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When Surgery Requires a Physician Assistant

When Surgery Requires a Physician Assistant

In collaboration with 15 specialty surgical organizations, the American College of Surgeons (ACS) has published and released its seventh edition of Physicians as Assistants at Surgery. The report is meant to provide guidance to CMS and third-party payors on how often an operation might require the use of a physician as an assistant. According to the ACS, a physician as an assistant during an operation should be a trained individual who can participate in and actively assist surgeons in completing surgeries safely. However, when surgeons are not available to serve as assistants, a qualified surgical resident or other qualified healthcare professional—such as a nurse or physician’s assistant with experience in assisting a procedure—can be used. The Update To update the report, each participating organization reviewed the 2012 and 2013 American Medical Association (AMA) Current Procedural Terminology (CPT) codes that were applicable to their specialty and classified by the CPT as “surgery.” The result was the addition of 107 new codes to the report, as well as the revision of 74 previously included codes. “CMS asks the specialty societies to make comments as to whether the surgical procedures for which the codes are assigned are appropriate for a physician assistant,” says Mark Savarise, MD, FACS, who served as ACS’s alternate advisor to the AMA CPT editorial panel. “In 2013, new codes came out for the use of skin substitutes, for instance, so those codes had to be reviewed.” Dr. Savarise notes that a slight discrepancy exists between the ACS and CMS. “The ACS and surgical specialty societies keep lists for procedures that require physician assistants and classifies them as ‘almost...
Knee & Hip Arthroplasties: Analyzing the Obesity Effect

Knee & Hip Arthroplasties: Analyzing the Obesity Effect

Published reports have shown that the number of total knee arthroplasty (TKA) procedures performed in the United States more than tripled from 1993 to 2009, while the number of total hip arthroplasty (THA) surgeries doubled during the same timeframe (Figure 1). “In the setting of healthcare reform and cost containment initiatives, increasing surgical volumes have gained greater attention,” says Peter B. Derman, MD, MBA. Several explanations have been proposed regarding the increasing prevalence of total joint arthroplasties, and it is likely that a multitude of interacting factors play a role. These include obesity, the aging population, supplier-induced demand, and changing expectations about the quality of an active lifestyle, among other factors. TKA vs THA Observational studies have described various trends in arthroplasty, examining its economic ramifications as well as projecting future utilization. Dr. Derman and colleagues conducted a study, published in the Journal of Bone & Joint Surgery, to further the understanding of why there has been a more rapid growth in TKA when compared with THA. “The increasing incidence of overweight and obesity was of particular interest to us,” says Dr. Derman. “Studies have linked high BMIs with an elevated risk of knee arthritis, but this relationship is less robust with respect to the hip. We postulated that this differential effect might explain why knee replacement volumes are growing faster than hip replacement volumes.” Weight & Age For the analysis, Dr. Derman and colleagues used data obtained from the Nationwide Inpatient Sample on TKA and THA volume, length of hospital stay, and in-hospital mortality. The sample included details on over 8 million admissions at more than 1,000 hospitals...
I Am Not a Patient Advocate

I Am Not a Patient Advocate

People have commented on some of my posts, expressing appreciation for my ‘patient advocacy.’ I hate that term. Let’s get something straight. I am not a patient advocate. Patient advocates are nurses and social workers with a Mother Teresa complex who see their mission as protecting the patient from evil uncaring doctors who would subject them to unnecessary pain and indignity. I have little tolerance for such people. If I am anything, I am an honest craftsman. When a patient comes to my office seeking surgical care, I am making a pact with them, a contract if you will. I pledge my honor as a surgeon, as an honest man, that I will do the right thing for them. The right operation for the right reason at the right time. I will be conscientious in the operating room and will do my utmost to give them a smooth and uneventful recovery. To the extent that I do these things, my patient will do well and recover. If there is a complication, the first question I ask is “What did I do wrong?” Note that in all of that, the real issue is my personal duty and integrity. If I do all those things right, the patient will recover and do well. But in the end, it’s not about the patient—it’s about the integrity of the work. The patient’s recovery is a happy side effect. It is the work that is the real motivation. My personal integrity is at stake each time I go to the operating room. I have pledged to that patient to do my best. I don’t...
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