Surgery News - August 2007 - (Page 13)

AUGUST 2007 • SURGERY NEWS OPINION tization are expensive and are not good long-term solutions. Our group at Cedars-Sinai initiated desensitization protocols in the early 1990s and conducted a randomized, placebocontrolled multicenter trial of IVIG vs. placebo for desensitization, sponsored by the National Institutes of Health. The trial found that IVIG showed a statistically significant benefit in reducing cytotoxic anti-HLA antibody levels, more than doubled the transplant rate compared to placebo, and saved an average of more than $300,000 per patient transplanted. Longterm suppression of anti-HLA antibodies was seen after four doses of IVIG given on 13 LETTERS Low Fees Dog Anesthesiologists, Too In “Surgeons Decry Low Fees, High ED Expectations” ( June 2007, p. 1), you quoted Dr. Charles M. Garner as saying, “Our field has almost become a laughingstock. You do a gallbladder [procedure], and the anesthesiologist gets as much as you do for reading the newspaper.” As an anesthesiologist, I was offended by this quote. The article mentions the importance of recognizing that in negotiating for higher reimbursement we often find ourselves in a budget-neutral situation. We therefore have to either convince someone else to take a smaller piece, or work together to get a bigger pie. Insulting one’s fellow physicians accomplishes neither of these goals. As for the actual quote, I was in fact glancing over SURGERY NEWS while a surgeon was performing a thyroid lobectomy on a 400-pound diabetic patient with a bad airway, obstructive sleep apnea, and coronary artery disease. The procedure was done in our outpatient center. I spent 45 minutes prepping/intubating this patient (while the surgeon was out of the room), checked sugars constantly, administered insulin, did controlled hypotension for the surgeon during the case, and followed the patient for several hours afterward due to his sleep apnea and blood sugars (while the surgeon was off doing his next case). I was paid less than half of the surgeon’s fee, despite being asked to administer what in this case could have been a lethal dose of anesthetic, in a nonideal environment, and spending at least as much time actively caring for the patient as the surgeon did. Anesthesiologists receive some of the lowest reimbursement rates of any medical specialty, including general surgery, and we are constantly taking further hits. In 2008, the anticipated 10% sustainable growth rate and the 1.1% practice expense cuts for anesthesiology will bring the Medicare conversion factor for anesthesia services down to $14.39, and, if SGR projections hold true, as low as $12.61 by 2010. Thus, next year’s conversion factor will be lower, in absolute dollars, than the 1995 anesthesia CF of $14.77. Furthermore, since the CF places a dollar value on each 15-minute unit of anesthesia time, in 2008 Medicare will value anesthesiologists’ time at less than $1 per minute. We all can provide examples of having gotten reimbursed with less than what we would have paid our mechanics or our plumbers. Physicians need to work together to fix the system, instead of complaining when one of our other starving colleagues gets a crumb. Jerome Adams, M.D. Muncie, Ind. Revisiting Organ Rejection In “Experts Examine Innovations for Organ Rejection” (May 2007, p. 21), Dr. Richard J. Howard states that intravenous immunoglobulin (IVIG) will not benefit the majority of patients since it must be continuously administered, and overall he finds that current approaches to desensi- dialysis and persisted up to 2.5 years in many patients. Because of these findings, IVIG has been approved by most insurance companies for desensitization purposes. At Cedars-Sinai, we do 60-70 highly HLA-sensitized patients per year after desensitization. We are able to transplant more than 90% of patients treated, and we are a major referral center for the western United States. Plasmapheresis and IVIG aren’t perfect, but they offer the best hope for transplantation among the highly HLA-sensitized patients. Stanley C. 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Table of Contents Feed for the Digital Edition of Surgery News - August 2007

Contents Drug Developments News From the College Thoracic Surgery Head & Neck Surgery

Surgery News - August 2007

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