New concurrent surgery guidelines receive mixed reviews

By Matt Kuhrt

Hospitals and doctors have mixed opinions about The American College of Surgeons' (ASC) new guidelines on concurrent surgeries, according to an article in the Boston Globe.

While it is not uncommon for surgeons to schedule procedures in more than one operating room at the same time, the practice has come in for increased scrutiny of late, in part thanks to an investigation by a U.S. Senate committee and a Florida lawsuit. The new ACS standards aim to bar surgeons from double-booking cases in such a way that "critical or key" parts of the surgeries overlap. The standards also require that surgeons notify patients when they will be conducting multiple simultaneous procedures.

Critics contend that Medicare's billing rules already encompass both the requirement to inform patients and the prohibition on overlapping key parts of procedures, though one of the rule's drafters, L.D. Britt, chairman of the department of surgery at Eastern Virginia Medical School, pointed out in the Globe that many surgeons have ignored those rules.

Where Britt sees the rules as "a wake-up call," others see a half-measure at best. Dennis Burke, M.D., a surgeon at Beth Israel Deaconess Hospital who previously campaigned against double-booking at Massachusetts General Hospital, characterized the new guidelines in the Globe as "a total capitulation to professional self-interest." For his part, Senator Charles Grassley of Iowa, a Republican serving on the Finance Committee, pointed out that both the Medicare rules and the ACS guidelines continue to afford surgeons leeway to define the "critical" parts of a procedure.

The article also points out that the guidelines continue to permit attending surgeons to overlap simultaneous critical and non-critical procedures, provided they have a backup in place for emergencies.

To learn more:
- here are the guidelines
- read the article