Surgery News - August 2008 - (Page 3) AUGUST 2008 • SURGERY NEWS NEWS Negative Appendectomies Reduced Outcomes • from page 1 Negative appendectomy rates varied from 0% to 11%. Hospitals with the highest negative appendectomy rates had the lowest rates of imaging accuracy as reflected in imaging/pathology concordance. “Driving up the accuracy of our images may be associated with a reduction in negative appendectomy. Just getting scans doesn’t seem to have the same dominant effect,” he said. Discussant Dr. John D. Birkmeyer estimated that if SCOAP-like reductions in negative appendectomy could be achieved nationally, 5,000 fewer people per year would undergo operations they don’t need. “SCOAP is a really innovative, cool program. Surgeons do it because they want to, not because they have to,” said Dr. Birkmeyer, an ACS Fellow who is professor of surgery at the University of Michigan, Ann Arbor, and director of the Michigan Surgical Collaborative for Outcomes Research and Evaluation Center. But he said that the negative appendectomy problem should not be laid at the radiologists’ doorstep; perhaps there’s something surgeons should be doing. For example, the decline in negative appendectomy rates over time could be attributed to differences in the use of ultrasound or laparoscopic versus open appendectomy, he suggested. Dr. Flum replied that disentangling the relative contributions of surgeon- and radiologist-related factors in Washington’s falling rates of negative appendectomy is a challenge that SCOAP is leaving to other researchers. “The goal of SCOAP is to improve quality of care; that is, to not operate on people who don’t have disease. I think for negative appendectomy we may have driven rates about as low as we can go,” he said. For more information on the project, go to www.surgicalCOAP.org. ■ proach to improving surgical outcomes by providing surgeons with feedback based on performance metrics that they—not the payers—have selected as meaningful. Dr. Flum reported on 3,540 appendectomies performed at participating SCOAP hospitals in 2006-2007. The overall negative appendectomy rate dropped from 11% in the first quarter of 2006 to 6% in the fourth quarter of 2007, dipping as low as 4.5% along the way. As negative appendectomy rates fell statewide over time, the rates of preoperative diagnostic imaging by CT or ultrasound rose. Hospitals that utilized preoperative imaging in virtually all cases—often with dedicated teams of radiologists—had much lower negative appendectomy rates than did hospitals with a more selective approach to imaging. Diagnostic imaging was used in 86% of cases (CT in 91% and ultrasound in the other 9%). Negative appendectomy rates were 9.8% in patients with no imaging, 8.1% in those assessed using ultrasound, and 4.5% in those assessed with CT. The odds of a negative appendectomy were increased 2.3-fold when no imaging was obtained. CT proved to be the more accurate imaging method. The concordance between imaging findings and the pathology report was 92% with CT, compared with 82% when ultrasound as used. One-quarter of patients with a negative appendectomy had no preoperative imaging. In another 10%, the imaging was accurately interpreted by the radiologist as showing no appendicitis, but the surgeon overruled the call and operated. In the other 65% of negative appendectomies, the CT or ultrasound was ambiguous, or the image interpretation was wrong. “That’s an opportunity for quality improvement with our radiology colleagues,” Dr. Flum noted. Aetna Makes Case for Rating Physicians B Y A L I C I A A U LT Else vier Global Medical Ne ws Program Changes Enrich Clinical Congress Content BY JANE ANDERSON S A N F R A N C I S C O — Speaking at the insurance industry’s annual meeting, an Aetna executive defended the company’s performance-based physician networks, saying that they were a way to keep costs down and to let patients know which physicians offered the best and most cost-effective care. Dr. Gerald Bishop, senior medical director for Aetna’s West division, spoke at the AHIP Institute, at a conference sponsored by America’s Health Insurance Plans. Preferred provider networks have been the subject of legal challenges around the country, most recently in Massachusetts and Connecticut. Physicians have claimed that the networks use inappropriate methodology to rate their performance. In 2007, New York Attorney General Andrew Cuomo struck a settlement with several insurers in which they agreed to publicly disclose rating methods and how much of the ratings is based on cost, and to retain an independent monitoring board to report on compliance. Aetna was one of the first insurers to sign on to that settlement, and has continued to comply, said Dr. Bishop. He noted that Aetna reviews and updates its provider list every 2 years and notifies physicians of any change in status. Physicians can appeal if there is an error—before any data are made public, he said. The company also encourages physicians to submit any relevant information from medical records if they have a question about the rating. Aetna began developing its Aexcel network in 2002, to mitigate rising costs, ensure patient access to specialists, and identify variations in costs and practices in individual markets, he said. The company found that 12 specialties represented 70% of spending on specialists and 50% of the overall spending: cardiology, cardiothoracic surgery, gastroenterology, general surgery, neurology, neurosurgery, obstetrics/gynecology, orthopedics, otolaryngology, plastic surgery, urology, and vascular surgery. To decide which physicians are eligible for the network, Aetna looks at the number of Aetna cases managed over a 3-year period. Using nationally recognized measures to gauge clinical performance, it excludes physicians who score statistically significantly below their peers. The company also uses the Episode Treatment Group methodology to evaluate 3 years of claims for cost and utilization patterns. Physicians whose scores are greater than the mean for that specialty and market are considered efficient, said Dr. Bishop. The Aexcel network exists in 35 markets and covers 670,000 members. Aetna members in most of those areas can log onto a secure Web site for cost and rating information. Dr. Bishop said Aetna has found that physicians in the Aexcel network perform 1%-8% more efficiently than their peers. Each client could save up to 4% of annual claim costs if all its covered workers used the network he said. ■ Else vier Global Medical Ne ws ttendees at the 94th annual Clinical Congress of the American College of Surgeons, to be held Oct. 12-16 in San Francisco, will have some interesting options for professional enrichment: new tracks for surgeons to focus on their specific interests, a wide variety of presentations featuring the latest clinical research, and informal “Meet the Professor” lunch sessions. The hope is that changes to the meeting program—the result of a year’s worth of brainstorming and development sessions— will bring new life to the Clinical Congress, said Dr. Barbara Bass, an ACS Fellow who is chair of the surgery department at Methodist Hospital in Houston and chair of the ACS program committee. “The changes are designed to meet the specific learning needs of individuals from various surgical specialties and to positively impact patient outcomes,” said Dr. Ajit K. Sachdeva, an ACS Fellow who is the director of the ACS Division of Education, in an interview. The major change is to weave into the Clinical Congress discipline- and thematic-based tracks for such subspecialties as vascular surgery, general surgery, oncology, and otolaryngology. Each track will feature several components, including symposia, paper sessions, and surgical forums, she said. Meeting planners also sought to add sessions for presenting new research, Dr. Bass said. To increase the amount of new information available, surgeons were chosen through a competitive process, with the top 15% selected to present abstracts of new techniques, procedures, and processes. About 400 posters will be presented, and surgeons will have more time to view them. Some courses have been moved to the weekend in an effort to avoid overlap with the free content available to attendees Monday through Wednesday, Dr. Bass said. Among the new types of sessions this year is the “Meet the Professor” luncheon series, which includes a box lunch for 20-25 participants. Program planners envision adding on to the new features. “This year, there will be 20 ‘Meet the Professor’ sessions. In the future, there may be 20 a day,” Dr. Bass said. ■ CT Scans Interfere With Electronic Medical Devices Food Administration is health care professionals Thealertingand Drugmalfunctions in about reports of pacemakers and other electronic medical devices worn by patients during computed tomography scanning. The agency has received a “small number” of adverse event reports “in which CT scans may have interfered with electronic medical devices, including pacemakers, defibrillators, neurostimulators, and implanted or externally worn drug infusion pumps,” according to a public health notification issued on July 14 by the FDA. The adverse events that were likely caused by x-rays from CT scans were unintended “shocks” (such as stimuli) from neurostimulators, malfunctions of insulin infusion pumps, and transient changes in the output pulse rate of pacemakers. To date, no deaths have been reported. The alert recommends moving external devices out of the range of the scan, if possible; and asking patients with neurostimulators to shut off the device during a scan. When a CT procedure requires scanning over the device continuously for more than a few seconds, “attending staff should be ready to take emergency measures to treat adverse reactions if they occur,” the alert emphasizes. Patients should be advised to check their devices for function even after turning them off, and to contact their health care providers if the http://www.surgicalCOAP.org http://www.fda.gov/cdrh/safety/071408-ctscanning.html http://www.fda.gov/cdrh/safety/071408-ctscanning.html
Table of Contents Feed for the Digital Edition of Surgery News - August 2008 Surgery News - August 2008 Contents The 20/20 Vision: Making Amends News From the College: Dedicated Effort Opinion: NOTESworthy? Pediatric Surgery: Burn Remedy Surgery News - August 2008 Surgery News - August 2008 - Contents (Page 1) Surgery News - August 2008 - Contents (Page 2) Surgery News - August 2008 - Contents (Page 3) Surgery News - August 2008 - Contents (Page 4) Surgery News - August 2008 - Contents (Page 5) Surgery News - August 2008 - The 20/20 Vision: Making Amends (Page 6) Surgery News - August 2008 - The 20/20 Vision: Making Amends (Page 7) Surgery News - August 2008 - News From the College: Dedicated Effort (Page 8) Surgery News - August 2008 - News From the College: Dedicated Effort (Page 9) Surgery News - August 2008 - News From the College: Dedicated Effort (Page 10) Surgery News - August 2008 - News From the College: Dedicated Effort (Page 11) Surgery News - August 2008 - Opinion: NOTESworthy? (Page 12) Surgery News - August 2008 - Pediatric Surgery: Burn Remedy (Page 13) Surgery News - August 2008 - Pediatric Surgery: Burn Remedy (Page 14) Surgery News - August 2008 - Pediatric Surgery: Burn Remedy (Page 15) Surgery News - August 2008 - Pediatric Surgery: Burn Remedy (Page 16)
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