Exploring the Intersection of Concurrent Surgeries and False Claims Enforcement

 

Renewed focus on concurrent surgeries underscores patient safety concerns. Newspaper investigation has thrust issue into national spotlight, prompting American College of Surgeon Updates

The practice of concurrent surgeries has become a top concern for hospitals across the country following a Boston Globe investigation into the practices of a reputable Massachusetts hospital.

In October, the Globe published a lengthy exposé into the practice of “concurrent” or “double-booking” surgeries at Massachusetts General Hospital (MGH), ranked as the top hospital in the nation by U.S. News and World Report in 2015-2016. The Globe’s investigation revealed an ongoing battle within the health system that pitted one long-time surgeon against the hospital’s top brass in his quest to eliminate concurrent surgeries. The investigation also described specific incidents in which patients were harmed or even paralyzed during double-booked procedures.

The Globe investigation has pushed the issues of concurrent surgeries – a common practice among many academic medical systems across the country – to the surface, drawing criticisms from patient safety advocates and prompting organizations like the American College of Surgeons (ACS) to review current policies on concurrent or overlapping surgeries.

 

David B. Hoyt, MD, FACS, executive director of the ASC, says the organization has assembled a work group to review the current recommendations, and expects to issue updates by the end of March.

“I would say that because our current policies seem to have caused confusion, we’re really trying to be responsive to what confusion has been raised,” he says. “I don’t think there is any real change in behaviors so much as we’re adjusting the policy to try and make it clearer.”

Across the country, major institutions are rethinking their approach to concurrent surgeries, according to a follow-up story published by the Globe in December. A survey by the newspaper found that overlapping surgeries are common in 47 hospitals across the country, although how long those surgeries overlap often varies. At least nine institutions – including Duke University Health System and Dartmouth-Hitchcock Medical Center – are reviewing internal policies, and in some cases, adding more prescriptive restrictions for double-booking procedures.

The issue has also drawn the attention of state and federal regulators. In November, investigators with the state U.S. Attorney’s Office and state attorney general’s office requested 10 years of internal records from MGH, according to the Globe. Prosecutors are looking into whether the hospital improperly billed for surgeries where the surgeon was not present for “critical” parts, a requirement for Medicare reimbursement.

Additionally, the Massachusetts Board of Registration in Medicine approved a new rule requiring surgeons to sign in and out of the operating room and requiring the primary surgeon to identify a backup surgeon, according to the Globe. The rule will require approval from several other state agencies before it can be finalized.

For patient safety advocates, the ongoing discussions surrounding concurrent surgeries have resurfaced key concerns about the potential for patient harm and the gaps in patient consent policies.

“Anyone involved with surgery in the past knows that things can go wrong at the most unexpected times during surgery,” says Brad Truax, MD, a patient safety consultant for The Truax Group in Grantham, New Hampshire. “It might happen early in the surgery; it might happen late in the surgery – it might not be in what is considered the ‘critical’ part of the surgery. I think we often delude ourselves by thinking we can predict what the riskiest part of the surgery is going to be.”

 

This is an excerpt from the April issue of Patient Safety Monitor. Subscribers can read the rest of the article here. Non-subscribers can find out more about the journal, its benefits, and how to subscribe by clicking here.