Surgery News - October 2007 - (Page 1)

VOL. 3 • NO. 10 • OCTOBER 2007 SURGERY NEWS THE OFFICIAL NEWSPAPER OF THE AMERICAN COLLEGE OF SURGEONS Odds for Survival Need Not Preclude ED Thoracotomy Penetrating trauma patients may benefit. B Y K AT E J O H N S O N INSIDE Surgeons, nurses, and other providers set their own metrics for pay-forperformance related to ProvenCare, said Dr. Glenn Steele. Else vier Global Medical Ne ws CABG Algorithm Raises Accountability Bar B Y A L I C I A A U LT Else vier Global Medical Ne ws rograms designed to document quality of care and provide transparency to consumers and health purchasers are blossoming, but surgeons are keeping an especially close eye on ProvenCare, an experiment under way at central Pennsylvania’s Geisinger Health System. In February 2006, the five cardiac surgeons at Geisinger’s three hospitals began using a closely tracked 40-process algorithm for coronary artery bypass graft (CABG) procedures performed on about a third of their patients. In addition, for a flat fee, the surgeons—and the hospitals—have agreed to take on the full cost of caring for these patients over a P 90-day period, from preadmission through rehabilitation. “What’s innovative about it is that they’ve held themselves accountable, not only in terms of quality transparency, but also to financial transparency and putting themselves on the line,” Dr. M. Michael Shabot said in an interview. Dr. Shabot, vice president and chief quality officer at Memorial Hermann Healthcare System in Houston, said that cardiac surgeons at his hospital follow the same 40 processes in their own way, but that nonperformance is not tied to any quality benchmark or financial risk. At Geisinger, the 40 processes include 12 preadmission checks See CABG • page 8 M O N T R E A L — Emergency department thoracotomy should be used more often for penetrating trauma patients who lack the traditionally accepted predictors of survival, Dr. Mark Seamon said at a meeting sponsored by the International Society of Surgery. “Although these predictors clearly portend a survival advantage, their absence may not necessarily indicate futility,” said Dr. Seamon, an ACS Fellow with Temple University Hospital in Philadelphia. He analyzed 180 patients who underwent emergency department thoracotomy (EDT) for penetrating injury. A total of 23 patients survived and were neurologically intact, and 157 patients did not survive. The average age of the cohort was 29 years, and 96% were male. Most patients (90%) had gunshot wounds to the torso, and 56% had multiple gunshot wounds. For each patient, Dr. Seamon compared six predictors of survival: injury mechanism, anatomic injury location, prehospital time, presence of field and ED signs of life, presence of obtainable vital signs, and initial cardiac rhythm in the ED. Overall, the mean prehospital time was 19 minutes, and nearly 76% of patients had signs of life at the scene, he reported. In the ED, 64% of patients had some signs of life, defined as any of the following: pupillary response, spontaneous ventilatory effort, palpable carotid pulse, measurable blood pressures, extremity movement, or cardiac electrical activity. Only 31% had measurable vital signs, and most presented with severely depressed mental status with a mean Glasgow Coma Scale score of 4.4, he said. Physiologic predictors were highly prevalent in the 23 survivors, with 96% showing field signs of life, 87% showing ED See Thoracotomy • page 3 Transplant GEISINGER HEALTH SYSTEM Lung Lasting Development of an artificial lung holds promise as a future bridge to transplant. • 6 General Surgery Bariatric Bonus Recent studies have linked weight-loss surgery with decreased mortality. • 1 4 News From the College Cutting Remarks A recent statement recommends ways to reduce sharps injuries in the OR. • 1 6 Practice Trends Helping Hemostasis A thrombin product derived from human plasma has won FDA approval to help control bleeding during surgery. • 2 1 Stark III Reverts to Old Exceptions Policy B Y A L I C I A A U LT Else vier Global Medical Ne ws VITAL SIGNS final regulations implementIn issuing the third phase of the ing the physician self-referral rule, also known as the Stark law, the Centers for Medicare and Medicaid Services has returned to a stance it held in the first phase. The Stark law governs whether, how, and when it is acceptable for physicians to refer patients to hospitals, laboratories, imaging facilities, or other entities in which they may have an ownership interest. Under the new rule, known as Stark III, published in the Federal Register, physicians will be considered to be “standing in the shoes” of the group practice when their investment arrangements are evaluated for compli- National Average Medicare Payments For Select Operations in 2006 Heart valve surgery Stomach and esophagus in adults* Kidney and bladder for cancer Replacement of hip, knee, or ankle Gallbladder removal, laparoscopic* Hernia in adults* Major small and large intestine Head and neck blood vessel Removal of prostate via urethra* $15,409 $11,916 $11,151 $9,130 $8,889 $6,178 $5,211 ELSEVIER GLOBAL MEDICAL NEWS $39,671 $27,622 ance, according to several attorneys. This reversion back to the initial Stark policy is among the most important changes in the 516-page document, said Daniel H. Melvin, J.D., a partner in the health law department of McDermott, Will & Emery’s Chicago office. As a result, “the application of exceptions will be different going forward,” Mr. Melvin said in an interview. SURGERY NEWS Most physicians who have referral arrangements will have “a lot of contracts that will have to be looked at and possibly revised,” said Amy E. Nordeng, J.D., a counsel in the government affairs office of the Medical Group Management Association. Under Stark II—an interim policy that began in 2004— See Policy • page 3 Presorted Standard U.S. Postage PAID Permit No. 384 Lebanon Jct. KY 60 Columbia Rd., Bldg. B Morristown, NJ 07960 CHANGE SERVICE REQUESTED *In patients with complications or preexisting conditions. Source: Centers for Medicare and Medicaid Services

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Surgery News - October 2007

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