56 |
FROM RESIDENCY TO RETIREMENT
for preoperative evaluation
and perioperative management
of the older surgical patient,
developed jointly by the
American College of Surgeons
and the American Geriatric
Society and available on their
websites at no charge.
3, 4
•Embrace population health.
Even further from core surgical
focus, the management
of chronic conditions in a
population, such as that of
a geographic area or the
summation of all primary care
provider panels of patients, will
be so important for hospitals
and systems that surgeons must
help. At minimum, a surgeon
can notify the family physician
when the surgeon identifies
hypertension, hyperglycemia,
smoking, lack of recommended
mammogram or colonoscopy, or
another potential risk.
•Satisfy patients. Traditionally,
surgeons would not thrive if
they provided less-than-excellent
service to patients and referring
physicians, but this service,
measured and publicly reported,
is now the basis for direct and
significant financial incentives
and penalties. Technical
excellence is insufficient; a
surgeon is scrutinized for
access to appointments, how
close a patient is seen to his or
her appointment time, alacrity
with calling the patient with lab
results, and more.
Conclusion
Maryland has become a
laboratory for health care
reform, including all-payor
rate setting and global hospital
budgets overseen by a central
state commission. So far,
the experiment appears to
be working, with decreased
costs and increased quality,
and therefore there will be
pressure on other states to
adopt some or all of these
dramatic changes. Surgeons
will be affected and those who
are prescient and prepare will
thrive in this new world. ♦
REFERENCES
1. Rajkumar R, Patel A, Murphy K, et
al. Maryland’s all-payer approach to
delivery-system reform. N Engl J Med.
2014;370( 6):493-495.
2. Patel A, Rajkumar R, Colmers JM,
Kinzer D, Conway PH, Sharfstein
JM. Maryland’s global hospital
budgets—preliminary results from
an all-payer model. N Engl J Med.
2015;373( 20):1899-1901.
3. Chow WB, Rosenthal RA, Merkow
RP, Ko CY, Esnaola NF. Optimal
preoperative assessment of the
geriatric surgical patient: A best
practices guideline from the
American College of Surgeons
National Surgical Quality
Improvement Program and the
American Geriatrics Society. J Am
Coll Surg.215( 4):453-466.
4. Mohany S, Rosental R, Russell
M, Neuman M, Ko C, Esnaola N.
Optimal Perioperative Management
of the Geriatric Patient. 2016.
Available at: facs.org/~/media/files/
quality%20programs/geriatric/
acs%20nsqip%20geriatric% 20
2016%20guidelines.ashx. Accessed
February 7, 2016.
So far, the experiment appears to be working, with decreased
costs and increased quality, and there will therefore be pressure
on other states to adopt some or all of these dramatic changes.
