A new study found that out of the 310 million surgery patients who receive surgery every year, 50 million suffer postoperative complications and more than 1.5 million die from those complications. Surprisingly, patients in low- and middle-income countries were less likely to experience complications than those in high-income nations.
The study was the first of its kind at the international level, and was conducted by the International Surgical Outcomes Study Group, led by Queen Mary University of London’s Professor Rupert Pearse and published in the British Journal of Anaesthesia (BJA). Researchers used data on 44,814 patients who underwent surgery within the same seven-day period, comparing different types of surgery with the frequency and severity of adverse outcomes. The patients came from 474 different hospitals in 27 different countries, ranging between high income (U.S., U.K., Germany) and low income (Uganda, Brazil, Romania.)
“There is still a great deal of work to be done to improve patient care around the time of surgery,” he said. “Initiatives such as that led by the Royal College of Anaesthetists Perioperative Medicine programme provide excellent examples of what can be done to resolve these problems.” [more]
A proposed CMS change to the 2017 Medicare Physician Fee Schedule will require surgeons document and report data every 10 minutes for new billing codes (G-codes). The penalty for not submitting this data is 5% of a facility’s Medicare reimbursement.
CMS’ plans to phase out 10-day and 90-day global surgery packages over the next two years. Instead, the fee schedule would have a zero-day package, with all preoperative and postoperative care bundled together on the day of the surgery. Surgeons would receive a lump sum for their work and bill CMS on a piecemeal basis for care provided before and after the day of surgery.
Surgeons and medical groups have loudly decried the move, calling it impractical, untested, and a huge waste of time and money. In one survey of 7,000 surgeons, 37% said the new codes will cost them between $25,000 and $100,000 per surgeon. Fifteen percent said it would cost them over $100,000 in hiring scribes to keep up with documentation, updating electronic health records, and having less time for patients.
Respondents also claimed that if the standards go into effect:
• 85.9% will have to modify EHR and billing systems
• 88.8% of physicians and 75.7% of staff will lose time tracking and processing global surgery information into EHR and billing systems
• 82.8% will have to develop new tracking and collecting methods for global surgery data
• 46.4% will need to buy more technology (such as handheld devices or stopwatches) to document time spent providing global surgery services
So far, the American College of Surgeons (ACS), the American Association of Orthopaedic Surgeons, the American Association of Neurological Surgeons (AANS), the Congress of Neurological Surgeons (CNS), the American Medical Association, and several others have filed protests with CMS.
“The claims-based data collection mandate is so burdensome that most physicians will not be able to comply by January 1, 2017, which will result in CMS being unable to collect accurate and usable data, particularly in light of the unfinished final rule at the time of this writing,” the AANS and CNS wrote in a letter to CMS.
For more, read the full article at HealthLeaders Media.
A study published in The Journal of the American Medical Association has found that surgery patients in hospitals with better nursing environments receive better care without drastically increasing costs. Researchers found the 30-day mortality rate for postoperative patients was 4.8% at hospitals with more than 1.5 nurses per bed (NPB), while facilities with less than one NPB had a 30-day mortality rate of 5.8%.
“It wasn’t just the number of nurses that made the difference. Magnet status hospitals recognized for having excellent nursing programs and cultures do better,” study author Linda Aiken, PhD, RN, said in a press release.
While there’ve been numerous studies showing the benefits of a bigger nursing staff, the cost of hiring new staff has been an impediment for many facilities. Despite this, better staffed hospitals actually paid less ($163) overall per patient than understaffed hospitals.