Part 1 department of surgery grand rounds


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Part 1 department of surgery grand rounds

  1. 1. Surgery and government: A post-election update from Washington John Maa, MD FACS Department of Surgery University of California, San Francisco December 16 th , 2010
  2. 2. The impact of health reform in Washington DC upon surgery <ul><li>The American College of Surgeons vision </li></ul><ul><li>The Palo Alto VA – “scope of practice” and “learning curve” </li></ul><ul><li>The anatomy of a malpractice lawsuit </li></ul><ul><li>The tools in health policy advocacy </li></ul><ul><li>Next steps for surgery </li></ul>
  3. 3. A special place in Washington DC
  4. 6. 5 signers of the Declaration of Independence were physicians
  5. 7. Dispelling myths – Paul Revere’s midnight ride and Dr. Samuel Prescott Paul Revere (MFA) Samuel Adams
  6. 8. What is the impact of ACA on surgery? <ul><li>Expanding coverage through Medicaid may overwhelm an already struggling healthcare delivery system. </li></ul><ul><li>How will we care for 32 million more Americans? </li></ul><ul><li>Is this real reform? </li></ul><ul><li>1) Independent Payment Advisory Board </li></ul><ul><li>2) Patient Centered Outcomes Research Institute </li></ul><ul><li>3) Center for Medicare Innovation </li></ul><ul><li>4) Accountable care organizations </li></ul><ul><li>5) Will the medical home raise costs? </li></ul><ul><li>6) Increased support of rural surgeons </li></ul><ul><li>7) Redistribution of general surgery residency positions </li></ul>
  7. 10. The ACS priorities – Executive Director Dr. David Hoyt October 2010 <ul><li>1) Payment reform & SGR fix </li></ul><ul><li>2) Accountable care organizations </li></ul><ul><li>3) Center for Medicare & Medicaid Innovation </li></ul><ul><li>4) Bundling </li></ul><ul><li>5) P4P and NSQIP </li></ul><ul><li>“ ACA is the blueprint for a whole new care delivery system… is up to us to do everything that we can to make sure that the final structure is sound and equitable for surgeons and patients.” </li></ul><ul><li>How will we ensure an adequate trained workforce to care for 32 million more Americans? </li></ul>
  8. 11. What are the next steps in DC? <ul><li>January 3, 2011 – the 112 th Congress convenes </li></ul><ul><li>Late January – State of the Union address </li></ul><ul><li>Feb 2011 - 1 year to the Iowa and New Hampshire caucus for the Presidential election of 2012 </li></ul><ul><li>Later 2011 - A Supreme Court hearing on the “individual mandate”, which has now been deemed unconstitutional in Arizona, Oklahoma, and Virginia </li></ul>
  9. 12. May 2010 - the new ACS headquarters – a forward base near Capitol Hill…. Thomas Circle
  10. 13. Glaucoma care at the Palo Alto VA – the sentinel event in 2009 A Veteran treated by the Optometry service since 2005 was seen for the first time by Ophthalmology and was found to have progressive visual loss
  11. 14. Glaucoma – one of the blinding diseases – damage to the optic nerve Open chronic vs acute closed angle “Silent thief of sight” Medical Rx with prostaglandin analogs, beta agonists Surgical Rx to lower IOP
  12. 15. Sacramento, California – the center of a national scope of practice battle
  13. 16. The learning curve in Optometry
  14. 17. July 2009 – the role of the media
  15. 18. A strong response of the California Optometry Association
  16. 19. VA loophole in credentialing as a way to expand optometry scope of practice <ul><li>The VA allows providers to practice with certification from a different state. </li></ul><ul><li>The Chief of Optometry was licensed in Washington. </li></ul><ul><li>This confusing variation nationally regarding oversight, competency, and credentialing highlights overlapping state and federal concerns </li></ul>
  17. 20. A slow inquiry…..
  18. 21. The origins of a lawsuit… <ul><li>After being informed by the VA, Mr. Woodward followed instructions to file a grievance. </li></ul><ul><li>He did not hear a response after 6 months, so he retained counsel to file a tort complaint. </li></ul>
  19. 22. Anatomy of a medical malpractice lawsuit
  20. 25. Do the federal government and VA have “sovereign immunity”? <ul><li>Malpractice plaintiff attorney – “ it is virtually impossible to win a case against the VA .” </li></ul><ul><li>Under the FTCA, the U.S. is subject to liability for the negligence of an independent contractor if it can be shown that the government had the authority to control the performance of the contractor, and exercised substantial supervision over daily activities. </li></ul>