Surgery News - December 2007 - (Page 4)

4 S U R G E R Y NEWS • D E C E M B E R 2 0 0 7 THE 20/20 BY JANE ANDERSON VISION Evolutionary Changes in Surgical Practice has been circulated among surgeons for comment. “What we’ve tried to do is offer a process by which surgical innovation can be regulated,” said Dr. Biffl. “Historically, there hasn’t been any oversight. There is no such thing as ‘standard of care’ when we’re talking about an innovation.” However, “surgical innovation can no longer enjoy its unmonitored status,” added Dr. Rebecca Minter of the department of surgery at the University of Michigan, Ann Arbor, who is also a member of the SUS panel and an ACS Fellow. Indeed, the draft position paper states: “A surgical innovator brought to trial by an unhappy patient who claims to have been an unknowing experimental subject lacks legal protections that would have been available to the prudent surgeon innovator who followed a prescribed oversight process.” The SUS also recommends that a national registry of surgical innovation be established, ideally through the Often, innovations are in the best in- American College of Surgeons. The terests of the patient and can offer a registry would contain a listing of onbetter alternative to the current stan- going and completed surgical innovadard of care, said Dr. Biffl, also of tions and contact information. Innovators would have to query the Brown University in Provnational registry before subidence, R.I. “But there can mitting a proposal and list be instances where they their innovation with the regare taken up maybe too istry once it has been aprapidly, and they prove not proved, according to the to be in the best interests statement. The ACS has exof patients—they prove pressed interest and has been not to be advantageous.” cooperative in setting up the The draft position stateregistry; the SUS received ment defines an “innovacomments on the proposal at tion” as a new or modified WALTER BIFFL, the second annual Academic surgical procedure that M.D., FACS Surgical Congress in Februdiffers from currently accepted local practice, the outcomes of ary 2007, Dr. Biffl said. The procedure outlined in the paper which have not been described and would allow the profession to provide which may entail risk to the patient. “Many innovations are used on an more oversight to its own innovators ad-hoc basis as dictated by the clinical while offering some protection to both situation,” according to the statement. surgeons and patients, Dr. Biffl said. “This seemed like a fair means of do“Some innovations, however, may be developed in a more systematic fashion ing it—it would be unbiased people doand may ultimately meet the criteria for ing the oversight, and [there would be] some mechanism for reporting the outhuman subject research.” The statement proposes that sur- comes, even if they’re not good,” Dr. geons seeking to introduce an innova- Biffl said, adding, “you’re not going to tion should meet certain criteria and see that in journals. In surgery, if a sursubmit a proposal to their local surgi- geon tries to do something in a new cal innovations committee for review. way and it doesn’t go well, nobody That committee “will assess the relative knows about it. So the next surgeon merits and potential adverse conse- might make the same mistake.” Dr. Biffl and Dr. Minter said they exquences of the innovation, and uphold ethical and patient safety standards. If pect some surgeons to worry that the and when the committee feels an in- new guidelines will hamper their abilinovation should be subjected to more ty to introduce new innovations that rigorous evaluation and/or that the will move the field forward. But they outcomes should be publicly reported, said they hope these concerns will dithe committee will direct the innovator minish as surgeons come to understand to an IRB [Institutional Review Board] the new process and realize it will protect both patients and themselves. ■ for approval,” the statement says. Adding Structure to Surgical Innovation Else vier Global Medical Ne ws T he increasing scrutiny of human subject research has prompted the creation of a position statement to define surgical innovation and ensure appropriate implementation and oversight of new procedures. Drafted by the Society of University Surgeons (SUS), the position statement evolved out of concern that, if the profession didn’t impose an oversight structure on surgical innovation, the government or society would do so—potentially in the form of malpractice litigation, according to Dr. Walter Biffl, chairman of the SUS Social and Legislative Issues Committee and an ACS Fellow. The Association of American Medical Colleges suggested the project to the SUS in 2004. Still in draft form, the statement CMS Boosts Pay for Outpatient Services B Y A L I C I A A U LT Else vier Global Medical Ne ws Medicaid Services will increase The Centers for Medicare andanpayments for outpatient services by average of 3.8% next year. The 2008 Hospital Outpatient Prospective Payment System final rule includes a revised method of paying for services in ambulatory surgical centers (ASCs). Starting in 2008, services performed in ASCs will be reimbursed at 65% of the rate paid for the same service in an outpatient hospital department. This rate is unchanged from the proposed rule. “The revised system takes a major step toward eliminating financial incentives for choosing one care setting over another, thereby placing patients’ needs first, increasing efficiencies, and leading to savings for both beneficiaries and the Medicare program,” said CMS Acting Administrator Kerry Weems. Hospitals will be required to report on seven quality measures, including five emergency department measures pertaining to transfer of acute myocardial infarction patients, and two surgical care improvement measures. Hospitals that fail to report on the seven measures will get an automatic 2% reduction in inpatient pay in 2009, according to CMS. Most cardiac procedures are slated for an increase—from a modest 1.9% for pacemaker insertion or replacement, to 5.2% for bare metal stents, to 13.3% for drug-eluting stents. Implantation of left ventricular pacing leads (add-on) will be cut by 12.4%, but that reduction comes on the heels of 3 years of 80%-180% increases. ■ http://www.ce-university.org/surgery

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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