Surgery News - June 2008 - (Page 4)
4 S U R G E R Y NEWS • J U N E 2 0 0 8 THE VISION Evolutionary Changes in Surgical Practice McCain Health Plan ACS Urges IOM to Weigh Impact Relies on Tax Changes Of Fewer Duty Hours in the Future the Democrats debate the need for individual for health coverage, Sen. Whileproposesmandatescontinue tothe tax exclusionJohn McCain a plan to eliminate that allows employees to avoid paying income tax on the value of their health benefits. Sen. McCain, the presumptive Republican presidential nominee, would replace that tax break with a refundable tax credit of $2,500 for individuals and $5,000 for families. For those who remain in their employer-sponsored plan, the tax credit would roughly offset the increased income tax burden. For those seeking to buy their own health coverage, the tax credit would be used to pay their premiums, according to Sen. McCain’s plan. “Insurance companies could no longer take your business for granted, offering narrow plans with escalating costs,” Sen. McCain said in a speech. For those with preexisting conditions, Sen. McCain is proposing a Guaranteed Access Plan. The GAP would reflect the best practices of the more than 30 states that have a “high-risk” pool for individuals who cannot obtain health insurance. He pledged to work with industry and the government to ensure adequate funding for the initiative the inclusion o fdisease management programs, individual case management, and health and wellness programs. Eliminating the employee health benefits tax exclusion would be an excuse for employers to avoid providing health insurance, said Roger Hickey, codirector of the Campaign for America’s Future, a progressive think tank. And a $5,000 tax credit wouldn’t be enough for family coverage. Dr. Jack Lewin, chief executive officer of the American College of Cardiology, called on Sen. McCain to rethink his tax proposal. To see a side-by-side comparison, go to www. acponline.org/advocacy/where_we_stand/election/. —Mary Ellen Schneider BY JANE ANDERSON 20/20 Else vier Global Medical Ne ws atient safety cannot be achieved by arbitrarily decreasing surgical resident work hours, and the Institute of Medicine needs to carefully study the implications of the 80hour work week before recommending any further changes, an American College of Surgeons panel told the IOM committee studying reductions in resident work hours. The report from the ACS Task Force on the Resident 80-Hour Work Week urged the IOM to recommend a fully funded, multi-institutional study to evaluate the impact of further reductions in duty hours and the optimal number needed to achieve curriculum objectives, maintain continuity of care, and address team training efforts. “We should not make any additional changes until a complete analysis has been made of the changes we’ve already made,” Dr. L.D. Britt said in an interview. Dr. Britt, an ACS Fellow, is chairman of the department of surgery at Eastern Vir- P ginia Medical School, Norfolk, and chairman of the ACS task force. “We cannot train a good surgeon in less than an 80-hour work week, and before we entertain that, we should look at some outcomes.” The ACS report is intended to help guide the IOM Committee on Optimizing Graduate Medical Trainee Hours and Work Schedules, which was formed at the request of Rep. John D. Dingell (D-Mich.) and colleagues on the House Committee on Energy and Commerce as part of an investigation into preventable medical errors. The IOM will publish a report including strategies and actions for implementing safe work schedules in February 2009, Dr. Britt said. The report may recommend additional work hour reductions. European countries have cut back further than 80 hours, Dr. Britt pointed out. In the United Kingdom, for example, surgical residents work 54-hour weeks, while those in the Netherlands put in less than 40 hours, he said. The reduced hours have led to problems with handoffs Strive to be the best. Seek accreditation from the Commission on Cancer (CoC) of the American College of Surgeons. Has your facility’s cancer program reached its full potential? When your facility’s cancer program is accredited by the CoC, it demonstrates its commitment to offering cancer patients the highest standard in quality treatment and care. Plus, the Commission on Cancer helps you strengthen your cancer program through its standard-setting, educational, and research initiatives. Even more, CoC accreditation offers a model for managing your facility’s cancer program by: Setting Standards to promote high-quality, multidisciplinary patient care Facilitating ongoing assessment of your program’s activities Providing real-time access to National Cancer Data Base data to evaluate and improve your delivery of care Take the challenge, build a bet ter cancer program for your facilit y and for your patients, and become accredited by the Commission on Cancer. Visit the Commission’s Web site at: www.facs.org/cancerprograms/mh08 Or send an E-mail query to: CoC@facs.org and medical mistakes, he said, adding, “they’re not being adequately trained. “You can train a good surgeon in 80 hours, but it has to be more streamlined. Why implement anything else when you haven’t looked at the impact of that? In all fairness, no organization should institute a work-hour reduction without analyzing and investigating what already has been done,” he said. The ACS task force, which represents several surgical subspecialties, reminded the IOM in the report that there has been no evidence-based study linking surgery resident duty hours with improved patient safety. Efforts to improve care should focus on optimal use of information technology, electronic health records, telemedicine, and simulation. The report raised several questions for the IOM to consider, including the optimal balance between resident duty hours and rest and whether “any gains in patient safety from less-fatigued residents would be overshadowed by the consequences of increased errors generally associated with handoffs.” The IOM should consider how training programs can provide adequate clinical/operative activity to ensure future availability of wellqualified surgeons, and examine the “unintended consequences of duty hour limitations on undergraduate medical education,” as well as funding for graduate medical education. The task force recommended establishing team training initiatives with an emphasis on patient safety and advised integrating advanced information technology and simulation into “all aspects of surgical residency training and healthcare delivery in order to enhance educational experiences and ensure patient safety.” Chief surgery residents should be exempt from the duty hour limitation “to allow a more realistic transition to a postgraduate career, and to acquire the knowledge and skills for practice,” the report said. The report advised removing the restrictive “cap” on graduate medical education positions funded by the Centers for Medicare & Medicaid Services, saying it would be “counterproductive to the current efforts to expand the undergraduate medical student pool in order to meet the future workforce needs.”
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