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Limits Urged on Surgeries by Low-Volume Providers

   May 20, 2015

An initiative by three major U.S. health systems aims to "minimize the number of patients who wind up getting their care by so-called 'hobbyists,' surgeons and hospitals that seldom do these procedures," says one of its chief proponents.

Leaders at Dartmouth-Hitchcock Medical Center, The Johns Hopkins Hospital and Health System, and the University of Michigan Health System are urging other systems to join their combined 20 hospitals in the "Take the Volume Pledge" campaign to place limits on surgical procedures.

The campaign aims to reduce complications linked to insufficient practice by setting minimum volume thresholds on 10 surgical procedures. The limits apply to hospitals and surgeons.

"We've gotten leaders at these organizations to draw a hard line in the sand so that no surgeon or hospital within these systems will allow those procedures unless they are meeting [certain] volumes," says John Birkmeyer, MD, a surgeon, outcomes researcher, and executive vice president for enterprise support services at Dartmouth-Hitchcock. He  announced the "Take the Volume Pledge" effort this week.

John Birkmeyer, MD

"Our intent with these thresholds is not to set such a high bar that every patient must go to one of five places for surgical care," Birkmeyer says. "What we're trying to do is minimize the number of patients who wind up getting their care by so-called 'hobbyists,' surgeons and hospitals that seldom do these procedures, certainly not enough to attain a high level of honed proficiency."

The effort's first goal is to get hospital leaders to rethink whether they should allow surgeries to be done within their organizations relatively infrequently, and by individual surgeons who rarely tackle such operations.  One option may be to tie surgeon volume with staffing privileges.  "We'll worry at another time about outcome differences between medium volume centers and very high volume centers," he says.

Birkmeyer adds that if all hospitals in the U.S. "applied our standards, it would prohibit half of all hospitals in the country that do these procedures from continuing to do them.  But just to be fair, looking at the volume distribution of these hospitals, you would only redirect 15% of the patients to other hospitals, because there are [not] so many hospitals now doing them that just don't do very many."


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