur- vascular surgeons. work together, so that for the geons would be unable to run DR. GLOVICZKI patient, we have the same so many clinical programs. “We have a great collaboration with these standards and the same quality,” he said. Vascular surgeons at Gonda and elsedisciplines,” he said. “Patients frequently get the opinions of two to three people where also have increased their use of before they decide on a single procedure.” imaging, especially intraoperative ultraAnother change in practice is reflected sound, Dr. Gloviczki said. Vascular surin the shift from open to minimally inva- geons around the country have added sive surgery. “I would say that nationwide, CT scans to their practices and learned how to use them, which has helped them plan their procedures. And for venous disease, they are using radiofrequency or laser to treat varicose veins or perforating veins, he explained. The American College of Surgeons’ Committee on Emerging Surgical Technology and Education has focused on the use of new technologies and expanding scope of practice, said Dr. David Scott Lind, an ACS Fellow who is chief of surgical oncology at the Medical College of Georgia in Augusta, and a member of the ACS committee. Advances in critical care, improvements in OR design, and virtual reality simulations and their role in teaching skills are among the topics the committee has addressed at the annual ACS Clinical Congress, he said. Surgeons today use imaging and endoscopy to improve patient care, Dr. Lind said. “We’re being much less invasive, but more accurate and less morbid.” In his own practice, sentinel node biopsy for breast cancer and melanoma, and staging cancer patients, have been accomplished at the molecular level. “I think surgeons need to have every possible technology at their disposal to best treat the patient,” he said.

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Surgery News - April 2008 Contents Comorbidities Sway Bariatric Outcomes Database Finds Gap in Dissection For Melanoma Future Surgeon Shortage Predicted Dexterity Demo Best for Bile? Health Policy Scan Plan

Surgery News - April 2008

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