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GeNerAlSurGeryNewS.com
April 2012 • Volume 39 • Number 4
The Independent Monthly Newspaper for the General Surgeon
opinion
An Optimistic Curmudgeon B y J on C. W hite , MD
O
ver the past two years I have written multiple editorials for General Surgery News cataloging the many challenges we have in health care today, including the obesity epidemic, the dysfunctional medical tort system, workforce shortages, the medical arms race and the unsustainable growth
we have experienced dramatic changes in our profession over the past century. of the health care industry. With each problem I have tried to outline potential solutions. I don’t know if any of my naive suggestions will be strategies that we ultimately adopt, but the important concept is that most problems have solutions. If we look back through the history of medicine in the United States, we will see that we have had a succession of problems, but they have always been solved. Often the solutions themselves engender new problems but, in time, see Optimistic page 30
Product Announcement
see page 11
CMS Rolls Out Changes for Ambulatory Surgical Centers Modest Pay Increases; New Data Reporting Requirements
Gloom and Doom Swirls Around Sepsis Research
B y C hristina F rangou
B y K ate o’r ourKe
M
ajor changes are under way in the Centers for Medicare & Medicaid Services (CMS) system of payments to ambulatory surgical centers (ASCs) and hospital outpatient departments. The CMS 2012 final rule increased payment rates to ASCs by 1.6% this year, and rates under the Outpatient Prospective Payment System rose by 1.9%. But, in a move that will prove more significant in the long term, CMS has adopted new quality measures for ASCs. The quality reporting system will be integrated over the next two years and will affect payments see ambulatOry surgery page 22
Innovative and Affordable Advances in Surgical Technology B y C hristina F rangou
world combined spent on these technologies. The overwhelming cost of surgical technology was the focus of an unusual panel session at last fall’s Clinical Congress of the American College of Surgeons (ACS). The session, titled “Extreme Affordability,” profiled surgeons
Houston—In the 1990s, two high-profile drugs for sepsis crashed and burned after promising early mortality data fizzled in later studies and the manufacturers had to halt the clinical trials. The mood among sepsis researchers was gloomy, and it now appears that the storm clouds are back—not only because of the withdrawal of drotrecogin alfa (activated; Xigris, Eli Lilly) from the market in October—but also due to more recent, disappointing results from other sepsis drug trials. These developments, outlined at the recent annual meeting of the Society of Critical Care Medicine (SCCM), have fueled the feeling that there are only gray clouds hovering over sepsis research. In fact, “we must be very anxious because the industry may no longer put its money in our field. They may just move away and go to other disciplines,” said JeanLouis Vincent, MD, PhD, head of the Department of Intensive Care at Erasme see glOOm and dOOm page 16
3-Part Series
san Francisco—Advances in surgical technology have been an undeniable boon for patients but, for budgets, not so much. The United States spent about $95 million on medical devices in 2011, roughly half of what the rest of the
REPORT IV Acetaminophen Improves Pain Management and Reduces Opioid Requirements in Surgical Patients: A Review of the Clinical Data and Case-based Presentations
see surgical innOvatiOn page 19
See insert at page 10
INSIDE In the News
Surgeons’ Lounge
Study hints at ‘prime time‘ Unreported clinical trial for surgeons: 35 to 50 data rampant, lead to years old . ......................... 4 research bias ............. 24
Experts discuss avoiding injury during laparoscopic cholecystectomy .............. 26