Surgery News- July 2008

VOL. 4 • NO. 7 • JULY 2008 Physician Pay Is In Limbo After Senate Inaction ACS pushes for retroactive solution. LAWRENCE LEA/LSUHSC-S INSIDE 20/20N VISIO THE Health Reform Private groups are pitching plans to help cure the nation’s health care ailments. • 4 B Y M A RY E L L E N SCHNEIDER Else vier Global Medical Ne ws “When technical misadventures occur in the presence of behavioral violations, we create a perfect storm,” said Dr. F. Dean Griffen. T Liability Claims Linked To Surgeons’ Behavior BY BRUCE JANCIN Else vier Global Medical Ne ws N E W Y O R K — Behavioral deficiencies emerged as a key preventable element in a national review of 460 closed liability claims against general surgeons involving payouts in excess of $25,000. The closed-claims review panel, composed of 40 board-certified surgeons, identified at least one discrete surgeon behavioral deficiency in 78% of cases. Some closed claims featured as many as five distinct behavioral deficiencies, Dr. F. Dean Griffen said at the annual meeting of the American Surgical Association. “These data are interesting in that they show that a technical misadventure in itself is a disaster, surely, but on the other hand, when technical misadventures occur in the presence of behavioral violations, we create a perfect storm,” said Dr. Griffen, an ACS Fellow who chaired the American College of Surgeons’ Patient Safety and Professional Liability Committee and is professor of surgery at Louisiana State University Health Sciences Center in Shreveport. He defined the behavioral dimension of surgical practice as elements of care requiring more time, patience, commitment, and diligence than knowledge and skill. The most common behavioral failures, in descending order, were not comSee Liability • page 3 he Bush administration gave Congress some extra time to work out a compromise that will keep a 10.6% Medicare physician pay cut from going into effect this year and at the same time issued a proposed rule that would cut fees by at least 5.4% and reform Medicare in a number of ways next year. Health and Human Services Secretary Mike Leavitt announced at the end of June that the federal government will exercise its legal authority to “minimize the impact” of the cuts on providers and beneficiaries. With that as the goal, officials at the Centers for Medicare and Medicaid Services have instructed the agency’s contractors not to process any physician and nonphysician practitioner claims for the first 10 business days of July. Agency officials estimate that by holding claims for services provided on or after July 1, they will not make payments based on the 10.6% cut until July 15 at the earliest. With just days to go before the original July 1 deadline, the Senate considered a bill that would have kept the current Medicare payment rates for the rest of 2008 and provided a 1.1% fee increase in 2009. However, the bill was never subjected to an up-or-down vote because a motion to end debate (cloture), which requires 60 votes to pass, failed by 2 votes. The bill, called the Medicare Improvements for Patients and Providers Act (H.R. 6331), passed the House by an overwhelming margin (355-59) earlier in the week. Senate leaders will have another chance to pass the legislation when they return from their week-long recess on July 7. See Pay Cut • page 2 Trauma Airway Anchor A gingival suture technique is proposed for securing an endotracheal tube. • 6 News From the College Jacobson Winner Dr. Donald L. Morton, FACS, is honored for his pioneering work in SLN biopsy. • 8 General Surgery Worth the Trouble A single-stage duodenal switch is hard to perform but gives superior results in bariatric surgery patients. • 1 2 Aetna Tops Cigna in Insurance Payments B Y A L I C I A A U LT Else vier Global Medical Ne ws VITAL SIGNS taken Cigna as and most Aetna hasthe fastestover from accurate national insurer for paying physicians, according to the third annual ranking of payer performance by one of the nation’s largest physician management companies. Cigna achieved the top rank in 2006, and Aetna was No. 2, having moved up from the fourth spot in the 2005 survey by AthenaHealth. The 2007 data are based on 30 million charge lines collected by AthenaHealth, and cover 137 national, regional, and government payers and 12,000 medical providers. The company, which is based in Watertown, Mass., collected almost $3 billion for its 980 physician clients in 2007. Of National Insurers, Aetna Pays Quickest Days in Accounts Receivable Aetna Humana Cigna Medicare Part B UnitedHealth Group Coventry Health Care WellPoint Champus Tricare Note: Based on 2007 data for 30 million charge lines. Source: AthenaHealth 26.9 days 30.1 days 32.6 days 34.5 days ELSEVIER GLOBAL MEDICAL NEWS According to the company, several trends were apparent in the data. Payers have moved to make Web portals more available to physicians, and they’ve become more proactive about contacting physicians with guideline changes. This has resulted in an almost 3% drop in the number of days that claims are in accounts receivable, at least for regional payers. Claims denial and resubmisSURGERY NEWS sion rates increased, however, partly due to problems implementing the new National Provider Identifier number required by Medicare. The full impact of that transition may not be felt until this year, according to AthenaHealth. After Aetna and Cigna, the top performers were Humana, Medicare Part B, UnitedHealth See Payments • page 2 Presorted Standard U.S. Postage PAID Permit No. 384 Lebanon Jct. KY 35.2 days 35.7 days 36.2 days 38.0 days 60 Columbia Rd., Bldg. B Morristown, NJ 07960 CHANGE SERVICE REQUESTED

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Surgery News- July 2008 Contents The 20/20 Vision: Health Reform Trauma: Airway Anchor News From the College: Jacobson Winner General Surgery: Worth the Trouble

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