Surgery News - October 2008 - (Page 1)

VOL. 4 • NO. 10 • OCTOBER 2008 PHOTOGRAPHY/WAKE FOREST UNIVERSITY SCHOOL Call to Action Issued to Support DVT, PE Prevention High incidence has prompted concern. BY DENISE NAPOLI INSIDE MEDICINE 20/20N VISIO Children’s Health States step up to close gaps in coverage imposed by SCHIP eligibility limitations. • 9 THE OF Else vier Global Medical Ne ws ‘Any hospital that does heart surgery’ can use extracorporeally supported DCD protocols, said Dr. Michael H. Hines. Protocol Changes May Increase Donor Organs B Y J E F F E VA N S Else vier Global Medical Ne ws dvances in the use of extracorporeal support technology could add a small but significant number of donor organs to the available pool, according to results obtained by two pioneering centers. The technology might preserve organs such as the kidneys, liver, and pancreas after withdrawal of life support and cardiac death in people with unrecoverable neurologic impairment. Kidneys procured under extracorporeally supported donation after cardiac death (DCD) protocols might have a lower rate of delayed graft function (DGF) than those obtained from tradi- A tional DCD or donation after brain death (DBD). Other preliminary results suggest that livers and pancreases from these donors also can be transplanted successfully. And using extracorporeal support protocols in situations involving uncontrolled organ donation, such as in sudden cardiac death, might expand the number of donors, according to experts in the field. “Any hospital that does heart surgery can do this,” said Dr. Michael H. Hines, an ACS Fellow who is a cardiothoracic surgeon at Wake Forest University Baptist Medical Center, Winston-Salem, N.C., where he also directs the See Donar Organs • page 10 WA S H I N G T O N — Although some progress has been made in preventing deep vein thrombosis and pulmonary embolism, the persistently high incidence of these conditions has prompted a Call to Action statement by Acting Surgeon General Steven K. Galson. Among hospitalized spinal cord injury patients who do not receive venous thromboembolism prevention, the risk of developing a deep vein thrombosis (DVT) is 60%-80%. The risk is 40%-60% among similar hip or knee surgery patients, 20%-40% among patients undergoing major general surgery or gynecologic procedures, and 10%-20% for patients with acute illnesses like pneumonia, according to the Venous Disease Coalition, which is a collaborative network of organizations working to increase public and health professional awareness of venous disease. The Call to Action statement was released at the second annual meeting of the Venous Disease Coalition. “There is now a public acknowledgment that this is a very significant health care issue that deserves attention from multiple facets of the medical community,” Dr. Thomas Wakefield said in an interview. “Although we’ve known for a long time that this is a very significant problem, since it doesn’t belong to one group or another and it spans so many specialties, it has been difficult to mobilize and raise awareness,” said Dr. Wakefield, an ACS Fellow and head of vascular surgery at the University of Michigan, Ann Arbor. Dr. Wakefield was one of the roughly 44 physicians and nonphysicians who met with former Surgeon General Richard H. Carmona, an ACS Fellow, in May 2006 to urge the medical See Call to Action • page 4 Opinion Election 2008 Physicians weigh in on health care proposals. • 7 News From the College Survival Strategy Improving care at low-volume hospitals could avoid deaths from cancer. • 1 2 General Surgery Innovations New devices and techniques hold promise for certain surgical procedures. • 18 CMS Targets 2011 for Switch to ICD-10 B Y M A RY E L L E N SCHNEIDER Else vier Global Medical Ne ws VITAL SIGNS Top Diagnoses by General Surgeons in 2007 Inguinal hernia* Cholelithiasis* Symptoms in breast* Malignant neoplasm of breast* Abdominal pain Cholecystitis* Sebaceous cyst Hypertension* Diffuse cystic mastopathy 3.7% 3.6% 2.9% 2.5% 2.2% ELSEVIER GLOBAL MEDICAL NEWS the for Medicare and Medicaid Officials toatreplaceCenters Services plan the ICD-9CM diagnosis and procedure code set with a significantly expanded set of codes—the ICD10—by Oct. 1, 2011. Calling the agency’s plan rushed and unworkable, physician groups are urging CMS to reconsider its compliance date. In addition to the requirements for using the ICD-10 code sets, CMS also is proposing to require entities covered under HIPAA to implement updated versions of electronic transmission standards—the Accredited Standards Committee X12 Version 5010 and the National Council for Prescription Drug 4.9% Programs Version D.0. Both electronic standards have a compliance date of April 1, 2010. The X12 Version 5010 must be in place before the ICD-10 codes can be used, according to CMS. The two proposed regulations were published in the Federal Register on Aug. 22. CMS will accept comments on the proposals until Oct. 21. The switch to ICD-10 has been under consideration by the SURGERY NEWS Department of Health and Human Services since 1997. Size and specificity are two of the biggest drawbacks of the ICD-9CM code set, according to CMS. Because many of the ICD-9-CM chapters are full, CMS has begun to assign codes to unrelated chapters, so that, for example, cardiac procedures have been put in the eye chapter. See ICD-10 • page 14 Presorted Standard U.S. Postage PAID Permit No. 384 Lebanon Jct. KY 60 Columbia Rd., Bldg. B Morristown, NJ 07960 CHANGE SERVICE REQUESTED 2.2% 1.9% 1.8% *Not otherwise specified. Note: Based on January-September 2007 data for 45,665 diagnoses. Source: Verispan

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Surgery News - October 2008 Contents Call to Action Issued to Support DVT, PE Prevention Protocol Changes May Increase Donor Organs CMS Targets 2011 for Switch to ICD-10 Opinion: Election 2008 The 20/20 Vision: Children's Health News From the College: Survival Strategy General Surgery: Innovations

Surgery News - October 2008

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