Wednesday, March 31, 2010

Medicare Participation Among Surgeons - Current Statistics and Forecast for the Future

Nation’s Surgical Groups Survey Members on Medicare Participation

March 26, 2010

Washington, DC–The results of a new member survey by the nation’s Surgical Coalition shows that the more than 21 percent pay cut to physicians that is scheduled to take effect April 1 will make it difficult, if not impossible, for already financially strapped surgical practices to continue to treat Medicare patients. A majority of the more than 14,000 surgeons and anesthesiologists who responded to the survey indicated that they will be forced to make significant changes in their practices if the cut goes into effect and that timely access to surgical care will be jeopardized if Medicare payments continue to decline. (Read the survey report (PDF))

The survey reveals that while 96 percent of respondents currently participate in Medicare, less than one-third of them will be able to remain as Medicare participating physicians. In addition, respondents indicated that practical realities will force them to stop providing certain services, reduce staff, defer the purchase of new medical equipment, and/or reduce time spent with Medicare patients. Thirty-seven percent said they will change their status to nonparticipating, and another 29 percent said they will opt out of the Medicare program for two years and contract privately with Medicare patients.

When asked, “If Medicare reimbursement to physicians is cut by over 21%, what changes to your Medicare participation status do you plan to make?” Respondents answered:
  • 37 percent will change their status to nonparticipating
  • 31 percent plan on remaining a Medicare participating physician
  • 29 percent will opt out of Medicare for two years and privately contract with Medicare patients
  • 3 percent will remain a Medicare nonparticipating physician
Among those remaining as Medicare participating physicians, three-fourths plan on making some change in their practice in the next 12 months. Respondents stated they would:
  • Limit the number of Medicare patient appointments (69%)
  • Reduce time spent with Medicare patients (47%)
  • Begin referring complex cases (46%)
  • Stop providing certain services (45%)
  • Defer purchase of new medical equipment (44%)
  • Reduce staff (43%)
  • Defer purchase of information technology (32%)
  • Significantly reduce workload/hours (17%)
  • Shift services from office to hospital (16%)
  • Discontinue rural outreach services (9%)
  • Close satellite offices (8%)
  • Discontinue nursing home visits (6%)
  • Retire (4%)
The payment cuts are the result of a flawed methodology called the sustainable growth rate (SGR) formula that is used to calculate payments for physicians who participate in the Medicare program. The formula contains administrative errors and fails to accurately reflect the costs of sustaining medical practices.

Physician participation is the foundation of a sustainable and functional Medicare program -- now and into the future. Therefore, the Surgical Coalition believes it is crucial that Congress pass legislation to permanently repeal the SGR to prevent the further declines in Medicare payments and to replace the flawed formula with a system that is reasonable and that will lead to a more workable reimbursement system.

The Surgical Coalition includes the American College of Surgeons and 22 other medical organizations and represents 240,000 surgeons and anesthesiologists.

The survey was conducted during February 2010. The nearly 14,000 surgeons and anesthesiologists who responded represented the following specialty areas: Anesthesiology, Cardio-Thoracic Surgery, Colon and Rectal Surgery, Facial Plastic and Reconstructive Surgery, General Surgery, Neurosurgery, OB-GYN, Ophthalmology, Oral and Maxillofacial Surgery, Orthopaedic Surgery, Otolaryngology – Head and Neck Surgery, Pediatric Surgery, Plastic Surgery, Urology, and Vascular Surgery.

Contact: Cory Petty
American College of Surgeons

Monday, March 15, 2010

The New Guidelines for Mammograms and Breast Self-Exams: An Interview with Three Breast Experts

The following is an article I conducted on the new recommendations and guidelines for mammograms and breast self-exams.

I interviewed three fantastic local (Bay Area) Breast Surgeons with whom I work closely on breast reconstruction cases.  Each was asked a short series of questions about their opinion of the new guidelines, and how their practice may be affected. 

Read on! (click on each page for a larger, more clear version of the magazine text)

The interview is published in the Junior League of San Francisco's Fogcutter Spring 2010 publication.

Friday, March 5, 2010

The Art of Breast Reconstruction - 9th Annual Breast Conference Conference, Presidio of San Francisco

I will be speaking this afternoon at the 9th Annual Allison Taylor Holbrooks/Barbara Joe Johnson Breast Cancer Conference: Beyond Breast Cancer - Golden Gate Club, The Presidio of San Francisco, 2:30 p.m. 

More slides from my presentation to follow...

Tuesday, March 2, 2010

What are drains? Why are they used?

A suction drain is a thin, soft, silicone tube that is inserted into an area of the body where surgery has been performed - examples are following a breast augmentation, tummy tuck or breast reconstruction procedure.  

The drain tubing exits through the skin and its purpose is to remove wound fluid during healing.  It is attached to a small suction bulb, often in the shape of a grenade (known as a JP, or Jackson-Pratt bulb), that when compressed, applies very gentle suction to the drain tube, and slowly removes fluid from the area of surgery.  

Initially, the drain wound fluid appears thick and red, as there is minor bleeding with any surgical procedure.  With time (over days to a week), there are less red blood cells in the wound fluid and the fluid becomes more clear and less red.  The color changes from dark to light red, pink, orange and finally clear light yellow (known as serous fluid).  It is at this point that the drains are ready to be removed.  

You will be asked to record the fluid your body is producing on a drain log (see the link for a downloadable form).

Just as when you scrape your knee and it initially bleeds and then weeps fluid for a time, wounds inside the body also make wound fluid.  This is a normal part of healing.  However, wounds outside the body that are exposed to air eventually dry out and form a scab.  

Wounds that are inside the body, such as around a breast implant, or in the area of a tummy tuck, continue to create wound fluid until the body is healed.  Bacteria love to grow in wound fluid - this is why Plastic Surgeons usually use drains to remove this fluid as it forms - to decrease the risk of infection and capsular contracture (contraction of scar tissue around a breast implant). 

Drains are not painful, and do not hurt when they are removed in the office, usually 3-10 days after surgery.  They are held in place by a small drain stitch (suture) that is cut, and the drain is easily pulled out.  

After breast implant or reconstructive surgery, I usually recommend that my patients avoid showering while their drains are in place, also to decrease the risk of infection of their breast implants.  You may sponge-bathe, shower only the lower half of their body, and either wash their hair in the sink or go to the salon for a wash and blow-dry (and splurge on a mani-pedi while they're there!).

Remember, "drains are your friends!".  They are there to help you heal without complications and will be removed when they are ready. 

Monday, March 1, 2010

Breast implant massage video - Instruction on how to keep your breast implants soft after breast augmentation

Following a breast augmentation, is is imperative that women massage their breasts to keep the implant inside mobile and to ensure a soft, natural result!

To watch the Women's Plastic Surgery video on breast implant massage technique, click here.


Video: Post Reconstruction Surgery, Implant Massage Techniques 

Video: Post Breast Augmentation Surgery, Implant Massage Techniques 

Capsular Contracture Prevention Program

Breast Implant Antibiotic Prophylactic Recommendations

We cannot over-emphasize how important your post-op massaging is in order to preserve your excellent results of breast augmentation surgery.

Massaging begins general at a week or two after breast augmentation surgery.  You will be taught by Dr. Horton and her staff how to massage directly only your own breast.

DO NOT WORRY, YOU CANNOT BREAK THE IMPLANT. It takes more than 50 times the force of a mammogram to rupture an implant!

You should be able to make your fingers meet through the implant in both the vertical and horizontal directions. You should also move the implant around in its pocket to keep the pocket open. The best time to massage is in the shower or when you are warm and relaxed. You should massage once or twice a day for five minutes.

If you have any questions about the massage technique or whether your implant is hardening, do not hesitate to contact us.


Eat-Sleep-Plastic Surgery!


This is my new favorite T-shirt!  It sums up my life, from a day-to-day basis.

This picture was taken by one of my patients while I was doing rounds at the hospital one early morning.  
Cool T-shirts like this and other custom messages can be ordered at