AI implementation: Radiologists' perspectives on AI-enabled opportunistic CT screening.

OBJECTIVE: AI adoption requires perceived value by end-users. AI-enabled opportunistic CT screening (OS) detects incidental clinically meaningful imaging risk markers on CT for potential preventative health benefit. This investigation assesses radiologists' perspectives on AI and OS. METHODS: An online survey was distributed to 7500 practicing radiologists among ACR membership of which 4619 opened the emails. Familiarity with and views of AI applications were queried and tabulated, as well as knowledge of OS and inducements and impediments to use. RESULTS: Respondent (n = 211) demographics: mean age 55 years, 73 % male, 91 % diagnostic radiologists, 46 % in private practice. 68 % reported using AI in practice, while 52 % were only somewhat familiar with AI. 70 % viewed AI positively though only 46 % reported AI's overall accuracy met expectations. 57 % were unfamiliar with OS, with 52 % of those familiar having a positive opinion. Patient perceptions were the most commonly reported (25 %) inducement for OS use. Provider (44 %) and patient (40 %) costs were the most common impediments. Respondents reported that osteoporosis/osteopenia (81 %), fatty liver (78 %), and atherosclerotic cardiovascular disease risk (76 %) could be well assessed by OS. Most indicated OS output requires radiologist oversight/signoff and should be included in a separate "screening" section in the Radiology report. 28 % indicated willingness to spend 1-3 min reviewing AI-generated output while 18 % would not spend any time. Society guidelines/recommendations were most likely to impact OS implementation. DISCUSSION: Radiologists' perspectives on AI and OS provide practical insights on AI implementation. Increasing end-user familiarity with AI-enabled applications and development of society guidelines/recommendations are likely essential prerequisites for Radiology AI adoption.

Primary care provider perspectives on the value of opportunistic CT screening.

BACKGROUND: Clinical adoption of AI applications requires stakeholders see value in their use. AI-enabled opportunistic-CT-screening (OS) capitalizes on incidentally-detected findings within CTs for potential health benefit. This study evaluates primary care providers' (PCP) perspectives on OS. METHODS: A survey was distributed to US Internal and Family Medicine residencies. Assessed were familiarity with AI and OS, perspectives on potential value/costs, communication of results, and technology implementation. RESULTS: 62 % of respondents (n = 71) were in Family Medicine, 64.8 % practiced in community hospitals. Although 74.6 % of respondents had heard of AI/machine learning, 95.8 % had little-to-no familiarity with OS. The majority reported little-to-no trust in AI. Reported concerns included AI accuracy (74.6 %) and unknown liability (73.2 %). 78.9 % of respondents reported that OS applications would require radiologist oversight. 53.5 % preferred OS results be included in a separate "screening" section within the Radiology report, accompanied by condition risks and management recommendations. The majority of respondents reported results would likely affect clinical management for all queried applications, and that atherosclerotic cardiovascular disease risk, abdominal aortic aneurysm, and liver fibrosis should be included within every CT report regardless of reason for examination. 70.5 % felt that PCP practices are unlikely to pay for OS. Added costs to the patient (91.5 %), the healthcare provider (77.5 %), and unknown liability (74.6 %) were the most frequently reported concerns. CONCLUSION: PCP preferences and concerns around AI-enabled OS offer insights into clinical value and costs. As AI applications grow, feedback from end-users should be considered in the development of such technology to optimize implementation and adoption. Increasing stakeholder familiarity with AI may be a critical prerequisite first step before stakeholders consider implementation.

ACR Lung CT Screening Reporting and Data System, a Systematic Review and Meta-Analysis Before Change in US Preventative Services Taskforce Eligibility Criteria: 2014 to 2021.

OBJECTIVE: To review Lung CT Screening Reporting and Data System (Lung-RADS) scores from 2014 to 2021, before changes in eligibility criteria proposed by the US Preventative Services Taskforce. METHODS: A registered systematic review and meta-analysis was conducted in MEDLINE, Embase, CINAHL, and Web of Science in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines; eligible studies examined low-dose CT (LDCT) lung cancer screening at institutions in the United States and reported Lung-RADS from 2014 to 2021. Patient and study characteristics, including age, gender, smoking status, pack-years, screening timeline, number of individual patients, number of unique studies, Lung-RADS scores, and positive predictive value (PPV) were extracted. Meta-analysis estimates were derived from generalized linear mixed modeling. RESULTS: The meta-analysis included 24 studies yielding 36,211 LDCT examinations for 32,817 patient encounters. The meta-analysis Lung-RADS 1-2 scores were lower than anticipated by ACR guidelines, at 84.4 (95% confidence interval [CI] 83.3-85.6) versus 90% respectively (P < .001). Lung-RADS 3 and 4 scores were both higher than anticipated by the ACR, at 8.7% (95% CI 7.6-10.1) and 6.5% (95% CI 5.707.4), compared with 5% and 4%, respectively (P < .001). The ACR's minimum estimate of PPV for Lung-RADS 3 to 4 is 21% or higher; we observed a rate of 13.1% (95% CI 10.1-16.8). However, our estimated PPV rate for Lung-RADS 4 was 28.6% (95% CI 21.6-36.8). CONCLUSION: Lung-RADS scores and PPV rates in the literature are not aligned with the ACR's own estimates, suggesting that perhaps Lung-RADS categorization needs to be reexamined for better concordance with real-world screening populations. In addition to serving as a benchmark before screening guideline broadening, this study provides guidance for future reporting of lung cancer screening and Lung-RADS data.

Medicare Reimbursement in Colorectal Surgery: A Growing Problem.

BACKGROUND: Medicare reimbursement rates have decreased across various specialties but have not yet been studied in colorectal surgery. OBJECTIVE: This study aimed to analyze Medicare reimbursement trends in colorectal surgery. DESIGN: Observational study. SETTING: The Centers for Medicare and Medicaid Services' Physician Fee Schedule was evaluated for reimbursement data for the 20 most common colorectal surgery procedures from 2006 to 2020. MAIN OUTCOME MEASURES: Inflation-adjusted annual percentage change, compound annual growth rate, and total percentage change were the outcome measures. A subanalysis was performed comparing the changes in reimbursement between 2006 to 2016 and 2016 to 2020 because of legislative changes that went into effect in 2016. RESULTS: During the study period, the inflation-unadjusted mean Medicare reimbursement rate for the 20 most common colorectal surgery procedures increased by +15.6%. This rise was surpassed by the inflation rate of +31.3%. Consequently, the inflation-adjusted reimbursement rate decreased by -11%. The adjusted reimbursement rates decreased the most at -33.8% for a flexible colonoscopy with biopsy and increased the most at +45.3% for a diagnostic rigid proctosigmoidoscopy. Annual percentage change was -0.79%, and the compound annual growth rate was -0.98%. There was an accelerated decrease in annual reimbursement rates from 2016 to 2020 at -2.23% compared to 2006 to 2016 at -0.22% ( p = 0.03). The only procedure that had an increase in adjusted reimbursement rate from 2016 to 2020 was the injection of sclerosing solution for hemorrhoids. LIMITATIONS: Only Medicare reimbursement data were analyzed. CONCLUSIONS: Medicare reimbursements for colorectal surgery procedures are decreasing at an accelerating rate. Although this study is limited to Medicare data, it still presents a representation of overall reimbursement changes because Medicare policies have a ripple effect in the commercial insurance market. It is vital to understand the financial trends to be able to structure future patient care teams and to advocate for the sustainability of colorectal surgery practices in the United States. See Video Abstract at http://links.lww.com/DCR/C136 . REEMBOLSO DE MEDICARE EN CIRUGA COLORRECTAL UN PROBLEMA CRECIENTE: ANTECEDENTES: Las tasas de reembolso de Medicare han disminuido en varias especialidades, pero aún no han sido estudiado en cirugía colorrectal.OBJETIVO: Analizar las tendencias de reembolso de Medicare en cirugía colorrectal.DISEÑO: Estudio observacional.CONTEXTO: Se evaluó el programa de tarifas médicas de los Centros de Servicios de Medicare y Medicaid para obtener datos de reembolso de los 20 procedimientos más comunes en cirugía colorrectal entre los años 2006 y 2020.PRINCIPALES MEDIDAS DE RESULTADO: Variación porcentual anual ajustada por inflación, tasa de crecimiento anual compuesta y variación porcentual total. Se realizó un subanálisis comparando los cambios en el reembolso entre los años 2006 a 2016 y 2016 a 2020 debido a los cambios legislativos que entraron en vigencia en 2016.RESULTADOS: Durante el período de estudio, la tasa media de reembolso de Medicare sin ajuste por inflación para los 20 procedimientos más comunes en cirugía colorrectal aumentó en +15,6 %. Esta suba fue superada por la tasa de inflación del +31,3%. En consecuencia, la tasa de reembolso ajustada por inflación disminuyó un -11%. Lo máximo que disminuyeron las tasas ajustadas de reembolso fue a -33,8% para una colonoscopia flexible con biopsia y aumentaron más a +45,3% para una proctosigmoidoscopia rígida de diagnóstico. El cambio porcentual anual fue -0,79% y la tasa de crecimiento anual compuesto fue -0,98%. Hubo una disminución acelerada en las tasas de reembolso anual de 2016 a 2020 a -2,23 % en comparación con 2006 a 2016 a -0,22% ( p = 0,03). El único procedimiento que tuvo un aumento en la tasa de reembolso ajustada de 2016 a 2020 fue la inyección de solución esclerosante para las hemorroides.LIMITACIONES: Solo se analizaron los datos de reembolso de Medicare.CONCLUSIONES: Los reembolsos de Medicare por procedimientos en cirugía colorrectal están disminuyendo a un ritmo acelerado. Aunque este estudio se limita a los datos de Medicare, aún presenta una representación de los cambios generales en los reembolsos, ya que las pólizas de Medicare tienen un efecto dominó en el mercado de seguros comerciales. Es fundamental comprender las tendencias financieras para poder estructurar futuros equipos de atención de pacientes y abogar por la sostenibilidad de las prácticas de cirugía colorrectal en los Estados Unidos. Consulte Video Resumen video en https://links.lww.com/DCR/C136 . (Traducción-Dr. Osvaldo Gauto ).

The Pre-Radiology Internship: Room for Improvement?

BACKGROUND: A clinical internship is currently required by the American Board of Radiology prior to Radiology residency. The purpose of this investigation is to evaluate practicing radiologists' perspectives on the value of the internship and their recommendations for optimization. METHODS: A five-minute online survey was distributed via email to practicing radiologist members of the American College of Radiology. RESULTS: A total of 566 completed responses (11.3% response rate) were received. Most respondents agreed that their internship was essential for improving non-radiology clinical knowledge (84%) and affirming their decision to become a radiologist (74%). Most respondents (59%) disagree that the one-year internship before residency should be eliminated. Most (53%) of the radiologists in an academic practice agreed that internship should be integrated into Radiology residency. If radiologists were to redesign the internship ("PreRad Internship"), a majority of the respondents would include training in other medical specialties (71%), working along technologists (55%) and informatics/AI/computer science (54%). While the greatest proportion (50%) of interventional radiologists reported a Surgery internship would be the most beneficial for their primary subspecialty (50%), diagnostic radiologists most commonly (27%) reported the PreRad Internship would be the most beneficial. The greatest proportions of Abdominal-, Breast-, and Neuroradiology-trained respondents reported a PreRad Internship would be the most beneficial internship for their primary field of subspecialty Radiology practice (32%, 36%, and 33%, respectively). CONCLUSION: The internship before Radiology residency offers some benefits but could be further optimized. There is support from practicing radiologists for a redesigned, more Radiology-specific PreRad Internship.

Billing and Utilization Trends for Hand Surgery Indicate Worsening Barriers to Accessing Care.

BACKGROUND: Hospitals and providers may increase hand surgery charges to compensate for decreasing reimbursement. Higher charges, combined with increasing utilization of ambulatory surgical centers (ASCs), may threaten the accessibility of affordable hand surgery care for uninsured and underinsured patients. METHODS: We queried the Physician/Supplier Procedure Summary to collect the number of procedures, charges, and reimbursements of hand procedures from 2010 to 2019. We adjusted procedural volume by Medicare enrollment and monetary values to the 2019 US dollar. We calculated weighted means of charges and reimbursement that were then used to calculate reimbursement-to-charge ratios (RCRs). We calculated overall change and r2 from 2010 to 2019 for all procedures and stratified by procedural type, service setting, and state where service was rendered. RESULTS: Weighted mean charges, reimbursement, and RCRs changed by + 21.0% (from $1,227 to $1,485; r2 = 0.93), +10.8% (from $321 to $356; r2 = 0.69), and -8.4% (from 0.26 to 0.24; r2 = 0.76), respectively. The Medicare enrollment-adjusted number of procedures performed in ASCs increased by 63.8% (r2 = 0.95). Trends in utilization and billing varied widely across different procedural types, service settings, and states. CONCLUSIONS: Charges for hand surgery procedures steadily increased, possibly reflecting an attempt to make up for reimbursements perceived to be inadequate. This trend places uninsured and underinsured patients at greater risk for financial catastrophe, as they are often responsible for full or partial charges. In addition, procedures shifted from inpatient to ASC setting. This may further limit access to affordable hand care for uninsured and underinsured patients.

Over 20 years of declining Medicare reimbursement for spine surgeons: a temporal and geographic analysis from 2000 to 2021.

OBJECTIVE: Procedural reimbursement for spine surgery has changed drastically over the past 20 years. A comprehensive understanding of these trends is important as major changes in reimbursement models of spine surgery continue to evolve within various spine specialties as well as broader national healthcare policy. In this study the authors evaluated the monetary trends in Medicare reimbursement rates for the 15 most common spinal surgery procedures from 2000 to 2021. METHODS: The National Surgery Quality Improvement Project database (2019) was queried to determine the 15 most commonly performed spine surgery procedures. The Current Procedural Terminology (CPT) codes for each of these procedures were obtained from the Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services, and comprehensive reimbursement data for each code were extracted. Changes in Medicare reimbursement rates were calculated and averaged for each procedure as both raw percent changes and percent changes adjusted for inflation to 2021 US dollars (USD) based on the consumer price index (CPI). The adjusted R2 value, the compound annual growth rate (CAGR), and both the average annual and the total percent change in reimbursement were calculated based on these adjusted trends for all included procedures. RESULTS: After adjustment for inflation, average reimbursement for all procedures decreased by 33.8% from 2000 to 2021. The greatest mean decrease was seen in anterior cervical arthrodesis (-38.7%), while the smallest mean decrease was in vertebral body excision (-17.1%). From 2000 to 2021, the adjusted reimbursement rate for all included procedures decreased by an average of 1.9% each year, with an average R2 value of 0.69. CONCLUSIONS: This is the first study to evaluate monetary trends in Medicare reimbursement for spine surgery procedures. After adjusting for inflation, Medicare reimbursement for the 15 most commonly performed spine procedures has steadily decreased from 2000 to 2021. Increased awareness of these trends and the forces driving them will be critical in the coming years as negotiations regarding reimbursement models continue to unfold. Greater understanding of spine surgery reimbursement among policy makers, hospitals, and surgeons will be important to ensure continued access to quality surgical spine care in the United States.

Decreasing Medicare Utilization, Reimbursement, and Reimbursement-to-Charge Ratio of Reconstructive Plastic Surgery Procedures: 2010 to 2019.

BACKGROUND: This study aimed to evaluate recent trends in utilization, reimbursement, and charges for reconstructive plastic surgery procedures billed to Medicare. METHODS: We queried the Physician/Supplier Procedure Summary from the Centers for Medicare and Medicaid Services for procedures billed by plastic surgeons to Medicare Part B between 2010 and 2019. We collected service counts, charges, and reimbursements. We adjusted utilization by Medicare enrollment and adjusted monetary values for inflation. We calculated the weighted mean charge and reimbursement, which were used to calculate the reimbursement-to-charge ratio (RCR). We examined trends over time by calculating differences and performing correlation analyses of utilization, charges, reimbursement, and RCR for all procedures and for different procedural categories. RESULTS: From 2010 to 2019, the overall enrollment-adjusted utilization for 912 reconstructive procedures decreased by 6.6% (r2 = 0.46). Utilization increased in certain procedural categories such as skin debridement (+36.9%, r2 = 0.48) and procedures of the breast (+114.9%, r2 = 0.48). Charges increased by 32.9% (r2 = 0.99), reimbursement decreased by 5.3% (r2 = 0.84), and RCR decreased by 28.7% (r2 = 0.99). Skin replacement/flaps/grafts procedures underwent the greatest relative decrease in reimbursement (-26.8%, r2 = 0.87). Reimbursement-to-charge ratio decreased for all procedural categories except for procedures of the auditory system. CONCLUSIONS: In the past decade, Medicare utilization and reimbursement for reconstructive plastic surgery procedures decreased, whereas charges increased. This resulted in decreasing reimbursement relative to charged amounts. These findings raise concerns regarding the economic viability of providing plastic surgery services to an aging population and may impact patients' ability to access affordable plastic surgical care.

Decline in Medicare Utilization and Reimbursement Rates in Ophthalmic Plastic and Reconstructive Surgery: 2010-2019.

BACKGROUND: Analysis of current and past reimbursement patterns for federally funded programs is crucial to develop sustainable future payment models. METHODS: The Centers for Medicare and Medicaid Services Physician Fee Schedule was used to evaluate 26 common ophthalmic plastic and reconstructive surgery (OPRS) procedures. From 2010 to 2019, compound annual growth rate, total percent change, and annual percent change were calculated using inflation-adjusted reimbursement rates. Centers for Medicare and Medicaid Services' Physician/Supplier Procedure Summary was used to assess the surgical volume of the 26 procedures in ophthalmology and plastic surgery services. RESULTS: From 2010 to 2019, total billed surgical procedures in OPRS decreased by 57.0%, affecting both ophthalmologists (-54.3%) and plastic surgeons (-80.1%). Over the study period, inflation-adjusted reimbursement rates decreased by 5.6%. Compound annual growth rate was -0.66%, and annual percent change was -0.62%. From 2010 to 2013, reimbursement rates increased by 1.8% each year. In contrast, from 2013 to 2019, reimbursement rates decreased by 1.7% each year (P < 0.0001). CONCLUSIONS: From 2010 to 2019, Medicare utilization has substantially declined for OPRS procedures. Inflation-adjusted Medicare reimbursement rates have decreased for the majority of common procedures since 2013. Surgeons and policymakers need to be aware of these trends to ensure future availability of subspecialty surgical services.

Medicare Reimbursement Trends for Hospital-Based Oral Maxillofacial Surgery Procedures: 2003 to 2020.

PURPOSE: To evaluate recent trends in Medicare reimbursement rates for common hospital-based oral-maxillofacial surgery procedures. METHODS: Physician Fee Schedule Look-Up Tool by the Centers for Medicare and Medicaid Services was searched for reimbursement rates for the 20 most performed oral-maxillofacial surgery procedures between 2003 and 2020. Total percent change, annual percent change, and compound annual growth rate (CAGR) were calculated using the adjusted reimbursement rates over the study period. Annual changes in reimbursement rates before and after 2016 were compared. RESULTS: After adjusting for inflation, average reimbursement rates for procedures decreased by 13.4%. Annual percent change and CAGR were -0.79 and -0.88%, respectively. Annual reimbursements decreased more between 2016 to 2020 (-1.83%,) than from 2003 to 2016 (-0.49%; P value = .003). CONCLUSION: Inflation-adjusted Medicare reimbursement rates for oral-maxillofacial surgery procedures have decreased from 2003 to 2020. The rate of reimbursement decreases has accelerated in recent years.

Thoracic surgery program websites: Bridging the content gap for improved applicant recruitment.

OBJECTIVE: To evaluate the website content of all US thoracic training programs, assessing the available content to identify areas for improvement. METHODS: A total of 98 accredited thoracic surgery fellowship and integrated residency programs were evaluated for the presence of 25 important online content items. Two authors assessed each website and social media page individually, and a third author resolved <4% of the initial data disagreement. The total number of alumni represented for each program was also recorded, including a breakdown of what the alumni pursued. RESULTS: Of the 98 accredited programs, 91 (92.9%) had a website. All 26 integrated residencies had a website, compared with 65 of 72 fellowships (90.3%). The 91 websites contained a mean of 8.2 ± 3.0 out of the 25 online content variables evaluated (33.0%), with rotation information (n = 69; 75.8%), application information (n = 65; 71.4%), program coordinator contact (n = 60; 65.9%), hospital affiliation (n = 49; 53.8%), number of positions per year (n = 49; 53.8%), and faculty listing (n = 46; 50.5%) found on ≥50% of the program websites. Areas lacking were retention rate (0% reported), social media links (n = 3; 3.3%), written and oral exam pass rates (both n = 5; 5.5%), graduate placement (n = 11; 12%), call duties (n = 12; 13.2%), cases performed (n = 17; 18.7%), and salary/benefits (n = 25; 27.5%). CONCLUSIONS: This study identifies gaps in content for prospective thoracic surgery applicants. Important information such as retention rate, social media links, exam pass rates, outcomes of graduates, call duties, cases performed, and salary/benefits were lacking in program websites. The improvement of websites may represent a straightforward and low-cost intervention that programs can undertake to enhance the recruitment of prospective applicants.

Trends in Diagnostic Imaging Medicare Reimbursements: 2007 to 2019.

PURPOSE: The aim of this study was to evaluate recent trends in Medicare reimbursement rates for various imaging studies. METHODS: Common diagnostic radiologic studies were selected across multiple imaging modalities: bone densitometry, CT, CT angiography, mammography, MR angiography, MRI, nuclear medicine, radiography, and ultrasound. The Physician Fee Schedule Look-Up Tool from CMS was queried for Current Procedural Terminology codes to extract reimbursement data. All monetary data were adjusted for inflation to 2019 US dollars. The compound annual growth rate, average annual change, and total percentage change in reimbursement were calculated on the basis of these adjusted trends. RESULTS: Inflation-adjusted Medicare reimbursement for all imaging modalities decreased between 2007 and 2019. The greatest mean decrease in reimbursement rates was observed for MRI (-$52.08), and the largest decrease in total percentage change was seen for bone densitometry (-70.5%). Nuclear medicine demonstrated the smallest mean decreases in both annual change (-$0.32) and total percentage change (-4.28%). CONCLUSIONS: This study examined Medicare reimbursements for radiologic studies from 2007 to 2019. After accounting for inflation, reimbursement rates were shown to decline for all studies across all imaging modalities except for individual studies in nuclear medicine, radiography, and ultrasound. Further investigation is encouraged to properly model future trends in reimbursement rates.

Malpractice claims associated with foot surgery.

Surgery of the foot constitutes a substantial portion of orthopedic procedures, performed by both orthopedic surgeons and doctors of podiatric medicine. Little research exists on the medicolegal implications of foot surgery amongst these specialties. This study seeks to investigate the different medical and legal factors associated with foot surgery-based malpractice litigation. Malpractice data between 2004 and 2017 was collected using the VerdictSearch legal database. Cases involving foot surgery were identified, and case information including physician specialty, procedure, medical outcome, verdict, and payment amount were obtained. A total of 72 cases were analyzed. A majority of lawsuits involved podiatrists (76.4%), with orthopedic surgeons accounting for 15.3%. Lawsuits against podiatrists primarily occurred over elective procedures (94.5%) and most frequently involved plaintiff complaints of persistent pain (41.8%) or deformation (27.3%). Podiatrist cases most often involved allegations of failure to treat (45.5%) or inappropriate surgical procedure (27.3%). Orthopedic surgeons saw higher rates of urgent cases (45.5%), with surgical complications (27.3%) occurring at higher rates than podiatrists. Despite different trends in case types, similar rates of plaintiff victories, and mean payments were seen between podiatrists (25.5%, $911,884 ± 1,145,345) and orthopedic surgeons (27.3%, $975,555 ± 448,795). This investigation is the first to analyze malpractice trends amongst podiatrists and orthopedic surgeons. Differing factors related to medical and legal outcomes can suggest quality improvement targets for both specialties. This data may assist in reducing malpractice risk and refining patient care, particularly with regards to outlining risks, benefits, and alternatives during pre-operative counselling.

Colorectal Cancer Litigation: 1988-2018.

INTRODUCTION: The purpose of this study was to examine colorectal cancer (CRC) malpractice suits over the past 20 years in the United States and evaluate the most common allegations, lawsuit outcomes, indemnity payment amounts, patient outcomes, and physician characteristics. METHODS: The malpractice section of VerdictSearch, a legal database, was queried for cases in which CRC was a principle component of the lawsuit. Legal notes were used to characterize plaintiff allegations, verdict, financial compensation, and case year. Clinical history for each case were analyzed for patient demographics, medical outcomes, and physician characteristics. RESULTS: A total of 240 CRC-related malpractice cases (1988-2018) were collected, resulting in defense (n = 101, 42.1%), plaintiff (n = 37, 15.4%), or settlement (n = 96, 40%) verdict. The primary defendants were often primary care physicians (n = 61, 25.4%) and gastroenterologists (n = 55, 22.9%). Most common plaintiff allegations are failure to perform diagnostic colonoscopy for patients with symptoms (n = 67, 27.9%), failure to perform screening colonoscopy according to screening guidelines (n = 46, 19.2%), or failure to detect CRC with colonoscopy (n = 45, 18.7%). A common alleged error in diagnosis before the median year of 2005 was failure to detect CRC by the noncolonoscopic methods (<2005: n = 22, 24.2%; >2005: n = 3, 3.09%). DISCUSSION: Plaintiff-alleged errors in diagnosis are consistently the most common reason for CRC malpractice litigation in the past 20 years, whereas specific diagnostic allegations (i.e., failure to screen vs failure to detect) and methods used for surveillance may vary over time. It is important to identify such pitfalls in CRC screening and explore areas for improvement to maximize patient care and satisfaction and reduce physician malpractice litigations.

Recognition and Management of Emergent Spinal Pathology Among First-Line Providers.

Spinal emergencies require prompt identification, management, and surgical referral (if needed) from first-line providers. Diagnostic delays from a failure to recognize emergency conditions can lead to adverse patient outcomes. The objective of this study was to understand the proficiency with which first-line providers can recognize and manage spinal conditions, particularly spinal emergencies. This was a cross-sectional analysis of 143 internal medicine, family medicine, emergency care, and neurology questionnaires collected at a single-site academic center. Participants were predominantly physicians (88.1%, n=126), with a smaller percentage of midlevel providers (11.9%, n=17). Only 35.0% (n=50) of respondents felt "very prepared" to handle spinal emergencies. Bivariate analyses revealed interdepartmental differences in clinical knowledge pertaining to the management of lumbar radiculopathy (P<.0001), epidural abscess (P=.0002), and cervical myelopathy (P<.0001). Following pairwise comparisons of interdepartmental differences, emergency medicine statistically outperformed internal medicine (P=.0007) and neurology (P<.0001) on initial management of lumbar radiculopathy, while also having markedly higher success in identifying and managing epidural abscess with respect to family medicine (P<.0001). The likelihood of appropriate initial treatment of cervical myelopathy was significantly higher for neurology than for emergency medicine (P<.0001). A minority of first-line providers reported being very prepared to handle spinal emergencies. Disparities exist between first-line provider specialties regarding clinical knowledge in managing and proficiently identifying emergent and nonemergent spinal conditions. Because appropriate handling of emergent spinal pathologies is essential to patient outcomes and optimal resource use, measures should be taken to further educate first-line providers regarding the spinal conditions they will be treating. [Orthopedics. 2020;43(4):e244-e250.].

Seasonality of postoperative pneumonia after coronary artery bypass grafting: A national inpatient sample study.

BACKGROUND: The development of postoperative pneumonia following cardiac surgery is associated with significant morbidity and mortality. However, seasonal variation as a risk factor for the development of postoperative pneumonia remains to be investigated. We sought to investigate whether patients undergoing coronary artery bypass grafting (CABG) during "flu season" (Fall and Winter months) at increased risk of postoperative pneumonia. MATERIALS AND METHODS: A retrospective cohort study of patients undergoing CABG in the National Inpatient Sample between 2005 and 2015 was completed. Concomitant diagnosis of pneumonia was defined as the primary outcome. Secondary outcomes were defined to include pneumonia secondary to several known pathogens. Outcomes with significant differences between Fall/Winter and Spring/Summer groups were further analyzed with additive time series decomposition. Odds ratios were generated and adjusted for age, sex, elective status, and 29 other Agency for Healthcare Research and Quality comorbidity measures. RESULTS: A total of 238 757 and 277 941 patients undergoing CABG during Fall/Winter and Spring/Summer, respectively, were identified. A significantly increased risk of postoperative pneumonia (adjusted odds ratio [aOR] = 1.15) and infection with influenza (aOR = 4.08), Haemophilus influenzae (aOR = 1.40), and Streptococcus pneumoniae (aOR = 1.47) was observed among patients receiving CABG in Q1 (January-March) compared to Q3 (July-September). CONCLUSIONS: There is a strong seasonality in the incidence of postoperative pneumonia after CABG which may persist across other cardiothoracic surgeries. In addition to optimizing infection control and perioperative care, cardiac surgeons should consider preoperative vaccination against seasonal influenza, H. influenzae, and S. pneumoniae to improve outcomes among high-risk patients.

Medicare Reimbursement for General Surgery Procedures: 2000 to 2018.

OBJECTIVE: The purpose of this study is to evaluate monetary trends from 2000 to 2018 in Medicare reimbursement rates for the most common general surgery procedures. SUMMARY BACKGROUND DATA: A complete understanding of financial trends in general surgery in the United States is lacking. As such, an evaluation of trends in reimbursement rates in general surgery is important for defining the specialty's current and future financial health. METHODS: The Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services was queried for each of the 20 top codes top in general surgery. The total raw percent change in Medicare reimbursement rate for each procedure from 2000 to 2018 was calculated and averaged. All data was corrected for inflation. Both average annual and total percentage change were calculated based on these adjusted trends. Compound annual growth rate was calculated using the adjusted data. RESULTS: After adjusting all data for inflation, the reimbursement rate for all included procedures decreased by an average of 24.4% throughout the study period. During this time, the adjusted reimbursement rate decreased by an average of 1.4% each year with an average compound annual growth rate of -1.6%. CONCLUSION: After adjusting for inflation, Medicare reimbursement rates in general surgery have steadily decreased from 2000 to 2018. It is important that these trends are understood and considered by surgeons, healthcare administrators, and policy-makers in order to develop and implement agreeable models of reimbursement while ensuring access to quality general surgery care in the United States.

Update on Mentorship in Orthopaedic Resident Education: A Report from the American Orthopaedic Association.

BACKGROUND: Mentorship has been identified as an important element of educational and professional development for surgeons. An assessment that was conducted and reported through the American Association of Orthopaedic Surgeons (AAOS) in 2008 showed variability among U.S. residencies regarding the structure and requirements for mentorship during orthopaedic training; the assessment also demonstrated variability in residents' satisfaction with mentorship opportunities during their surgical training. METHODS: An updated survey was developed and distributed via e-mail to residents attending the Resident Leadership Forum at the 2015 American Orthopaedic Association Annual Meeting to determine their views regarding the importance of mentorship, as well as their assessments of formal mentorship programs within their residencies. The updated data were compared with the prior survey results from 2008. RESULTS: A total of 149 (87.6%) of 170 residents responded to the survey. Of these, 34.9% (51 of 146) reported the existence of a formal mentorship program within their residency, as compared with 26.0% of residencies as stated in the 2008 report. One hundred percent of residents indicated that having a mentor during orthopaedic residency was either critical (63.7%, 93 of 146) or advantageous (36.3%, 53 of 146) to professional development as a surgeon; 74.7% (109 of 146) of residents reported currently having mentors, which appears to represent an increase from the prior report (51%, 258 of 506). However, the percentage of residents who reported being "very" satisfied (17.9%, 25 of 140) or "somewhat" satisfied (43.6%, 61 of 140) with their mentorship opportunities was almost identical to the prior report (61.9% [86 of 139] versus 61.0%, respectively). Overall, residents from programs with formal mentorship programs in place reported significantly higher satisfaction with their mentoring program/environment compared with those from programs without formal mentorship programs in place (3.98 versus 3.54, p = 0.026). CONCLUSIONS: Orthopaedic residents continue to overwhelmingly indicate that mentorship is an important component of residency education: 34.9% of residencies have a formal mentorship program, compared with 26.0% in the prior survey. Additionally, 74.7% of current residents reported having a mentor compared with 51% of residents in the prior study. Despite this difference, a very similar percentage of residents indicated that they were either "very" or "somewhat" satisfied with their mentorship experience. Residents from programs with formal mentorship programs reported significantly higher satisfaction with their mentorship programs compared with those without formal programs. These results support continued efforts toward improving mentorship opportunities within U.S. orthopaedic residency programs.