surgeries

Study: Bariatric surgery repays cost within two to four years

Anne Zieger — Tue, 09 Sep 2008 10:43:20 -0400

Though it typically costs between $17,000 and $26,000, gastric bypass surgery's costs are typically offset within two to four years by saving on other forms of medical care, according to a new journal article published in the American Journal of Managed Care. In the study, the authors divided up 3,651 largely female, severely obese patients in a claims database, matching those who had had the surgery with those that didn't, for factors including age, gender, geography, health status and baseline costs.

The analysis, which covered six months of presurgical evaluation, the surgery and 18 months of postsurgical care, included costs from surgical complications, payments for prescription drugs, doctor visits and hospital services. Researchers concluded that insurers fully recovered the cost of laparascopic surgery (at about $17,000) within 25 months. Traditional bariatric surgery costs ($26,000) were repaid within 49 months.

These findings put further pressure on health plans, many of which specifically exclude weight-loss surgery despite mounting evidence that it treats not only obesity, but also related illnesses such as diabetes. These plans often exclude not only gastric bypasses, but also less costly laparascopic banding.

Of course, one major issue is that the study was paid for by Johnson & Johnson, whose Ethicon Endo-Surgery unit makes devices used in such surgeries. The author, Pierre Yves Cremieux, a health economist at a Boston economic consulting firm, swears that the device maker had no part in his conclusions and didn't get involved in the study.

To learn more about the study:
- read this Wall Street Journal piece (sub. req.)

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SPOTLIGHT: Da Vinci robot growing popular

Anne Zieger — Mon, 28 Jul 2008 01:06:32 -0400

What's that device in the operating room--the one with four arms? It's the da Vinci robot, a new surgical device that allows doctors to perform surgery using small incisions while giving them more flexibility than they're used to with laparoscopic devices. They're typically used for prostate surgery, but also for gynecological surgeries such as hysterectomies. While such devices have mostly been found at university medical centers in the past, they're growing increasingly common at community medical centers. Article

CA lawmakers push for tougher plastic surgery rules

Tue, 27 May 2008 06:59:54 -0400

Driven in part by the death of the mother of hip-hop star Kanye West, who was getting liposuction and breast implant surgery, California physicians and lawmakers are pushing to tighten up regulation of the cosmetic surgery industry in the state. Right now, such surgeries are increasingly being done in outpatient clinics, where doctors don't face rigorous reviews. However, as with doctors in other states (such as Florida), California legislators would like to see tougher oversight of doctors performing such procedures.

Legislators are being forced to take such steps despite their already being rules on the books designed to prevent safety problems during outpatient cosmetic surgery. More than 10 years ago, the state passed a law requiring cosmetic surgery centers to be recognized by the state, have resuscitation equipment and have procedures to transfer patients to a hospital. However, critics say the law hasn't been effective.

To learn more about this initiative:
- read this Los Angeles Times piece

Case study: Hospital takes lessons from Toyota

Tue, 18 Mar 2008 07:59:54 -0400

Among a certain breed of progressive hospitals, it's becoming increasingly in vogue to lift efficiency lessons directly from leaders in industrial manufacturing. One such case is Seattle's Virginia Mason Hospital and Medical Center, which began rethinking its processes in 2000 when leaders noticed that the hospital was built around staff, not patients. After searching for better options, execs discovered the Toyota Production system, known best as "lean manufacturing." In 2002, Virginia Mason's managers traveled to Japan to visit Toyota and Yamaha plants and get a sense of why they were turning out great results. Since then, nearly 200 employees have had such tours.

Studying lean manufacturing has led to a host of changes at Virginia Mason, some small and some very significant. For example, the hospital now uses a system that puts a reminder card at the bottom of a set of supplies, allowing workers to re-order just when those supplies are needed. Execs created standardized instrument trays for surgeries and procedures, saving hundreds of dollars by making sure only needed instruments are opened (which avoids having to discard of opened but uninsured ones). Yet another changes borrowed from manufacturing is the patient safety alert system. As on the manufacturing floor, if an error is found, the whole process is stopped and the problem fixed immediately--while most hospitals typically fix problems after the fact, when they've occurred multiple times.

These, and dozens of other changes, have led to many tangible benefits, including an 85 percent reduction in how long patients wait to get lab results back, plus lowering costs by $1 million. They've also redesigned facilities to make patient and staff workflow more productive, reducing overtime and temp labor expenses by $500,000 in one year and increasing productivity by 93 percent.

To learn more about Virginia Mason's process redesigns:
- read this Seattle Post-Intelligencer article

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CA hospital cited for 'wrong-site' incident

Mon, 03 Mar 2008 06:59:55 -0500

An Orange County, CA-based hospital is now under state investigation after doing knee-repair surgery on a patient's healthy knee, marking the third "wrong-site" procedure to take place there since January 2006. Surgeons at St. Joseph's Hospital not only operated on the wrong knee, they'd previously made an incision on the wrong side of a patient's head and inserted an ear tube in the wrong ear. Now, the hospital is under investigation by the California Department of Public Health. According to hospital authorities, it has adopted Joint Commission protocols for avoiding wrong-site surgeries, but hasn't disclosed whether a failure to follow them helped engender the mistakes that were made.

To learn more about the hospital's error problem:
- read this Los Angeles Times piece

HHS advisories give guidance on doctor gain-sharing

Thu, 07 Feb 2008 06:59:55 -0500

With the release of two new advisory opinions by HHS, it's clearer now how hospitals can share cost savings with doctors without running afoul of regulators. One of the two opinions address address anesthesiologists, and the other a group of cardiac surgeons. In both cases, HHS approved arrangements that rely on clinical and historical data for norms to meet, to make sure physicians aren't shaving costs in a way that could undercut care or get rewards that more or less add up to kickbacks.

For example, in the opinion dealing with the anesthesiologists, the HHS opinion permits the anesthesiologists to use a less-expensive catheter when clinical appropriate during surgeries. Since data suggests that it would be clinically appropriate 90 percent of the time, the HHS plan forbids them from profiting for using them more often than that. HHS has placed a similar importance on historical and clinical data when it accepted prior plans, only 10 of which have been approved since 2001.

That being said, it's still important for hospitals and physicians to get explicit approval for their gain-sharing plans, experts say. If parties go ahead with an arrangement that HHS doesn't like, they're still facing legal problems even if a hospital withholds payments to physicians.

To learn more about this issue:
- read this Modern Physician piece

Related Articles:
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RI hospital faces third fine for wrong-side brain surgery

Tue, 27 Nov 2007 06:59:56 -0500

What should be a never event seems to be a "sometimes" event at one Rhode Island facility. Rhode Island Hospital has just been fined $50,000 and reprimanded by the state Department of Health after a physician performed brain surgery on the wrong side of a patient's head for the third time this year. Rhode Island Hospital, which is owned by Lifespan, is a teaching hospital for Brown University.

Two of the patients receiving wrong-side surgery suffered no apparent injuries, but one, who received brain surgery in August, died a few weeks later. In the wake of the fines, the hospital has issued a statement saying that it is re-evaluating its policies and training, tightening up supervision and giving nurses the power to flag procedural violations.

To find out more about the problems at Rhode Island Hospital:
- read this Associated Press piece

Related Articles:
Study: Wrong-site surgeries, close calls common. Report
Study: Pre-op briefing can lower surgical error rates. Report
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BCBS plans phasing out pay for errors, 'never events'

Tue, 13 Nov 2007 06:59:58 -0500

Though they won't implement this change immediately, the Blue Cross and Blue Shield plans have decided that they won't pay for serious errors and "never events" like wrong surgical procedures and leaving foreign objects in the body after surgeries. Over the next several years, the nation's 39 Blue plans intend to begin changing coding systems to make such events easier to identify in claims, according to Kevin Shanklin, executive director of the Office of the President at Blue Cross and Blue Shield Association. At present, no Blue plans are currently refusing such payments. However, other major insurers are taking this tack, and CMS will stop paying for never events starting October 1, 2008.

To learn more about the Blues' plans:
- read this Modern Healthcare article

Related Articles:
Businesses say "no pay" for major mistakes. Report
CMS's McClellan tells Congress that Medicare shouldn't reimburse for never events. Article
Other payors may follow CMS's 'no pay' lead. Report
By 2008, Medicare won't pay for hospital errors. Report

Study: Surgical fires more common than thought

Wed, 07 Nov 2007 06:59:54 -0500

Operating room fires are a particularly nasty complication of surgery, but in most cases, an extremely rare one--or so it has been thought. However, new data suggests that OR fires aren't quite as unusual as has been commonly believed. The data comes from Pennsylvania, which collects comprehensive statistics on the subject. It seems that the state has seen 28 OR fires a year for each of three years, or about 1 fire for every 87,000 surgeries. Other studies suggest that 44 percent of surgical fires occur during head, face, neck or chest surgery, when electric tools are closest to oxygen supplies.

If Pennsylvania's experience is any indication, there may be hundreds of fires each year in the U.S., rather than the 50 to 100 fires per year estimated by some patient safety organizations. Research suggests that some predictable sources, including use of 100 percent oxygen and alcohol-based cleaning products, often cause the fires.

To learn more about this issue:
- read this article from The Boston Globe

Related Articles:
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New tech designed to limit surgical errors

Mon, 05 Nov 2007 06:59:56 -0500

Here in FierceHealthcare, we've written often on the difficulty hospitals face in cutting down on the rate of serious surgical mistakes, including wrong-site or wrong-person surgeries. Perhaps this approach will help. A St. Louis-area physician has invented a new technology, the CheckSite System, which proposes to make it far more difficult to make sure mistakes. When hospitals use CheckSite, the patient wears a wristband with a microchip, and there's two sensors on near each operating room door. If the OR team doesn't verify and mark the proper site, then deactivate the band with a sticker, the sensors go off.

Right now, six healthcare centers are using CheckSite, and five plan to buy it. Wristbands cost $2.50 per patient, and the OR sensors cost about $3,000 per pair-but hospitals who do more than 10,000 surgeries a year get the sensor for free on loan.

To learn more about this approach:
- read this St. Louis Post-Dispatch article

Related Articles:
Study: Pre-op briefing can lower surgical errors. Report
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