Nobody stands up to argue against quality and value in healthcare. You might as well argue against motherhood, or puppies. Yet many physicians are inherently skeptical of definitions of “quality” that are imposed from above, whether by outside evaluators like The Joint Commission, or (worse) by the government.     There’s good reason for skepticism. Some of the “evidence” behind “evidence-based medicine” has turned out to be flawed, tainted by financial conflict of interest or outright fraudulent. Any experienced physician knows that there are fads in healthcare just as there are in fashion, and today’s evidence-based medicine may be tomorrow’s malpractice. Let’s take a closer look at what’s really going on in the world of quality metrics, and why it matters if payments to you and your hospital are increasingly linked to how you score.   Surgical Site Infections   The financial toll of surgical site infections (SSIs) is huge, estimated...

No anesthesiologist has ever told me that he or she thought that the measures established by Medicare’s Physician Quality Reporting System (PQRS) or even the Surgical Care Improvement Project (SCIP) provided much insight into the quality of his or her practice. To the contrary, clients and friends have often asked me, “Why are we reporting these process measures? What do they prove?”   We are very pleased to welcome the well-known anesthesiologist and writer Karen S. Sibert, MD to the pages of the Communiqué and to bring you Dr. Sibert’s thought-provoking reflections on the PQRS and SCIP quality measures. In The Dark Side of Quality, Dr. Sibert systematically reviews the literature and leads the reader to share in the conclusion that, at best, the PQRS/SCIP measures have not reduced surgical site infection rates and, at worst, in the case of tight glucose control for cardiac surgery patients and preoperative beta blockade...

By: Christopher Ryan, Esq.Giarmarco, Mullins & Horton, PC, Troy, MI Danial Laird, MD, JDGage Law Firm, Las Vegas, NV Medical errors happen. Healthcare providers are human and humans are not infallible. For many healthcare providers, making a mistake or even being involved in a case with an untoward outcome can be unnerving, frightening, or even devastating to their practice. In such a situation, many healthcare providers feel a natural and understandable urge to express sympathy, remorse, or regret to the patient or perhaps the patient’s family. This article will outline some considerations when deciding whether or not to engage in such conduct. There is a clear distinction between a disclosure of an unexpected medical result and an apology. The American Medical Association’s Code of Ethics 8.121 states in part that: “Physicians must offer professional and compassionate concern toward patients who have been harmed, regardless of whether the harm was caused by...

At some point toward the beginning of their careers, physicians are required to take the Hippocratic Oath in which the physician covenants to heal the sick or to prescribe measures for the good of the patient. Unfortunately, in an environment in which overdoses on prescription medication are quickly rising to the top of the list of causes of death, zealous adherence to this portion of the Oath could leave pain management physicians exposed to liability. Furthermore, blind adherence to the Oath is not a legal defense to injury or death associated with the misuse or diversion of prescriptions. Luckily, there are steps that pain management physicians can follow early on to promote a beneficial relationship for the patient and to minimize legal risk to the physician. Still, even when preventative steps do not produce the intended results, there are measures that can be taken to legally terminate the relationship with the...

CMS defines surgical anesthesia time as “the continuous, actual presence of a qualified anesthesia provider. This time begins when the anesthesia provider begins preparing the patient for anesthesia in the operating room or equivalent area. Anesthesia time ends when the anesthesia provider is no longer in personal attendance.” The ASA Relative Value Guide has a similar definition: “anesthesia time begins when the anesthesiologist begins to prepare the patient for anesthesia care in the operating room or in an equivalent area and ends when the patient is safely placed under post-anesthesia supervision.” This is a typical “clear as mud” definition when it comes to anesthesia and CMS. Exactly what is an equivalent area? Is this “equivalent area” ambiguity something we can use to our advantage or is it a disadvantage? Could it be both? It all depends on how or who does the interpretation of the anesthesia record; nevertheless, as long as...