The safety of bariatric surgery has come a long way in the past decade, but quality improvement
efforts are focused on appropriate risk assessment and reduction of postop complications.
DROP project continues the push
to reduce bariatric readmissions
of MACRA start
BY GREGORY TWACHTMAN
Frontline Medical News
Implementation of some MACRA (Medicare Access and CHIP Reauthorization Act of 2015 ) provisions could be delayed, CMS Acting Administrator Andy Slavitt told
committee members at a hearing of the Senate Finance
Officials at the Centers for Medicare & Medicaid Services are considering “alternative start dates, looking at
whether shorter periods could be used, and finding other
ways for physicians to get experience with the program before the impact of it really hits them,” Mr. Slavitt testified.
Many of the comments that were submitted by surgeons
and other stakeholders on the proposed MACRA rule called
for delayed implementation, Mr. Slavitt said. Other key
themes included ensuring that patients are the focus, simplifying the rules, creating more pathways to advanced payment models, and providing a greater consideration of the
needs of small and solo practices, particularly rural ones.
“We need to launch this program so that it begins on the
right foot. That means that every physician in the country
needs to feel like they are set up for success,” Mr. Slavitt
said. He added that CMS may release an interim final
VOL. 12 • NO. 8
See MACRA Â page 4
7 l Commentary
Dr. Patrick V. Bailey’s monthly
column highlights the ACS approach
to the proposed PFS for 2017.
16 l General Surgery
‘Failed discharges’ after hernia
surgery can be reduced by stepped up
efforts to prevent postop GI disorders.
22 l Palliative Care
Dr. Bridget N. Fahy sums up CPT
codes and the fee schedule for
advance care planning conversations. Late admission Early admission
BY DOUG BRUNK
Frontline Medical News
FROM THE ACS NSQIP NATIONAL CONFERENCE
SAN DIEGO – Bariatric surgery today has a
high degree of safety and a very low mortality risk, but this wasn’t always the case, especially for higher risk Medicare patients.
“About 10-15 years ago, bariatric surgery
had a problem when it came to mortality,”
John Morton, MD, FACS, said at the Amer-
ican College of Surgeons/National Surgical
Quality Improvement Program National Con-
ference. “You can’t move forward without
A 2005 study using 1996-2002 data on early
mortality among Medicare beneficiaries un-
dergoing bariatric procedures found a 30-day
mortality of 9% and a 1-year mortality of 21%
(JAMA. 2005 Oct. 19;294[ 15]:1903-8). These
were patients over age 65 and operated on by
surgeons with a relative low volume of procedures.
Such data prompted surgical leaders to
push for accreditation in the field. In 2012,
the ACS Bariatric Surgery Center Network
program and the American Society for Metabolic and Bariatric Surgery (ASMBS) Bariatric
Centers of Excellence program were extend-
See DROP Â page 9
Slow start on ‘virtual groups’ is a concern
Pres orte d Sta n d ard
U . S . P o sta g e
Permit N o. 3 84
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ACSSURGERY N E W S C H A N GE SERVICE RE Q UESTE D
151 Fairchild A ve.,
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Online & In-Depth
Merging practices can mean merging EHRs.
How hard can that be? Dr. Jacqueline
Fincher of McDuffie Medical Associates in
Thompson, Ga., spoke at the ACP annual
meeting on unexpected problems and
complexities encountered in combining two
EHR systems. View the story at http://goo.
Laparoscopic common bile duct exploration vs.
endoscopic retrograde cholangiopancreatography
Patrick L. Molt, MD, FACS, presents a debate between Adnan Alseidi,
MD, FACS, and Kimberly M. Brown, MD, FACS, on options for managing
choledocholithiasis. This discussion originated in the ACS Communities
and is one of many ongoing conversations about clinical topics.
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