The way it has always worked was that doctors and their patients made the decision for surgery and what surgery and the hospital agreed and everyone was happy and, unless the procedure was considered cosmetic or experimental, Medicare and other insurances covered it. No one considered the wisdom of the procedure or the expertise of the surgeon or mortality risk of the operation. If the risk was high, hopefully the doctor discussed this with the patient.
But a change is in the air. Three well known teaching hospitals in the US are planning to limit surgeries that are infrequently performed, have high mortality rates, and doctors who have limited experienc will be denied approval. Dartmouth, U of Michigan and Johns Hopkins will impose the voluntary guidelines by the end of 2015. Other hospitals around the country are considering joiniing the coalition but I suspect that if it is not done voluntarily, it will soon be done by coersion.
These three hospitals created a list of ten procedures that research has shown have the highest negative results. They include joint replacement, bariatric surgery, lung cancer surgery, esophagus surgeries. The article in US News did not specify what the other procedures on tthe list were. This move is accompanied by an analysis that found patients were at greater risk of death from undergoing common provedures at hospitals that seldom performed them. This reinforces the position that the "industry" should place some restrictions on who and where and on whom certain operations are performed.
Other major medical centers are reviewing the plan and considering taking similar action.
I can pretty much guarantee that my hospital where I was operated and my surgeon who performed my surgery would not be among the approved group. My hospital is a small branch of a large hospital chain and my surgeon, while very well trained, is rather ypung. When I went for the required pre-surgery class for joint replacement patients, I was the only patient there who was scheduled for rTSA and the only patient scheduled for TSA (total shoulder arthroplasty). Even though I asked a time or two I never learned how many such procedures had been performed there previously. I can understand no one wanted to say "we've done five" or "you are the first." But haven't we all, as young people looking for a job, been faced with the quandry of the employer who wants someone with experience but how do we get experience if no one will hire us? So how does the young orthopedic surgeon gain the necessary experience if the rules restrict certain procedures to only the older surgeons? Is this actually a move to restrict the volume of certain operations? Certainly limiting access to receiving certain levels of care by requiring travel to major medical centers would have that result.
As we say in our family "There's the good reason and there's the real reason."
But a change is in the air. Three well known teaching hospitals in the US are planning to limit surgeries that are infrequently performed, have high mortality rates, and doctors who have limited experienc will be denied approval. Dartmouth, U of Michigan and Johns Hopkins will impose the voluntary guidelines by the end of 2015. Other hospitals around the country are considering joiniing the coalition but I suspect that if it is not done voluntarily, it will soon be done by coersion.
These three hospitals created a list of ten procedures that research has shown have the highest negative results. They include joint replacement, bariatric surgery, lung cancer surgery, esophagus surgeries. The article in US News did not specify what the other procedures on tthe list were. This move is accompanied by an analysis that found patients were at greater risk of death from undergoing common provedures at hospitals that seldom performed them. This reinforces the position that the "industry" should place some restrictions on who and where and on whom certain operations are performed.
Other major medical centers are reviewing the plan and considering taking similar action.
I can pretty much guarantee that my hospital where I was operated and my surgeon who performed my surgery would not be among the approved group. My hospital is a small branch of a large hospital chain and my surgeon, while very well trained, is rather ypung. When I went for the required pre-surgery class for joint replacement patients, I was the only patient there who was scheduled for rTSA and the only patient scheduled for TSA (total shoulder arthroplasty). Even though I asked a time or two I never learned how many such procedures had been performed there previously. I can understand no one wanted to say "we've done five" or "you are the first." But haven't we all, as young people looking for a job, been faced with the quandry of the employer who wants someone with experience but how do we get experience if no one will hire us? So how does the young orthopedic surgeon gain the necessary experience if the rules restrict certain procedures to only the older surgeons? Is this actually a move to restrict the volume of certain operations? Certainly limiting access to receiving certain levels of care by requiring travel to major medical centers would have that result.
As we say in our family "There's the good reason and there's the real reason."
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