Policy & Practice


Office-Based Surgery

A recent study points to the use of general anesthesia as being a more significant factor in patient injury in cosmetic surgeries than whether the procedure is performed in a physician's office or a surgical facility, according to the American Society for Dermatologic Surgery. The study, published in the December 2004 issue of Dermatologic Surgery, finds that patients who undergo cosmetic procedures under general anesthesia are at a greater risk of complication and death than those who had procedures with local anesthesia. The study is based on analysis of 3 years of data from Florida, a state that has the highest reporting of adverse incidents from in-office surgical procedures in the country. These findings conflict with a 2003 study published in the Archives of Surgery that found that deaths and adverse events are more likely in the physician's office than in an ambulatory surgery center. "Office-based surgery is safe and effective when performed by a properly trained physician with the appropriate procedure and level of anesthesia," Gary Monheit, M.D., president-elect of the American Society for Dermatologic Surgery said in a statement. "The real concern is that patients who undergo cosmetic procedures are often unaware of all the risks involved, including where to have the surgery and which types of anesthesia are available."

Medical Spa Trend

Medical spas, a phenomenon that was popular in 2004, will continue to thrive this year, according to an analysis from Spa Finder, a spa marketing and publishing company. The group lists the medical spa as one of the Top 10 spa trends to watch in 2005. These spas are becoming popular places for executive physicals, health and wellness programs, and cosmetic dermatology and dentistry treatments. Spa Finder predicts that these facilities will continue to earn the respect of the medical community as physicians embrace alternative therapies and cosmetic procedures.

Smallpox Vaccine Stockpile

The United States has pledged 20 million doses of smallpox vaccine toward the global stockpile managed by the World Health Organization (WHO). The vaccine doses will physically remain in the U.S. Strategic National Stockpile but will be available for use by the WHO in the event of an emergency. The global stockpile is designed to help those countries, especially those in the developing world, that have no smallpox vaccine and are not prepared to respond to an outbreak of the disease. The global stockpile will only be used if at least one case of smallpox is confirmed in the human population. U.S. government officials have been urging the creation of a WHO Smallpox Vaccine Bank, which would create a physical stockpile of vaccine in Geneva and a virtual global stockpile of pledged vaccine stocks around the world.

Computer Entries Lead to Errors

Automation isn't necessarily a foolproof way to improve patient safety and reduce medical errors, a report from the United States Pharmacopeia (USP) found. Computer entry errors were the fourth leading cause of medication errors according to MEDMARX, USP's national medication error reporting system. These errors have steadily increased and represent about 12% of all MEDMARX records from 1999 through 2003. Performance deficits—wherein an otherwise qualified physician makes a mistake—were the most frequently reported cause of errors. Distractions were the leading contributing factor, accounting for almost 57% of errors associated with computer entry. The report provided an analysis of 235,159 medication errors voluntarily reported by 570 hospitals and health care facilities nationwide.

Improper Payments Increase

Medicare made approximately $20 billion in improper payments in fiscal year 2004, a report from the Centers for Medicare and Medicaid Services has found. The sum included $900 million in underpayments to providers due to errors made by insurers and $20.8 billion in overpayments made to providers. Medicare hopes to cut the rate of erroneous payments by more than half, to 4%, in 2008 by conducting more extensive payment reviews and by implementing other quality control measures. "We have made significant strides in how we measure the error rate in Medicare payments, and that will enable us to do even more to bring it down," commented Mark McClellan, M.D., CMS administrator. "We have much better data that will help us pinpoint problems and allow us to work with the Medicare contractors and providers to make sure claims are submitted and paid properly."

Patients Turn to CAM

Discouraged by the high cost of conventional treatments, 6 million Americans turned to alternative medicines in the past year to treat conditions such as depression and chronic pain, the Center for Studying Health System Change reported. People using these approaches to save money are often uninsured and usually lack a medical home. While the price is right, these alternative treatments "may be of questionable value," said HSC President Paul Ginsburg, Ph.D. About 63% of the respondents said they used herbal remedies, yet two of the most popular remedies—St. John's wort and kava—have been known to cause serious side effects. In more than half these cases, a conventional medical professional was unaware of a patient using an alternative treatment. The study was based on the 2002 National Health Interview Survey, a government survey that includes information on 31,000 adults.

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