ACS Surgery News

While President Obama's re-election may have solidified the Affordable Care Act as the law of the land, Americans are still split on some of the key provisions. On Election Day, voters in Alabama, Wyoming, and Montana approved ballot measures nullifying the federal mandate that individuals obtain health insurance.

Those states join four others whose voters approved similar measures in 2010 and 2011. But the rejection of the ACA's individual insurance mandate is largely symbolic since states can't supercede federal law. 

But that doesn't mean the ACA won't undergo some changes. Former Senate Majority Leader Bill Frist (R-Tenn.) said the law could be modified to limit Medicaid expansion and health insurance subsidies. And the Independent Payment Advisory Board could be on the chopping block.

Meanwhile, physicians face a 26.5% cut to their Medicare pay, unless Congress acts before Dec. 31. While Congress had historically acted to avert the cut, lawmakers will be primarily focused on addressing the so-called fiscal cliff. Rep. Michael Burgess (R-Tex.) said that means a permanent fix is unlikely this year and physicians should expect another temporary SGR patch.

For more election details, listen to this week's Policy & Practice Podcast.

--Frances Correa (@FMCReporting)

While President Obama's re-election may have solidified the Affordable Care Act as the law of the land, Americans are still split on some of the key provisions. On Election Day, voters in Alabama, Wyoming, and Montana approved ballot measures nullifying the federal mandate that individuals obtain health insurance.

Those states join four others whose voters approved similar measures in 2010 and 2011. But the rejection of the ACA's individual insurance mandate is largely symbolic since states can't supercede federal law. 

But that doesn't mean the ACA won't undergo some changes. Former Senate Majority Leader Bill Frist (R-Tenn.) said the law could be modified to limit Medicaid expansion and health insurance subsidies. And the Independent Payment Advisory Board could be on the chopping block.

Meanwhile, physicians face a 26.5% cut to their Medicare pay, unless Congress acts before Dec. 31. While Congress had historically acted to avert the cut, lawmakers will be primarily focused on addressing the so-called fiscal cliff. Rep. Michael Burgess (R-Tex.) said that means a permanent fix is unlikely this year and physicians should expect another temporary SGR patch.

For more election details, listen to this week's Policy & Practice Podcast.

--Frances Correa (@FMCReporting)

While President Obama's re-election may have solidified the Affordable Care Act as the law of the land, Americans are still split on some of the key provisions. On Election Day, voters in Alabama, Wyoming, and Montana approved ballot measures nullifying the federal mandate that individuals obtain health insurance.

Those states join four others whose voters approved similar measures in 2010 and 2011. But the rejection of the ACA's individual insurance mandate is largely symbolic since states can't supercede federal law. 

But that doesn't mean the ACA won't undergo some changes. Former Senate Majority Leader Bill Frist (R-Tenn.) said the law could be modified to limit Medicaid expansion and health insurance subsidies. And the Independent Payment Advisory Board could be on the chopping block.

Meanwhile, physicians face a 26.5% cut to their Medicare pay, unless Congress acts before Dec. 31. While Congress had historically acted to avert the cut, lawmakers will be primarily focused on addressing the so-called fiscal cliff. Rep. Michael Burgess (R-Tex.) said that means a permanent fix is unlikely this year and physicians should expect another temporary SGR patch.

For more election details, listen to this week's Policy & Practice Podcast.

--Frances Correa (@FMCReporting)

BALTIMORE – As the Nov. 16 deadline draws near for states to determine whether and how they will run their own health insurance exchange, Maryland has no doubt about where it stands.

The state moved quickly to set up its Maryland Health Benefit Exchange so that will be ready when open enrollment starts in October 2013, as required under the Affordable Care Act.

Physicians have been involved in creating the exchange and will have an ongoing say in how it operates, according to Gene M. Ransom, CEO of MedChi, the Maryland State Medical Society.

MedChi has been watching closely the exchange’s development in part because the society wants to ensure that protections currently in place – such as those restricting how prior authorization is used by insurers – will not be overturned or altered as part of the new insurance framework, Mr. Ransom said in an interview.

In addition, many Maryland physicians are very likely to purchase employee health coverage through the state exchange, Mr. Ransom said, noting that as small businesses, the rates available through the exchange might be more attractive than those currently available on the open market.

Doctors also may end up helping to fund the exchange’s ongoing operations, although how – and how much they will be asked to pony up – is not entirely clear yet, according to Rebecca Pearce, executive director of the Maryland Health Benefit Exchange.

While the Maryland exchange is fully funded via federal grants through 2014, it is required by law to become self-sustaining after that.

A task force is formulating funding recommendations for the state legislature. Based on past work, possible funding mechanisms include a transaction-based fee on providers; a fee attached to licensure; or a special assessment on insurers or hospitals, Ms. Pearce said.

The notion of physicians being asked to help fund the exchange does not sit well with MedChi, said Mr. Ransom, who added that such an idea has not been mentioned publicly during exchange board meetings or exchange committee meetings. Nor has it been broached privately with any MedChi lobbyists or staff, he added.

If such a fee were levied, "We would be adamantly opposed," Mr. Ransom said.

Health insurance exchanges, a major feature of the Affordable Care Act, are supposed to create an open marketplace for individuals and small groups to buy health insurance coverage and help to bring them some of the economies of scale enjoyed by large groups.

The marketplaces have been likened to an Orbitz or Travelocity for health insurance. Under the ACA, a state can either run its own exchange, have the federal government run it, partner with the federal government, or opt out.

As of early November, 16 states said they would go solo, 3 wanted partnerships, 16 were studying options, 8 were silent, and 8 said they would not create an exchange, according to the Kaiser Family Foundation.

Five states -- Connecticut, Maryland, Nevada, Rhode Island, and Vermont – as well as Washington, D.C., have received advanced (level 2) funding from Health and Human Services department.

Maryland has been certain of its plans since the passage of the ACA. In September 2011, Gov. Martin O’Malley (D) appointed Ms. Pearce. The Maryland Health Benefit Exchange has received $157 million through four planning and establishment grants from the HHS.

The exchange is lead by a board of trustees chaired by Dr. Joshua M. Sharfstein, state secretary of health and mental hygiene. Dr. Georges C. Benjamin, executive director of the American Public Health Association, also is on the board.

Physicians – many of them active MedChi members, according to Mr. Ransom – as well as advocates, insurance carriers, consumers, business leaders, and community leaders, also serve on the five committees the exchange has established. Those committees address navigators, continuity of care, plan management, finances, and implementation.

The exchange has also set up a website for the Maryland Health Connection, through which consumers will find and select insurance.

About 14% (730,000) of Maryland’s population is uninsured, but only 40% of them are thought to be eligible for the exchange coverage, Ms. Pearce said in an interview. In the first year, an estimated 145,000-180,000 will enroll for coverage through the Connection, she said. By 2020, some 250,000 will likely be purchasing coverage through the exchange.

As required by the ACA, the Maryland exchange will use navigators to reach special populations, such as non-English speakers, or the disabled. Navigators will offer in-person assistance to walk people through their choices and the enrollment process.

Navigators also are tasked with helping individuals and small employers apply for tax credits as well as linking individuals to other programs for which they might be eligible for, such as Medicaid or the Children’s Health Insurance Program. Navigators may not have conflicts of interest, although independent insurance agents and brokers may serve as navigators.

Maryland will contract with certain entities who will then hire individual navigators. Those navigators will not be employees of the exchange. The aim is to have a full cadre of navigators by late spring and to have them completely trained by late summer, said Danielle Davis, director of communications and outreach for the Maryland Health Connection.

What Will Plans Look Like in Maryland?

The ACA requires each state health insurance exchange to establish an essential benefits package; every plan for sale in the exchange must offer these benefits. In Maryland, plans must offer:

• Ambulatory services.

• Emergency services.

• Hospitalization.

• Maternity and newborn care.

• Mental health and substance use disorder services.

• Prescription drugs.

• Rehabilitative and habilitative services and devices.

• Laboratory services.

• Preventive and wellness services and chronic disease management.

• Pediatric services, including oral and vision care.

Each state exchange must choose a benchmark plan that covers the essential benefits; insurance carriers build upon that plan. Maryland chose its state employees’ health benefits plan as its benchmark.

So far, all 12 insurers in Maryland’s small group and individual markets have indicated they want to participate in the exchange, Ms. Pearce said. Consumers can begin enrolling on Oct. 1, 2013; coverage starts on Jan. 1, 2014.

For physicians, the transition should be seamless, said Ms. Pearce. Patients who gain coverage through the exchange will have benefits and identification cards from insurance carriers, just like every insured patient.

BALTIMORE – As the Nov. 16 deadline draws near for states to determine whether and how they will run their own health insurance exchange, Maryland has no doubt about where it stands.

The state moved quickly to set up its Maryland Health Benefit Exchange so that will be ready when open enrollment starts in October 2013, as required under the Affordable Care Act.

Physicians have been involved in creating the exchange and will have an ongoing say in how it operates, according to Gene M. Ransom, CEO of MedChi, the Maryland State Medical Society.

MedChi has been watching closely the exchange’s development in part because the society wants to ensure that protections currently in place – such as those restricting how prior authorization is used by insurers – will not be overturned or altered as part of the new insurance framework, Mr. Ransom said in an interview.

In addition, many Maryland physicians are very likely to purchase employee health coverage through the state exchange, Mr. Ransom said, noting that as small businesses, the rates available through the exchange might be more attractive than those currently available on the open market.

Doctors also may end up helping to fund the exchange’s ongoing operations, although how – and how much they will be asked to pony up – is not entirely clear yet, according to Rebecca Pearce, executive director of the Maryland Health Benefit Exchange.

While the Maryland exchange is fully funded via federal grants through 2014, it is required by law to become self-sustaining after that.

A task force is formulating funding recommendations for the state legislature. Based on past work, possible funding mechanisms include a transaction-based fee on providers; a fee attached to licensure; or a special assessment on insurers or hospitals, Ms. Pearce said.

The notion of physicians being asked to help fund the exchange does not sit well with MedChi, said Mr. Ransom, who added that such an idea has not been mentioned publicly during exchange board meetings or exchange committee meetings. Nor has it been broached privately with any MedChi lobbyists or staff, he added.

If such a fee were levied, "We would be adamantly opposed," Mr. Ransom said.

Health insurance exchanges, a major feature of the Affordable Care Act, are supposed to create an open marketplace for individuals and small groups to buy health insurance coverage and help to bring them some of the economies of scale enjoyed by large groups.

The marketplaces have been likened to an Orbitz or Travelocity for health insurance. Under the ACA, a state can either run its own exchange, have the federal government run it, partner with the federal government, or opt out.

As of early November, 16 states said they would go solo, 3 wanted partnerships, 16 were studying options, 8 were silent, and 8 said they would not create an exchange, according to the Kaiser Family Foundation.

Five states -- Connecticut, Maryland, Nevada, Rhode Island, and Vermont – as well as Washington, D.C., have received advanced (level 2) funding from Health and Human Services department.

Maryland has been certain of its plans since the passage of the ACA. In September 2011, Gov. Martin O’Malley (D) appointed Ms. Pearce. The Maryland Health Benefit Exchange has received $157 million through four planning and establishment grants from the HHS.

The exchange is lead by a board of trustees chaired by Dr. Joshua M. Sharfstein, state secretary of health and mental hygiene. Dr. Georges C. Benjamin, executive director of the American Public Health Association, also is on the board.

Physicians – many of them active MedChi members, according to Mr. Ransom – as well as advocates, insurance carriers, consumers, business leaders, and community leaders, also serve on the five committees the exchange has established. Those committees address navigators, continuity of care, plan management, finances, and implementation.

The exchange has also set up a website for the Maryland Health Connection, through which consumers will find and select insurance.

About 14% (730,000) of Maryland’s population is uninsured, but only 40% of them are thought to be eligible for the exchange coverage, Ms. Pearce said in an interview. In the first year, an estimated 145,000-180,000 will enroll for coverage through the Connection, she said. By 2020, some 250,000 will likely be purchasing coverage through the exchange.

As required by the ACA, the Maryland exchange will use navigators to reach special populations, such as non-English speakers, or the disabled. Navigators will offer in-person assistance to walk people through their choices and the enrollment process.

Navigators also are tasked with helping individuals and small employers apply for tax credits as well as linking individuals to other programs for which they might be eligible for, such as Medicaid or the Children’s Health Insurance Program. Navigators may not have conflicts of interest, although independent insurance agents and brokers may serve as navigators.

Maryland will contract with certain entities who will then hire individual navigators. Those navigators will not be employees of the exchange. The aim is to have a full cadre of navigators by late spring and to have them completely trained by late summer, said Danielle Davis, director of communications and outreach for the Maryland Health Connection.

What Will Plans Look Like in Maryland?

The ACA requires each state health insurance exchange to establish an essential benefits package; every plan for sale in the exchange must offer these benefits. In Maryland, plans must offer:

• Ambulatory services.

• Emergency services.

• Hospitalization.

• Maternity and newborn care.

• Mental health and substance use disorder services.

• Prescription drugs.

• Rehabilitative and habilitative services and devices.

• Laboratory services.

• Preventive and wellness services and chronic disease management.

• Pediatric services, including oral and vision care.

Each state exchange must choose a benchmark plan that covers the essential benefits; insurance carriers build upon that plan. Maryland chose its state employees’ health benefits plan as its benchmark.

So far, all 12 insurers in Maryland’s small group and individual markets have indicated they want to participate in the exchange, Ms. Pearce said. Consumers can begin enrolling on Oct. 1, 2013; coverage starts on Jan. 1, 2014.

For physicians, the transition should be seamless, said Ms. Pearce. Patients who gain coverage through the exchange will have benefits and identification cards from insurance carriers, just like every insured patient.

BALTIMORE – As the Nov. 16 deadline draws near for states to determine whether and how they will run their own health insurance exchange, Maryland has no doubt about where it stands.

The state moved quickly to set up its Maryland Health Benefit Exchange so that will be ready when open enrollment starts in October 2013, as required under the Affordable Care Act.

Physicians have been involved in creating the exchange and will have an ongoing say in how it operates, according to Gene M. Ransom, CEO of MedChi, the Maryland State Medical Society.

MedChi has been watching closely the exchange’s development in part because the society wants to ensure that protections currently in place – such as those restricting how prior authorization is used by insurers – will not be overturned or altered as part of the new insurance framework, Mr. Ransom said in an interview.

In addition, many Maryland physicians are very likely to purchase employee health coverage through the state exchange, Mr. Ransom said, noting that as small businesses, the rates available through the exchange might be more attractive than those currently available on the open market.

Doctors also may end up helping to fund the exchange’s ongoing operations, although how – and how much they will be asked to pony up – is not entirely clear yet, according to Rebecca Pearce, executive director of the Maryland Health Benefit Exchange.

While the Maryland exchange is fully funded via federal grants through 2014, it is required by law to become self-sustaining after that.

A task force is formulating funding recommendations for the state legislature. Based on past work, possible funding mechanisms include a transaction-based fee on providers; a fee attached to licensure; or a special assessment on insurers or hospitals, Ms. Pearce said.

The notion of physicians being asked to help fund the exchange does not sit well with MedChi, said Mr. Ransom, who added that such an idea has not been mentioned publicly during exchange board meetings or exchange committee meetings. Nor has it been broached privately with any MedChi lobbyists or staff, he added.

If such a fee were levied, "We would be adamantly opposed," Mr. Ransom said.

Health insurance exchanges, a major feature of the Affordable Care Act, are supposed to create an open marketplace for individuals and small groups to buy health insurance coverage and help to bring them some of the economies of scale enjoyed by large groups.

The marketplaces have been likened to an Orbitz or Travelocity for health insurance. Under the ACA, a state can either run its own exchange, have the federal government run it, partner with the federal government, or opt out.

As of early November, 16 states said they would go solo, 3 wanted partnerships, 16 were studying options, 8 were silent, and 8 said they would not create an exchange, according to the Kaiser Family Foundation.

Five states -- Connecticut, Maryland, Nevada, Rhode Island, and Vermont – as well as Washington, D.C., have received advanced (level 2) funding from Health and Human Services department.

Maryland has been certain of its plans since the passage of the ACA. In September 2011, Gov. Martin O’Malley (D) appointed Ms. Pearce. The Maryland Health Benefit Exchange has received $157 million through four planning and establishment grants from the HHS.

The exchange is lead by a board of trustees chaired by Dr. Joshua M. Sharfstein, state secretary of health and mental hygiene. Dr. Georges C. Benjamin, executive director of the American Public Health Association, also is on the board.

Physicians – many of them active MedChi members, according to Mr. Ransom – as well as advocates, insurance carriers, consumers, business leaders, and community leaders, also serve on the five committees the exchange has established. Those committees address navigators, continuity of care, plan management, finances, and implementation.

The exchange has also set up a website for the Maryland Health Connection, through which consumers will find and select insurance.

About 14% (730,000) of Maryland’s population is uninsured, but only 40% of them are thought to be eligible for the exchange coverage, Ms. Pearce said in an interview. In the first year, an estimated 145,000-180,000 will enroll for coverage through the Connection, she said. By 2020, some 250,000 will likely be purchasing coverage through the exchange.

As required by the ACA, the Maryland exchange will use navigators to reach special populations, such as non-English speakers, or the disabled. Navigators will offer in-person assistance to walk people through their choices and the enrollment process.

Navigators also are tasked with helping individuals and small employers apply for tax credits as well as linking individuals to other programs for which they might be eligible for, such as Medicaid or the Children’s Health Insurance Program. Navigators may not have conflicts of interest, although independent insurance agents and brokers may serve as navigators.

Maryland will contract with certain entities who will then hire individual navigators. Those navigators will not be employees of the exchange. The aim is to have a full cadre of navigators by late spring and to have them completely trained by late summer, said Danielle Davis, director of communications and outreach for the Maryland Health Connection.

What Will Plans Look Like in Maryland?

The ACA requires each state health insurance exchange to establish an essential benefits package; every plan for sale in the exchange must offer these benefits. In Maryland, plans must offer:

• Ambulatory services.

• Emergency services.

• Hospitalization.

• Maternity and newborn care.

• Mental health and substance use disorder services.

• Prescription drugs.

• Rehabilitative and habilitative services and devices.

• Laboratory services.

• Preventive and wellness services and chronic disease management.

• Pediatric services, including oral and vision care.

Each state exchange must choose a benchmark plan that covers the essential benefits; insurance carriers build upon that plan. Maryland chose its state employees’ health benefits plan as its benchmark.

So far, all 12 insurers in Maryland’s small group and individual markets have indicated they want to participate in the exchange, Ms. Pearce said. Consumers can begin enrolling on Oct. 1, 2013; coverage starts on Jan. 1, 2014.

For physicians, the transition should be seamless, said Ms. Pearce. Patients who gain coverage through the exchange will have benefits and identification cards from insurance carriers, just like every insured patient.

SAN DIEGO – Preoperative nasal application of a povidone-iodine solution may be more efficacious than nasal mupirocin for preventing deep surgical site infections caused by Staphylococcus aureus, a study has shown.

Investigators led by Dr. Michael Phillips of the New York University Langone Medical Center conducted a randomized trial, assigning 1,697 patients undergoing arthroplasty or spine fusion surgery evenly to the two treatments. All patients in the study also underwent chlorhexidine cleansing of the skin and received standard antimicrobial prophylaxis.

Trial results, reported at IDWeek, showed that the rate of S. aureus deep surgical site infections was one-sixth as high in the povidone-iodine group as in the mupirocin group. The povidone-iodine group also had a lower rate of adverse events and less often rated their treatment as unpleasant.

"We feel that individuals should consider the use of nasal povidone-iodine as a component of a multifaceted approach to prevent S. aureus infection after high-risk surgery," Dr. Phillips said.

In the trial, adult patients undergoing arthroplasty or spine fusion surgery at the NYU Hospital for Joint Diseases had nasal cultures for S. aureus before surgery and were then assigned to two groups.

In one group, patients were given 2% mupirocin nasal ointment and told to apply it twice daily for the 5 days leading up to surgery. The mupirocin was provided directly to the patients because a survey suggested that some patients were skipping the mupirocin because of its cost, as it is not routinely covered by insurance, he explained at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

In the other group, research personnel applied a 5% solution of povidone-iodine to both nostrils in patients up to 2 hours before incision.

Both groups also were given chlorhexidine wipes and told to use them from chin to toes the evening before and again the morning of surgery. Both groups received standard perioperative antimicrobial prophylaxis (cefazolin or clindamycin, plus vancomycin for those having a positive nasal culture for methicillin-resistant S. aureus). Both also had surgical site prepping with 2% chlorhexidine and alcohol.

The patients’ median age was 62 years; 60% were women and 80% were white. Preoperative nasal culture results showed that one in five patients was colonized with S. aureus.

The rate of noncompletion of the protocol was 11% in the mupirocin group and 8% in the povidone-iodine group, Dr. Phillips reported. The leading reason for noncompletion in the mupirocin group was failure to apply mupirocin at least seven times. In the povidone-iodine group, it was failure to use the chlorhexidine wipes.

In intent-to-treat analyses, patients in the nasal povidone-iodine group had a 0.7% rate of any deep surgical site infection at 3 months; those in the mupirocin group had a 1.6% rate. The rate of S. aureus deep surgical site infections was 0.1% and. 0.6%, respectively.

In a univariate analysis, patients had a higher risk of S. aureus deep surgical site infection if they were in the mupirocin group (relative risk, 1.01; P = .04) or were colonized with S. aureus preoperatively (relative risk, 6.79; P = .02).

When patients were stratified by colonization status, there was a trend toward a lower rate of S. aureus deep surgical site infection with povidone-iodine versus mupirocin for those who were colonized (P = .08) but not for those who were not.

Patients in the povidone-iodine group had a lower rate of study drug adverse events overall (2% vs. 9%, P less than .0001). The difference was significant for rhinorrhea, headache, congestion, and pharyngeal pain individually.

In addition, patients in the povidone-iodine group were less likely to report that application of the study medication was unpleasant or very unpleasant (4% vs. 38%).

Dr. Phillips disclosed that he received a research grant from 3M Corp., manufacturer of the povidone-iodine solution. The study was supported by 3M.

SAN DIEGO – Preoperative nasal application of a povidone-iodine solution may be more efficacious than nasal mupirocin for preventing deep surgical site infections caused by Staphylococcus aureus, a study has shown.

Investigators led by Dr. Michael Phillips of the New York University Langone Medical Center conducted a randomized trial, assigning 1,697 patients undergoing arthroplasty or spine fusion surgery evenly to the two treatments. All patients in the study also underwent chlorhexidine cleansing of the skin and received standard antimicrobial prophylaxis.

Trial results, reported at IDWeek, showed that the rate of S. aureus deep surgical site infections was one-sixth as high in the povidone-iodine group as in the mupirocin group. The povidone-iodine group also had a lower rate of adverse events and less often rated their treatment as unpleasant.

"We feel that individuals should consider the use of nasal povidone-iodine as a component of a multifaceted approach to prevent S. aureus infection after high-risk surgery," Dr. Phillips said.

In the trial, adult patients undergoing arthroplasty or spine fusion surgery at the NYU Hospital for Joint Diseases had nasal cultures for S. aureus before surgery and were then assigned to two groups.

In one group, patients were given 2% mupirocin nasal ointment and told to apply it twice daily for the 5 days leading up to surgery. The mupirocin was provided directly to the patients because a survey suggested that some patients were skipping the mupirocin because of its cost, as it is not routinely covered by insurance, he explained at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

In the other group, research personnel applied a 5% solution of povidone-iodine to both nostrils in patients up to 2 hours before incision.

Both groups also were given chlorhexidine wipes and told to use them from chin to toes the evening before and again the morning of surgery. Both groups received standard perioperative antimicrobial prophylaxis (cefazolin or clindamycin, plus vancomycin for those having a positive nasal culture for methicillin-resistant S. aureus). Both also had surgical site prepping with 2% chlorhexidine and alcohol.

The patients’ median age was 62 years; 60% were women and 80% were white. Preoperative nasal culture results showed that one in five patients was colonized with S. aureus.

The rate of noncompletion of the protocol was 11% in the mupirocin group and 8% in the povidone-iodine group, Dr. Phillips reported. The leading reason for noncompletion in the mupirocin group was failure to apply mupirocin at least seven times. In the povidone-iodine group, it was failure to use the chlorhexidine wipes.

In intent-to-treat analyses, patients in the nasal povidone-iodine group had a 0.7% rate of any deep surgical site infection at 3 months; those in the mupirocin group had a 1.6% rate. The rate of S. aureus deep surgical site infections was 0.1% and. 0.6%, respectively.

In a univariate analysis, patients had a higher risk of S. aureus deep surgical site infection if they were in the mupirocin group (relative risk, 1.01; P = .04) or were colonized with S. aureus preoperatively (relative risk, 6.79; P = .02).

When patients were stratified by colonization status, there was a trend toward a lower rate of S. aureus deep surgical site infection with povidone-iodine versus mupirocin for those who were colonized (P = .08) but not for those who were not.

Patients in the povidone-iodine group had a lower rate of study drug adverse events overall (2% vs. 9%, P less than .0001). The difference was significant for rhinorrhea, headache, congestion, and pharyngeal pain individually.

In addition, patients in the povidone-iodine group were less likely to report that application of the study medication was unpleasant or very unpleasant (4% vs. 38%).

Dr. Phillips disclosed that he received a research grant from 3M Corp., manufacturer of the povidone-iodine solution. The study was supported by 3M.

SAN DIEGO – Preoperative nasal application of a povidone-iodine solution may be more efficacious than nasal mupirocin for preventing deep surgical site infections caused by Staphylococcus aureus, a study has shown.

Investigators led by Dr. Michael Phillips of the New York University Langone Medical Center conducted a randomized trial, assigning 1,697 patients undergoing arthroplasty or spine fusion surgery evenly to the two treatments. All patients in the study also underwent chlorhexidine cleansing of the skin and received standard antimicrobial prophylaxis.

Trial results, reported at IDWeek, showed that the rate of S. aureus deep surgical site infections was one-sixth as high in the povidone-iodine group as in the mupirocin group. The povidone-iodine group also had a lower rate of adverse events and less often rated their treatment as unpleasant.

"We feel that individuals should consider the use of nasal povidone-iodine as a component of a multifaceted approach to prevent S. aureus infection after high-risk surgery," Dr. Phillips said.

In the trial, adult patients undergoing arthroplasty or spine fusion surgery at the NYU Hospital for Joint Diseases had nasal cultures for S. aureus before surgery and were then assigned to two groups.

In one group, patients were given 2% mupirocin nasal ointment and told to apply it twice daily for the 5 days leading up to surgery. The mupirocin was provided directly to the patients because a survey suggested that some patients were skipping the mupirocin because of its cost, as it is not routinely covered by insurance, he explained at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

In the other group, research personnel applied a 5% solution of povidone-iodine to both nostrils in patients up to 2 hours before incision.

Both groups also were given chlorhexidine wipes and told to use them from chin to toes the evening before and again the morning of surgery. Both groups received standard perioperative antimicrobial prophylaxis (cefazolin or clindamycin, plus vancomycin for those having a positive nasal culture for methicillin-resistant S. aureus). Both also had surgical site prepping with 2% chlorhexidine and alcohol.

The patients’ median age was 62 years; 60% were women and 80% were white. Preoperative nasal culture results showed that one in five patients was colonized with S. aureus.

The rate of noncompletion of the protocol was 11% in the mupirocin group and 8% in the povidone-iodine group, Dr. Phillips reported. The leading reason for noncompletion in the mupirocin group was failure to apply mupirocin at least seven times. In the povidone-iodine group, it was failure to use the chlorhexidine wipes.

In intent-to-treat analyses, patients in the nasal povidone-iodine group had a 0.7% rate of any deep surgical site infection at 3 months; those in the mupirocin group had a 1.6% rate. The rate of S. aureus deep surgical site infections was 0.1% and. 0.6%, respectively.

In a univariate analysis, patients had a higher risk of S. aureus deep surgical site infection if they were in the mupirocin group (relative risk, 1.01; P = .04) or were colonized with S. aureus preoperatively (relative risk, 6.79; P = .02).

When patients were stratified by colonization status, there was a trend toward a lower rate of S. aureus deep surgical site infection with povidone-iodine versus mupirocin for those who were colonized (P = .08) but not for those who were not.

Patients in the povidone-iodine group had a lower rate of study drug adverse events overall (2% vs. 9%, P less than .0001). The difference was significant for rhinorrhea, headache, congestion, and pharyngeal pain individually.

In addition, patients in the povidone-iodine group were less likely to report that application of the study medication was unpleasant or very unpleasant (4% vs. 38%).

Dr. Phillips disclosed that he received a research grant from 3M Corp., manufacturer of the povidone-iodine solution. The study was supported by 3M.

Sixteen hospitals in North Carolina have signed on to the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP^®), a leading model for outcomes-based surgical quality improvement that collects clinical, risk-adjusted, 30-day outcomes data in a nationally benchmarked database.

The following North Carolina hospitals have joined ACS NSQIP: Carolinas Medical Center, Charlotte, including branches of Lincoln in Lincolnton, Mercy in Charlotte, Northeast in Concord, Pineville in Charlotte, Union in Monroe, and University in Charlotte; Cleveland Regional Medical Center in Shelby; Columbus Regional Healthcare System Hospital in Whiteville; Grace Hospital in Morganton; Harris Regional Hospital in Sylva; Haywood Regional Medical Center in Clyde; Levine Children’s Hospital in Charlotte; Scotland Memorial Hospital in Laurinburg; Valdese Hospital in Valdese; and Stanly Regional Medical Center in Albermarie.

Go to http://site.acsnsqip.org/ for more information about ACS NSQIP.

Sixteen hospitals in North Carolina have signed on to the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP^®), a leading model for outcomes-based surgical quality improvement that collects clinical, risk-adjusted, 30-day outcomes data in a nationally benchmarked database.

The following North Carolina hospitals have joined ACS NSQIP: Carolinas Medical Center, Charlotte, including branches of Lincoln in Lincolnton, Mercy in Charlotte, Northeast in Concord, Pineville in Charlotte, Union in Monroe, and University in Charlotte; Cleveland Regional Medical Center in Shelby; Columbus Regional Healthcare System Hospital in Whiteville; Grace Hospital in Morganton; Harris Regional Hospital in Sylva; Haywood Regional Medical Center in Clyde; Levine Children’s Hospital in Charlotte; Scotland Memorial Hospital in Laurinburg; Valdese Hospital in Valdese; and Stanly Regional Medical Center in Albermarie.

Go to http://site.acsnsqip.org/ for more information about ACS NSQIP.

Sixteen hospitals in North Carolina have signed on to the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP^®), a leading model for outcomes-based surgical quality improvement that collects clinical, risk-adjusted, 30-day outcomes data in a nationally benchmarked database.

The following North Carolina hospitals have joined ACS NSQIP: Carolinas Medical Center, Charlotte, including branches of Lincoln in Lincolnton, Mercy in Charlotte, Northeast in Concord, Pineville in Charlotte, Union in Monroe, and University in Charlotte; Cleveland Regional Medical Center in Shelby; Columbus Regional Healthcare System Hospital in Whiteville; Grace Hospital in Morganton; Harris Regional Hospital in Sylva; Haywood Regional Medical Center in Clyde; Levine Children’s Hospital in Charlotte; Scotland Memorial Hospital in Laurinburg; Valdese Hospital in Valdese; and Stanly Regional Medical Center in Albermarie.

Go to http://site.acsnsqip.org/ for more information about ACS NSQIP.

The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Surgical Care survey is now available on the American College of Surgeons (ACS) website.

The ACS, in partnership with other surgical and anesthesia organizations and the Agency for Healthcare Research and Quality’s (AHRQ) CAHPS® Consortium, developed the survey to assess surgical patients’ experiences before, during, and after operations to identify opportunities for improving quality of care, surgical outcomes, and patient experience of care, as well as for purposes of public reporting.

The CAHPS® Surgical Care survey is a standardized patient survey that produces clear and usable comparative information for both consumers and health care providers. The CAHPS® Surgical Care Survey is the only National Quality Forum-endorsed measure designed to assess surgical quality from the patient’s perspective. Go to www.facs.org/ahp/cahps/index.html to access the survey.

The ACS is interested in learning about surgeons’ experiences in administering the CAHPS® Surgical Care Survey. To share your experience, contact Jill Shelly at [email protected] or 202-672-1507.☐

The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Surgical Care survey is now available on the American College of Surgeons (ACS) website.

The ACS, in partnership with other surgical and anesthesia organizations and the Agency for Healthcare Research and Quality’s (AHRQ) CAHPS® Consortium, developed the survey to assess surgical patients’ experiences before, during, and after operations to identify opportunities for improving quality of care, surgical outcomes, and patient experience of care, as well as for purposes of public reporting.

The CAHPS® Surgical Care survey is a standardized patient survey that produces clear and usable comparative information for both consumers and health care providers. The CAHPS® Surgical Care Survey is the only National Quality Forum-endorsed measure designed to assess surgical quality from the patient’s perspective. Go to www.facs.org/ahp/cahps/index.html to access the survey.

The ACS is interested in learning about surgeons’ experiences in administering the CAHPS® Surgical Care Survey. To share your experience, contact Jill Shelly at [email protected] or 202-672-1507.☐

The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Surgical Care survey is now available on the American College of Surgeons (ACS) website.

The ACS, in partnership with other surgical and anesthesia organizations and the Agency for Healthcare Research and Quality’s (AHRQ) CAHPS® Consortium, developed the survey to assess surgical patients’ experiences before, during, and after operations to identify opportunities for improving quality of care, surgical outcomes, and patient experience of care, as well as for purposes of public reporting.

The CAHPS® Surgical Care survey is a standardized patient survey that produces clear and usable comparative information for both consumers and health care providers. The CAHPS® Surgical Care Survey is the only National Quality Forum-endorsed measure designed to assess surgical quality from the patient’s perspective. Go to www.facs.org/ahp/cahps/index.html to access the survey.

The ACS is interested in learning about surgeons’ experiences in administering the CAHPS® Surgical Care Survey. To share your experience, contact Jill Shelly at [email protected] or 202-672-1507.☐

LOS ANGELES – Full left-atrial ablation by the modified Cox MAZE procedure to treat atrial fibrillation led to significant reductions in left atrial function, based on a detailed assessment of 31 patients who underwent this treatment using bilateral bipolar radiofrequency.

The damaging effect of complete left-atrial ablation contrasted with the impact of a less extensive procedure, pulmonary vein isolation, which kept left-atrial function intact and even improved it by some parameters. Opinions split on the implications of these findings.

"Our advice is that left-atrial ablation should be restricted to those cases where pulmonary vein isolation will likely be insufficient" to restore and maintain sinus rhythm, Dr. Marieke G. Compier said as she presented the findings at the annual scientific sessions of the American Heart Association on Nov. 6.

But a cardiac surgeon who heard the results disagreed, contending that the top priority is performing the procedure that will result in durable prevention of atrial fibrillation (AF) recurrence.

"Recurrence of atrial fibrillation is a more important determinant of [successful] clinical outcomes than preserved atrial function," said Dr. Pierre Page, chief of cardiac surgery at the University of Montreal. "The data we have today show that left-atrial ablation is very beneficial," Dr. Page said in an interview.

Dr. Compier and her associates used echocardiography to assess left-atrial function in 31 patients who underwent a modified Cox-MAZE procedure for complete left-atrial ablation using bilateral bipolar radiofrequency, and 31 patients who underwent pulmonary-vein isolation (PVI) only. In the full ablation group, 25 patients had persistent AF and 6 had paroxysmal AF; in the PVI group, 25 patients had paroxysmal disease and 6 had persistent AF. All patients also underwent concurrent coronary artery bypass, valve surgery, or both.

The researchers assessed the efficacy of AF treatment using 24-hour ECG monitoring at 3, 6, and 12 months following surgery. They also used two-dimensional echocardiography to assess left atrial size and function at 3 months and 1 year after surgery.

After 1 year, 68% of the patients who had full ablation and 81% of those who underwent PVI were free of AF and completely off anti-arrhythmic drug treatment; the other patients in each group had AF recurrences. The different long-term success in maintaining sinus rhythm in the two groups probably stemmed from the unbalanced distribution of patients with paroxysmal and persistent AF, said Dr. Compier, a cardiologist in the Heart Center at Leiden (the Netherlands) University Medical Center. "I think this is why full ablation seemed less successful," she said.

After 1 year, echocardiographic examinations showed that patients treated with full ablation had statistically significant reductions in left atrial volume and strain, and 42% of patients had A-wave restoration. Compared with measurements made prior to surgery, strain rate fell by an average of about 50%, peak A-wave dropped by an average of about a third, and average left-atrial ejection fraction and filling fraction each dropped by about 20%. All of these changes were statistically significant, compared with baseline.

In contrast, patients who underwent PVI had no significant change in their strain rate or peak A wave, and their average left-atrial ejection fraction and filling fraction each rose by about 10% compared with baseline, statistically significant differences. A-wave restoration occurred in 87% of the PVI patients.

Stepwise regression analysis of baseline differences between the two study groups showed that the follow-up differences seen in left-atrial size and function were best explained by the different ablation treatments the two groups received, Dr. Compier said.

Dr. Compier said that she had no disclosures.

LOS ANGELES – Full left-atrial ablation by the modified Cox MAZE procedure to treat atrial fibrillation led to significant reductions in left atrial function, based on a detailed assessment of 31 patients who underwent this treatment using bilateral bipolar radiofrequency.

The damaging effect of complete left-atrial ablation contrasted with the impact of a less extensive procedure, pulmonary vein isolation, which kept left-atrial function intact and even improved it by some parameters. Opinions split on the implications of these findings.

"Our advice is that left-atrial ablation should be restricted to those cases where pulmonary vein isolation will likely be insufficient" to restore and maintain sinus rhythm, Dr. Marieke G. Compier said as she presented the findings at the annual scientific sessions of the American Heart Association on Nov. 6.

But a cardiac surgeon who heard the results disagreed, contending that the top priority is performing the procedure that will result in durable prevention of atrial fibrillation (AF) recurrence.

"Recurrence of atrial fibrillation is a more important determinant of [successful] clinical outcomes than preserved atrial function," said Dr. Pierre Page, chief of cardiac surgery at the University of Montreal. "The data we have today show that left-atrial ablation is very beneficial," Dr. Page said in an interview.

Dr. Compier and her associates used echocardiography to assess left-atrial function in 31 patients who underwent a modified Cox-MAZE procedure for complete left-atrial ablation using bilateral bipolar radiofrequency, and 31 patients who underwent pulmonary-vein isolation (PVI) only. In the full ablation group, 25 patients had persistent AF and 6 had paroxysmal AF; in the PVI group, 25 patients had paroxysmal disease and 6 had persistent AF. All patients also underwent concurrent coronary artery bypass, valve surgery, or both.

The researchers assessed the efficacy of AF treatment using 24-hour ECG monitoring at 3, 6, and 12 months following surgery. They also used two-dimensional echocardiography to assess left atrial size and function at 3 months and 1 year after surgery.

After 1 year, 68% of the patients who had full ablation and 81% of those who underwent PVI were free of AF and completely off anti-arrhythmic drug treatment; the other patients in each group had AF recurrences. The different long-term success in maintaining sinus rhythm in the two groups probably stemmed from the unbalanced distribution of patients with paroxysmal and persistent AF, said Dr. Compier, a cardiologist in the Heart Center at Leiden (the Netherlands) University Medical Center. "I think this is why full ablation seemed less successful," she said.

After 1 year, echocardiographic examinations showed that patients treated with full ablation had statistically significant reductions in left atrial volume and strain, and 42% of patients had A-wave restoration. Compared with measurements made prior to surgery, strain rate fell by an average of about 50%, peak A-wave dropped by an average of about a third, and average left-atrial ejection fraction and filling fraction each dropped by about 20%. All of these changes were statistically significant, compared with baseline.

In contrast, patients who underwent PVI had no significant change in their strain rate or peak A wave, and their average left-atrial ejection fraction and filling fraction each rose by about 10% compared with baseline, statistically significant differences. A-wave restoration occurred in 87% of the PVI patients.

Stepwise regression analysis of baseline differences between the two study groups showed that the follow-up differences seen in left-atrial size and function were best explained by the different ablation treatments the two groups received, Dr. Compier said.

Dr. Compier said that she had no disclosures.

LOS ANGELES – Full left-atrial ablation by the modified Cox MAZE procedure to treat atrial fibrillation led to significant reductions in left atrial function, based on a detailed assessment of 31 patients who underwent this treatment using bilateral bipolar radiofrequency.

The damaging effect of complete left-atrial ablation contrasted with the impact of a less extensive procedure, pulmonary vein isolation, which kept left-atrial function intact and even improved it by some parameters. Opinions split on the implications of these findings.

"Our advice is that left-atrial ablation should be restricted to those cases where pulmonary vein isolation will likely be insufficient" to restore and maintain sinus rhythm, Dr. Marieke G. Compier said as she presented the findings at the annual scientific sessions of the American Heart Association on Nov. 6.

But a cardiac surgeon who heard the results disagreed, contending that the top priority is performing the procedure that will result in durable prevention of atrial fibrillation (AF) recurrence.

"Recurrence of atrial fibrillation is a more important determinant of [successful] clinical outcomes than preserved atrial function," said Dr. Pierre Page, chief of cardiac surgery at the University of Montreal. "The data we have today show that left-atrial ablation is very beneficial," Dr. Page said in an interview.

Dr. Compier and her associates used echocardiography to assess left-atrial function in 31 patients who underwent a modified Cox-MAZE procedure for complete left-atrial ablation using bilateral bipolar radiofrequency, and 31 patients who underwent pulmonary-vein isolation (PVI) only. In the full ablation group, 25 patients had persistent AF and 6 had paroxysmal AF; in the PVI group, 25 patients had paroxysmal disease and 6 had persistent AF. All patients also underwent concurrent coronary artery bypass, valve surgery, or both.

The researchers assessed the efficacy of AF treatment using 24-hour ECG monitoring at 3, 6, and 12 months following surgery. They also used two-dimensional echocardiography to assess left atrial size and function at 3 months and 1 year after surgery.

After 1 year, 68% of the patients who had full ablation and 81% of those who underwent PVI were free of AF and completely off anti-arrhythmic drug treatment; the other patients in each group had AF recurrences. The different long-term success in maintaining sinus rhythm in the two groups probably stemmed from the unbalanced distribution of patients with paroxysmal and persistent AF, said Dr. Compier, a cardiologist in the Heart Center at Leiden (the Netherlands) University Medical Center. "I think this is why full ablation seemed less successful," she said.

After 1 year, echocardiographic examinations showed that patients treated with full ablation had statistically significant reductions in left atrial volume and strain, and 42% of patients had A-wave restoration. Compared with measurements made prior to surgery, strain rate fell by an average of about 50%, peak A-wave dropped by an average of about a third, and average left-atrial ejection fraction and filling fraction each dropped by about 20%. All of these changes were statistically significant, compared with baseline.

In contrast, patients who underwent PVI had no significant change in their strain rate or peak A wave, and their average left-atrial ejection fraction and filling fraction each rose by about 10% compared with baseline, statistically significant differences. A-wave restoration occurred in 87% of the PVI patients.

Stepwise regression analysis of baseline differences between the two study groups showed that the follow-up differences seen in left-atrial size and function were best explained by the different ablation treatments the two groups received, Dr. Compier said.

Dr. Compier said that she had no disclosures.

More than 70 percent of the clinicians who participated in a survey conducted earlier this year identified the following barriers to their ability to effectively exchange electronic health care information: lack of interoperability, lack of an information exchange infrastructure, and the cost of setting up and maintaining interfaces and exchanges.

The survey was conducted earlier this year by Doctors Helping Doctors Transform Health Care in collaboration with the Bipartisan Policy Center, the American College of Physicians, and other stakeholder groups. The American College of Surgeons sent out the survey.

A report summarizing the survey findings, titled Clinicians Perspectives on Electronic Health Information Sharing for Transitions of Care, contains the following additional findings:

• Most clinicians surveyed believe that electronic exchange of health information will have a positive impact on improving the quality of patient care, coordinating care, meeting the demands of new care models, and participating in third-party reporting and incentive programs.

• More than half of respondents prefer that information they view as "essential" get "pushed" to them, with the ability to access the rest of the information through a query.

• Most respondents consider "within 24 hours" a reasonable timeframe for the exchange of information when a patient requires follow-up care or is being treated for an urgent problem.

• When updating the electronic health record with information received from an external source, clinicians prefer to be able to selectively pick and choose the information they want integrated.

• Clinicians indicated that access to medication lists and relevant laboratory and imaging test results are commonly recognized as high priorities when patients change health care providers.

Go to http://bipartisanpolicy.org/library/report/accelerating-electronic-information-sharing-improve-quality-and-reduce-costs-health-c to review the report and survey results.

More than 70 percent of the clinicians who participated in a survey conducted earlier this year identified the following barriers to their ability to effectively exchange electronic health care information: lack of interoperability, lack of an information exchange infrastructure, and the cost of setting up and maintaining interfaces and exchanges.

The survey was conducted earlier this year by Doctors Helping Doctors Transform Health Care in collaboration with the Bipartisan Policy Center, the American College of Physicians, and other stakeholder groups. The American College of Surgeons sent out the survey.

A report summarizing the survey findings, titled Clinicians Perspectives on Electronic Health Information Sharing for Transitions of Care, contains the following additional findings:

• Most clinicians surveyed believe that electronic exchange of health information will have a positive impact on improving the quality of patient care, coordinating care, meeting the demands of new care models, and participating in third-party reporting and incentive programs.

• More than half of respondents prefer that information they view as "essential" get "pushed" to them, with the ability to access the rest of the information through a query.

• Most respondents consider "within 24 hours" a reasonable timeframe for the exchange of information when a patient requires follow-up care or is being treated for an urgent problem.

• When updating the electronic health record with information received from an external source, clinicians prefer to be able to selectively pick and choose the information they want integrated.

• Clinicians indicated that access to medication lists and relevant laboratory and imaging test results are commonly recognized as high priorities when patients change health care providers.

Go to http://bipartisanpolicy.org/library/report/accelerating-electronic-information-sharing-improve-quality-and-reduce-costs-health-c to review the report and survey results.

More than 70 percent of the clinicians who participated in a survey conducted earlier this year identified the following barriers to their ability to effectively exchange electronic health care information: lack of interoperability, lack of an information exchange infrastructure, and the cost of setting up and maintaining interfaces and exchanges.

The survey was conducted earlier this year by Doctors Helping Doctors Transform Health Care in collaboration with the Bipartisan Policy Center, the American College of Physicians, and other stakeholder groups. The American College of Surgeons sent out the survey.

A report summarizing the survey findings, titled Clinicians Perspectives on Electronic Health Information Sharing for Transitions of Care, contains the following additional findings:

• Most clinicians surveyed believe that electronic exchange of health information will have a positive impact on improving the quality of patient care, coordinating care, meeting the demands of new care models, and participating in third-party reporting and incentive programs.

• More than half of respondents prefer that information they view as "essential" get "pushed" to them, with the ability to access the rest of the information through a query.

• Most respondents consider "within 24 hours" a reasonable timeframe for the exchange of information when a patient requires follow-up care or is being treated for an urgent problem.

• When updating the electronic health record with information received from an external source, clinicians prefer to be able to selectively pick and choose the information they want integrated.

• Clinicians indicated that access to medication lists and relevant laboratory and imaging test results are commonly recognized as high priorities when patients change health care providers.

Go to http://bipartisanpolicy.org/library/report/accelerating-electronic-information-sharing-improve-quality-and-reduce-costs-health-c to review the report and survey results.

Staff from the American College of Surgeons Division of Advocacy and Health Policy recently attended a Magnet Safety Stakeholder Meeting at the American Academy of Pediatrics.

The group convened to address the growing number of injuries experienced by children and teens who swallow multiple high-powered, rare-earth magnets. According to studies, 10 to 20 percent of such magnet ingestions require endoscopic retrieval; approximately 1 percent require surgical intervention after multiple magnets attract inside the body causing obstruction or perforation.

Rare-earth magnets are marketed to adults as "desk toys," but according to the Consumer Product Safety Commission (CPSC), neither warning labels nor voluntary recall efforts have been effective in preventing ingestion in children. The CPSC recently proposed banning certain high-powered magnet sets due to the unreasonable risk of injury.

While most manufacturers have complied with voluntary recalls, some argue that the current safety warnings on packaging and websites are sufficient, and a safety ban is unwarranted. Comments on this proposed rule are due by November 19 to the CPSC.

To view additional information or to submit comments, go to www.cpsc.gov/info/magnets/index.html.

The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition has also set up a Facebook page with supplementary information.

Surgeons who have been asked to treat magnet ingestion may report cases to the CPSC.

Do you have experience with cases of magnet ingestion that have required surgical intervention? If you have expertise in this area, contact Matthew Coffron at [email protected].

Staff from the American College of Surgeons Division of Advocacy and Health Policy recently attended a Magnet Safety Stakeholder Meeting at the American Academy of Pediatrics.

The group convened to address the growing number of injuries experienced by children and teens who swallow multiple high-powered, rare-earth magnets. According to studies, 10 to 20 percent of such magnet ingestions require endoscopic retrieval; approximately 1 percent require surgical intervention after multiple magnets attract inside the body causing obstruction or perforation.

Rare-earth magnets are marketed to adults as "desk toys," but according to the Consumer Product Safety Commission (CPSC), neither warning labels nor voluntary recall efforts have been effective in preventing ingestion in children. The CPSC recently proposed banning certain high-powered magnet sets due to the unreasonable risk of injury.

While most manufacturers have complied with voluntary recalls, some argue that the current safety warnings on packaging and websites are sufficient, and a safety ban is unwarranted. Comments on this proposed rule are due by November 19 to the CPSC.

To view additional information or to submit comments, go to www.cpsc.gov/info/magnets/index.html.

The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition has also set up a Facebook page with supplementary information.

Surgeons who have been asked to treat magnet ingestion may report cases to the CPSC.

Do you have experience with cases of magnet ingestion that have required surgical intervention? If you have expertise in this area, contact Matthew Coffron at [email protected].

Staff from the American College of Surgeons Division of Advocacy and Health Policy recently attended a Magnet Safety Stakeholder Meeting at the American Academy of Pediatrics.

The group convened to address the growing number of injuries experienced by children and teens who swallow multiple high-powered, rare-earth magnets. According to studies, 10 to 20 percent of such magnet ingestions require endoscopic retrieval; approximately 1 percent require surgical intervention after multiple magnets attract inside the body causing obstruction or perforation.

Rare-earth magnets are marketed to adults as "desk toys," but according to the Consumer Product Safety Commission (CPSC), neither warning labels nor voluntary recall efforts have been effective in preventing ingestion in children. The CPSC recently proposed banning certain high-powered magnet sets due to the unreasonable risk of injury.

While most manufacturers have complied with voluntary recalls, some argue that the current safety warnings on packaging and websites are sufficient, and a safety ban is unwarranted. Comments on this proposed rule are due by November 19 to the CPSC.

To view additional information or to submit comments, go to www.cpsc.gov/info/magnets/index.html.

The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition has also set up a Facebook page with supplementary information.

Surgeons who have been asked to treat magnet ingestion may report cases to the CPSC.

Do you have experience with cases of magnet ingestion that have required surgical intervention? If you have expertise in this area, contact Matthew Coffron at [email protected].

The American College of Surgeons (ACS) in October held the ACS Surgical Health Care Quality Forum Philadelphia, the ninth stop in a national tour to drive discussions on effective quality improvement methods used by surgeons, physicians, and hospitals to improve patient safety and reduce costs.

The Philadelphia forum focused on the importance of physician-led quality improvement initiatives in sustaining better outcomes, using the ACS National Surgical Quality Improvement Program (ACS NSQIP) as a leading model that provides surgeons with reliable data to help pinpoint areas for improvement.

"We’re all faced with the challenges of navigating a complex and ever-changing health care system," said Marshall Z. Schwartz, MD, FACS, professor of surgery and pediatrics at Drexel University, pediatric surgeon-in-chief at St. Christopher’s Hospital for Children, Philadelphia, a member of the ACS Board of Regents, and event co-host. "The good news is we don’t have to re-invent the wheel to achieve the level of quality improvement and cost savings we need for health reform to be successful."

"Using proven quality improvement methods like ACS NSQIP is a perfect example of what we, as physicians, can do together to support health reform," added Howard M. Snyder III, MD, FACS, attending urologist at Children’s Hospital of Philadelphia, professor of urology in surgery at the University of Pennsylvania School of Medicine, Philadelphia, a member of the ACS Board of Regents, and event co-host.

Keynote speaker U.S. Rep. Jim Gerlach (R-PA), a member of the influential House Ways and Means Committee, cited parallels between the government’s health care reform efforts and quality improvement programs such as ACS NSQIP, which collects clinical, risk-adjusted, 30-day outcomes data in a nationally benchmarked database. He also addressed the need to link higher quality care to reimbursement.

"The mission of the Ways and Means Committee right now is to prevent the 27 percent cuts in Medicare reimbursement and extend it until we can come up with a proper formula for reimbursing physicians," said Representative Gerlach. "You [surgeons] bring a credibility and knowledge that legislators don’t have, and I would encourage you to advocate for these changes we need to have and the programs you want to save because they work."

A 2009 study published in the Annals of Surgery determined that hospitals participating in ACS NSQIP each prevented 200-500 complications annually and saved an average of 12-36 lives per year by reducing complications. With the average cost of medical complications equaling $11,000 per occurrence, the combined potential savings of 4,500 hospitals could add up to $13-26 billion each year, amounting to an estimated total savings of $260 billion over a period of 10 years (Ann. Surg. 2009; 250:363-76).

The forum emphasized the reduction of complications with a focus on surgical outcomes – an objective that is not new in Pennsylvania.

"Pennsylvania was the first state to publicly report hospital-acquired infections and that transparency has improved the appetite for quality improvement programs in our state and around the country," said Larry R. Kaiser, MD, FACS, senior executive vice president for health services, dean, Temple University School of Medicine; and president and chief executive officer, Temple University Health System.

"Surgeons trust and embrace clinical data which is why the Society of Thoracic Surgeons National Database and ACS NSQIP have been successful tools to reduce complications and improve patient care," he added.

"For ten years, Geisinger has focused on an intervention framework to identify variation in care and re-engineer best practices, resulting in decreased costs and improved quality," said Glenn D. Steele Jr., MD, PhD, FACS, president and chief executive officer, Geisinger Health System, Danville, PA. "Surgery departments present a clear opportunity to define complications and implement and assess solutions, as there is a distinct starting and end point to support accurate measurement."

Beyond improving patient care and reducing costs, ACS NSQIP is a valuable source of information that is leveraged by surgeons to compare themselves with their colleagues and that can be used by individuals to differentiate hospitals in their community.

"Using a program like ACS NSQIP allows us to benchmark ourselves against our colleagues as well as other hospitals across the country and create a national standard," said John S. Kukora, MD, FACS, FACE, chairman, department of surgery, program director, general surgery residency program, Abington Memorial Hospital (PA). "This [type of] reporting isn’t just for surgeons and hospital administrators. It can also inform consumers’ choices as they are armed with knowledge and can choose a hospital based on its performance record."

While much of the panel focused on the profession’s quality improvement successes, one panelist pointed out enhanced ways to study and measure the successes of ACS NSQIP in hospitals around the country.

"From a business school perspective, continuous quality improvement [CQI] is a good idea in theory but rarely works in practice," said Mark V. Pauly, PhD, Bendheim Professor, professor of health care management, professor of business economics and public policy, The Wharton School, University of Pennsylvania. "However, based on what I’ve seen thus far, I’m encouraged to believe ACS NSQIP is an exception to the rule, though more empirical evidence comparing outcomes data between hospitals with the program and those without is needed to convince health economists that CQI can be effective."

The ACS has hosted community forums across the nation throughout 2012. To view the archived forum video and follow updates on upcoming tour locations, please visit InspiringQuality.FACS.org or the College’s YouTube channel.

The American College of Surgeons (ACS) in October held the ACS Surgical Health Care Quality Forum Philadelphia, the ninth stop in a national tour to drive discussions on effective quality improvement methods used by surgeons, physicians, and hospitals to improve patient safety and reduce costs.

The Philadelphia forum focused on the importance of physician-led quality improvement initiatives in sustaining better outcomes, using the ACS National Surgical Quality Improvement Program (ACS NSQIP) as a leading model that provides surgeons with reliable data to help pinpoint areas for improvement.

"We’re all faced with the challenges of navigating a complex and ever-changing health care system," said Marshall Z. Schwartz, MD, FACS, professor of surgery and pediatrics at Drexel University, pediatric surgeon-in-chief at St. Christopher’s Hospital for Children, Philadelphia, a member of the ACS Board of Regents, and event co-host. "The good news is we don’t have to re-invent the wheel to achieve the level of quality improvement and cost savings we need for health reform to be successful."

"Using proven quality improvement methods like ACS NSQIP is a perfect example of what we, as physicians, can do together to support health reform," added Howard M. Snyder III, MD, FACS, attending urologist at Children’s Hospital of Philadelphia, professor of urology in surgery at the University of Pennsylvania School of Medicine, Philadelphia, a member of the ACS Board of Regents, and event co-host.

Keynote speaker U.S. Rep. Jim Gerlach (R-PA), a member of the influential House Ways and Means Committee, cited parallels between the government’s health care reform efforts and quality improvement programs such as ACS NSQIP, which collects clinical, risk-adjusted, 30-day outcomes data in a nationally benchmarked database. He also addressed the need to link higher quality care to reimbursement.

"The mission of the Ways and Means Committee right now is to prevent the 27 percent cuts in Medicare reimbursement and extend it until we can come up with a proper formula for reimbursing physicians," said Representative Gerlach. "You [surgeons] bring a credibility and knowledge that legislators don’t have, and I would encourage you to advocate for these changes we need to have and the programs you want to save because they work."

A 2009 study published in the Annals of Surgery determined that hospitals participating in ACS NSQIP each prevented 200-500 complications annually and saved an average of 12-36 lives per year by reducing complications. With the average cost of medical complications equaling $11,000 per occurrence, the combined potential savings of 4,500 hospitals could add up to $13-26 billion each year, amounting to an estimated total savings of $260 billion over a period of 10 years (Ann. Surg. 2009; 250:363-76).

The forum emphasized the reduction of complications with a focus on surgical outcomes – an objective that is not new in Pennsylvania.

"Pennsylvania was the first state to publicly report hospital-acquired infections and that transparency has improved the appetite for quality improvement programs in our state and around the country," said Larry R. Kaiser, MD, FACS, senior executive vice president for health services, dean, Temple University School of Medicine; and president and chief executive officer, Temple University Health System.

"Surgeons trust and embrace clinical data which is why the Society of Thoracic Surgeons National Database and ACS NSQIP have been successful tools to reduce complications and improve patient care," he added.

"For ten years, Geisinger has focused on an intervention framework to identify variation in care and re-engineer best practices, resulting in decreased costs and improved quality," said Glenn D. Steele Jr., MD, PhD, FACS, president and chief executive officer, Geisinger Health System, Danville, PA. "Surgery departments present a clear opportunity to define complications and implement and assess solutions, as there is a distinct starting and end point to support accurate measurement."

Beyond improving patient care and reducing costs, ACS NSQIP is a valuable source of information that is leveraged by surgeons to compare themselves with their colleagues and that can be used by individuals to differentiate hospitals in their community.

"Using a program like ACS NSQIP allows us to benchmark ourselves against our colleagues as well as other hospitals across the country and create a national standard," said John S. Kukora, MD, FACS, FACE, chairman, department of surgery, program director, general surgery residency program, Abington Memorial Hospital (PA). "This [type of] reporting isn’t just for surgeons and hospital administrators. It can also inform consumers’ choices as they are armed with knowledge and can choose a hospital based on its performance record."

While much of the panel focused on the profession’s quality improvement successes, one panelist pointed out enhanced ways to study and measure the successes of ACS NSQIP in hospitals around the country.

"From a business school perspective, continuous quality improvement [CQI] is a good idea in theory but rarely works in practice," said Mark V. Pauly, PhD, Bendheim Professor, professor of health care management, professor of business economics and public policy, The Wharton School, University of Pennsylvania. "However, based on what I’ve seen thus far, I’m encouraged to believe ACS NSQIP is an exception to the rule, though more empirical evidence comparing outcomes data between hospitals with the program and those without is needed to convince health economists that CQI can be effective."

The ACS has hosted community forums across the nation throughout 2012. To view the archived forum video and follow updates on upcoming tour locations, please visit InspiringQuality.FACS.org or the College’s YouTube channel.

The American College of Surgeons (ACS) in October held the ACS Surgical Health Care Quality Forum Philadelphia, the ninth stop in a national tour to drive discussions on effective quality improvement methods used by surgeons, physicians, and hospitals to improve patient safety and reduce costs.

The Philadelphia forum focused on the importance of physician-led quality improvement initiatives in sustaining better outcomes, using the ACS National Surgical Quality Improvement Program (ACS NSQIP) as a leading model that provides surgeons with reliable data to help pinpoint areas for improvement.

"We’re all faced with the challenges of navigating a complex and ever-changing health care system," said Marshall Z. Schwartz, MD, FACS, professor of surgery and pediatrics at Drexel University, pediatric surgeon-in-chief at St. Christopher’s Hospital for Children, Philadelphia, a member of the ACS Board of Regents, and event co-host. "The good news is we don’t have to re-invent the wheel to achieve the level of quality improvement and cost savings we need for health reform to be successful."

"Using proven quality improvement methods like ACS NSQIP is a perfect example of what we, as physicians, can do together to support health reform," added Howard M. Snyder III, MD, FACS, attending urologist at Children’s Hospital of Philadelphia, professor of urology in surgery at the University of Pennsylvania School of Medicine, Philadelphia, a member of the ACS Board of Regents, and event co-host.

Keynote speaker U.S. Rep. Jim Gerlach (R-PA), a member of the influential House Ways and Means Committee, cited parallels between the government’s health care reform efforts and quality improvement programs such as ACS NSQIP, which collects clinical, risk-adjusted, 30-day outcomes data in a nationally benchmarked database. He also addressed the need to link higher quality care to reimbursement.

"The mission of the Ways and Means Committee right now is to prevent the 27 percent cuts in Medicare reimbursement and extend it until we can come up with a proper formula for reimbursing physicians," said Representative Gerlach. "You [surgeons] bring a credibility and knowledge that legislators don’t have, and I would encourage you to advocate for these changes we need to have and the programs you want to save because they work."

A 2009 study published in the Annals of Surgery determined that hospitals participating in ACS NSQIP each prevented 200-500 complications annually and saved an average of 12-36 lives per year by reducing complications. With the average cost of medical complications equaling $11,000 per occurrence, the combined potential savings of 4,500 hospitals could add up to $13-26 billion each year, amounting to an estimated total savings of $260 billion over a period of 10 years (Ann. Surg. 2009; 250:363-76).

The forum emphasized the reduction of complications with a focus on surgical outcomes – an objective that is not new in Pennsylvania.

"Pennsylvania was the first state to publicly report hospital-acquired infections and that transparency has improved the appetite for quality improvement programs in our state and around the country," said Larry R. Kaiser, MD, FACS, senior executive vice president for health services, dean, Temple University School of Medicine; and president and chief executive officer, Temple University Health System.

"Surgeons trust and embrace clinical data which is why the Society of Thoracic Surgeons National Database and ACS NSQIP have been successful tools to reduce complications and improve patient care," he added.

"For ten years, Geisinger has focused on an intervention framework to identify variation in care and re-engineer best practices, resulting in decreased costs and improved quality," said Glenn D. Steele Jr., MD, PhD, FACS, president and chief executive officer, Geisinger Health System, Danville, PA. "Surgery departments present a clear opportunity to define complications and implement and assess solutions, as there is a distinct starting and end point to support accurate measurement."

Beyond improving patient care and reducing costs, ACS NSQIP is a valuable source of information that is leveraged by surgeons to compare themselves with their colleagues and that can be used by individuals to differentiate hospitals in their community.

"Using a program like ACS NSQIP allows us to benchmark ourselves against our colleagues as well as other hospitals across the country and create a national standard," said John S. Kukora, MD, FACS, FACE, chairman, department of surgery, program director, general surgery residency program, Abington Memorial Hospital (PA). "This [type of] reporting isn’t just for surgeons and hospital administrators. It can also inform consumers’ choices as they are armed with knowledge and can choose a hospital based on its performance record."

While much of the panel focused on the profession’s quality improvement successes, one panelist pointed out enhanced ways to study and measure the successes of ACS NSQIP in hospitals around the country.

"From a business school perspective, continuous quality improvement [CQI] is a good idea in theory but rarely works in practice," said Mark V. Pauly, PhD, Bendheim Professor, professor of health care management, professor of business economics and public policy, The Wharton School, University of Pennsylvania. "However, based on what I’ve seen thus far, I’m encouraged to believe ACS NSQIP is an exception to the rule, though more empirical evidence comparing outcomes data between hospitals with the program and those without is needed to convince health economists that CQI can be effective."

The ACS has hosted community forums across the nation throughout 2012. To view the archived forum video and follow updates on upcoming tour locations, please visit InspiringQuality.FACS.org or the College’s YouTube channel.