Surgery News - December 2007 - (Page 2)

NEWS SURGERY NEWS • D E C E M B E R 2 0 0 7 Integrating Intervention Codes • from page 1 adviser at the Center for Substance Abuse Treatment in the Substance Abuse and Mental Health Services Administration— prevailed by pointing out that tobacco, alcohol, and drug abuse can be linked in some way to most causes of deaths in the United States. Furthermore, there is strong evidence that SBI will help to reduce health care spending. “Brief interventions reduce reinjury by 50% and have a return on investment of about $4 per dollar spent on health care costs. However, few physicians did it because it re- Medical facilities have been able to seek reimbursement for these services through the use of Healthcare Common Procedure Coding System (HCPCS) codes approved in July 2006. According to Bertha Madras, Ph.D., deputy director of demand reduction at the White House Office of National Drug Control Policy, the addition of CPT codes for use by physicians and other health care professionals is likely to make SBI a more commonly rendered service. “By adding these codes to CPT, the American Medical Association is helping to make screening and brief intervention a routine part of primary and emergency care. The new CPT codes will encourage doctors to address alcohol and drug problems, [which can lead] to a reduction in the tremendous social and medical costs associated with addiction,” Dr. Goplerud said. The Centers for Medicare and Medicaid Services is instructing its fiscal intermediaries to pay on two new G codes, G0396 and G0397, which replicate CPT 99408 and 99409. The new G codes will allow Medicare to pay for alcohol and drug assessment and brief intervention. When advocates for the new codes first approached the AMA’s CPT/Relative Value Unit Committee about adding the new E/M codes for SBI, they were rebuffed on the grounds that the codes were not intended to be disease specific, Dr. Gentilello said. However, the team—Dr. Gentilello; Dr. Goplerud; Dr. Madras; Dr. David Lewis, the Donald G. Millar Distinguished Professor of Alcohol and Addiction Studies at Brown University, Providence, R.I.; and Tom Stegbauer, lead public health THERE IS EVIDENCE THAT SCREENING AND BRIEF INTERVENTION WILL HELP TO REDUCE HEALTH CARE SPENDING. quired them to devote time to providing a nonreimbursable service,” Dr. Gentilello said. SBI is a tool to identify and counsel individuals who put themselves at risk for alcohol- and substance use–related health care problems and injury, Dr. Gentilello explained. Nonetheless, “only a small percentage of the American population meets the criteria for being defined as alcoholics— that is to say, are alcohol dependent,” he added. About 85% of those who present to the ED or a trauma center because of an alcohol-related injury or illness just need a “wake-up call” about how their drinking or substance abuse puts them and others at risk for reinjury or long-term medical conditions. Often, patients are most receptive to this sort of counseling after receiving emergency care, Dr. Gentilello said. Dr. Madras, who is on a leave of absence as a professor of psychobiology at Harvard Medical School, said that outcomes studies show that regardless of an individual’s age, ethnicity, or geographic location, SBI is associated with decreased alcohol and drug consumption and the adverse consequences of such behaviors. (At press time, several federal agencies were reviewing the studies.) But it is not part of standard operating procedures in most EDs or medical centers, she said. Few physicians are trained in detection and intervention. However, Dr. Madras said that the Accreditation Council for Continuing Medical Education has adopted guidelines and rules for specialty societies to follow in developing SBI programs. And Dr. Gentilello said that the ACS has been promoting training in SBI for trauma surgeons since 2006. The ACS Committee on Trauma has distributed a guide on SBI to all trauma surgeons who are ACS members. This manual was developed in cooperation with several government agencies that, along with the ACS Committee on Trauma, have presented 10 regional training programs to teach health care professionals who provide trauma services how to integrate SBI into routine care. “These workshops were very well attended, and we intend to continue this program in 2008. We’ve already trained hundreds of surgeons, nurses, and social workers in how to do this. I think more are going to be interested in getting this training now that they will be reimbursed for providing SBI services,” he added. ■ CMS Plans 10.1% Fee Cut in 2008 B Y A L I C I A A U LT Else vier Global Medical Ne ws Congress steps in, the UnlessCenters for Medicare and Medicaid Services will reduce payments to physicians by about 10% beginning in January 2008, a slightly deeper cut than had been proposed earlier in the year. Federal estimates show that the Medicare program will spend about $59 billion for services under its Physician Fee Schedule in 2008. Some 900,000 doctors participate in Medicare, according to the CMS. The 1,481-page rule announcing the fee schedule also contains many other changes in how physicians are reimbursed for various services, and what types of services are covered. Among the biggest changes: Anesthesiologists are due to get a 32% increase in their work value as a result of a recommendation by the American Medical Association’s (AMA) Relative Value Update Committee. But anesthesiologists still will feel the pinch of the 10.1% overall cut. The 10.1% cut is a result of Congress failing to come up with an alternative to the Sustainable Growth Rate (SGR), the formula that sets physician payment rates partly on the growth in the gross domestic product. For the last 5 years, Congress has at the last minute disregarded the SGR and legislated temporary 1or 2-year adjustments in pay- ments. Last fall, legislators froze 2007 payment rates at 2006 levels, averting a slated 5% cut, but setting the stage for a 10% cut in 2008 because, by law, the 5% had to be accounted for at some point. Physician organizations have sought a permanent replacement of the SGR, but that’s unlikely to happen this year. Instead, the battle again will be to reverse the cuts, and to find a way to cover the payments. Congress is required to offset any new spending. The American College of Surgeons has been proposing a change in the Medicare physician payment system that would replace the SGR with a system of separate expenditure targets and fee schedule conversion factors for various categories of physician services. When such a system was in effect in the early 1990s, surgical services were spared from annual cuts in reimbursement because growth in service volume and intensity is much slower for surgery than for other physician services. The House-passed CHAMP Act, which would have reversed the conversion factor cuts for 2 years, included a proposal to establish six separate targets, including one for major surgical services. That legislation, which also reauthorized the State Children’s Health Insurance Program (SCHIP), was stripped of the Medicare provisions and vetoed by the President. ■ SURGERY NEWS SURGERY NEWS Editor in Chief, SURGERY NEWS Lazar J. Greenfield, M.D., FACS ACS Director of Communications Linn Meyer EDITORIAL ADVISORY BOARD Mark S. Allen, M.D., FACS, Cardiothoracic Surgery, Minnesota John H. Armstrong, M.D., FACS, Trauma and Mass Casualties, Florida Hunt Batjer, M.D., FACS, Neurological Surgery, Illinois Mark R. Belsky, M.D., FACS, Orthopedic Surgery, Massachusetts David G. Burris, M.D., FACS, Trauma and Uniformed Services, Maryland Gregory S. Cherr, M.D., ACS Resident/Associate Society, New York Fred A. Crawford, Jr., M.D., FACS, Cardiothoracic Surgery, South Carolina William J. Hoskins, M.D., FACS, Obstetrics and Gynecology, Georgia James W. Jones, M.D., Ph.D., Ethics, Texas Natalie C. Kerr, M.D., FACS, Ophthalmology, Tennessee William M. Kuzon, Jr., M.D., Ph.D., FACS, Plastic Surgery, Michigan Robert Madoff, M.D., FACS, Colorectal Surgery, Minnesota James Markmann, M.D., FACS, Transplantation, Pennsylvania Jack W. McAninch, M.D., FACS, Urology, California Robert Morell, M.D., Anesthesiology, Florida James P. Neifeld, M.D., Surgical Oncology, Virginia Richard A. Prinz, M.D., FACS, Endocrine Surgery, Illinois David W. Rattner, M.D., FACS, Minimally Invasive Surgery, Massachusetts Thomas F. Tracy, Jr., M.D., FACS, Pediatric Surgery, Rhode Island Kevin K. Tremper, M.D., Ph.D., Anesthesiology, Michigan Patricia L. Turner, M.D., FACS, Information Technology, Maryland Thomas Wakefield, M.D., FACS, Vascular Surgery, Michigan Mark Weissler, M.D., FACS, Otolaryngology, North Carolina Steven E. Wolf, M.D., FACS, Trauma (Burns and Mass Casualties), Texas SURGERY NEWS is the official newspaper of the American College of Surgeons and provides the practicing surgeon with timely and relevant news and commentary about clinical developments and about the impact of health care policy on the profession and on surgical practice today. Content for SURGERY NEWS is provided by International Medical News Group and Elsevier Global Medical News. Content for the NEWS FROM THE COLLEGE is provided by the American College of Surgeons. The ideas and opinions expressed in SURGERY NEWS do not necessarily reflect those of the College or the Publisher. The American College of Surgeons and Elsevier Society News Group, a division of Elsevier Inc., will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services mentioned herein. POSTMASTER: Send changes of address (with old mailing label) to Circulation, SURGERY NEWS, 60 B Columbia Rd., 2nd flr., Morristown, NJ 07960. The American College of Surgeons’ headquarters is located at 633 N. Saint Clair St., Chicago, IL 60611-3211. SURGERY NEWS (ISSN 1553-6785) is published monthly for the

Table of Contents Feed for the Digital Edition of Surgery News - December 2007

Surgery News - December 2007 Contents Breast Radiation Boost Cuts Cancer Recurrence Mortality Soars in Some Patients With Respiratory Distress New Codes Promote Alcohol Screening New Ideas News From the College: Quality Standards General Surgery: Helping Hand Trauma: Spleen Protocol

Surgery News - December 2007

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