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'Alarmed' Senate Committee Wants Action on Concurrent Surgeries

News  |  By Debra Shute  
   December 07, 2016

A Senate Finance Committee report calls for "additional measures" to address two major concerns related to the practice of overlapping surgeries: patient safety and improper payments.

Hospitals that haven't yet settled on strict definitions and policies governing the practice of simultaneous surgeries are on notice.

A Senate Finance Committee report released Tuesday acknowledges that "evidence on the practice—safe or otherwise—of concurrent or overlapping surgeries is lacking," but calls for "additional measures" to address two major concerns, patient safety and improper payments by the Centers for Medicare & Medicaid Services.

"Absence of data," the report notes, "does not mean that there is no risk."

The American College of Surgeons (ACS) updated its guidance on concurrent surgeries last spring in the wake of an investigation into the practice at Massachusetts General Hospital by the Boston Globe.

Concurrent Surgery Gets the Spotlight Treatment

The Senate Finance Committee's investigation was in turn sparked by the Globe's report, which rendered the Committee "alarmed by the allegations of patient harm, surgeon misconduct, and inappropriate billing."

In response, its chairman, Senator Orrin Hatch (R-UT), ordered an investigation of 20 hospital systems to ascertain the nature of their policies for simultaneous surgeries.

Defining and Disclosing
While 17 of the 20 hospitals in the Senate inquiry modified or created policies to measure up to ACS standards, the policies of three systems were not complete in time for inclusion in the report.

The Committee reviewed conformance with ACS guidance along six dimensions:

  • Defining "concurrent" and "overlapping" surgeries
  • Defining the "critical portions" of an overlapping surgery
  • Disclosing information to patients
  • Defining what it meant for a surgeon to be "immediately available"
  • Arranging for a backup surgeon
  • Ensuring compliance with new policies

"The Committee staff commends the efforts that some hospitals and surgeons have taken in a relatively short timeframe to address many of the concerns surrounding concurrent and overlapping surgeries," the report stated.

But given the small sample size and ongoing concerns about patient safety and improper payments from CMS, the Committee report recommends that CMS should raise its policy standards for simultaneous surgeries to the level of the ACS' current guidelines and encourages accrediting bodies to do the same.

Mayo Clinic Offers New Data
Meanwhile, new data on the practice has surfaced.

Research published Dec. 1 in the Annals of Surgery compared thousands of overlapping and non-overlapping operations performed at the Mayo Clinic's Rochester, MN, campus, and found no difference in the rates of postoperative complications or deaths within a month after surgery between the two groups.

"Our data shows that overlapping surgery as practiced here is safe," said co-author Robert Cima, MD, acolorectal surgeon and chair of surgical quality at Mayo Clinic's Rochester campus. "We think it provides value to our patients because it allows more patients timely access to surgery and care by expert teams."

In addition, Mayo researchers noted that patient safety may even be enhanced by planning surgeries to overlap during the day, as complications are more likely for night surgeries.

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.

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