Marriott Rivercenter San Antonio, Texas Oct. 13-16
orexcellence.com

Best Practices in Reprocessing Reusable Medical Devices
Instrument sterilization is more complex than ever (can you say duodenosopes?). Are your techs up to the task? Sterile processing expert Rose Seavey, RN, BSN, MBA, CNOR, CRCST, CSPDT, will help you tackle the challenges surgical facilities face and update you on the latest standards in her OR Excellence presentation. "In addition to constantly changing standards and recommended practices, one of the biggest problems out there is a lack of competency and training for reprocessing techs," says Ms. Seavey.
Register now at orexcellence.com to see Ms. Seavey live at the beautiful Marriott RiverCenter in San Antonio.

The best joint replacement surgeon looks the worst on the Surgeon Scorecard. He has the most complications — infections and readmissions — because he does all the redos and hard cases. But he's hardly a dunce with a slew of demerits. He's the doc you'd want to give you your new knees. That's the trouble with surgeon scorecards and report cards: They don't always measure what matters most, and they punish surgeons who perform the riskiest surgeries on the sickest patients.

ProPublica released its Surgeon Scorecard project (projects.propublica.org/surgeons) last month. In its first 2 weeks, the online database has been viewed more than 1.3 million times by people looking up doctors — and by doctors looking up doctors, seeing where they stand relative to their peers.

ProPublica compared the performance of surgeons by examining 5 years of Medicare records for 8 common elective procedures, including knee and hip replacements, spinal fusions and prostate removals so that "patients will be able to weigh surgeons' past performance as they make what can be a life-and-death decision." Overall, Surgeon Scorecard looked at 2.3 million surgical procedures and rated nearly 17,000 surgeons by their death and complication rates.

Report cards can penalize more skilled and more aggressive surgeons for operating on patients at higher risk. That's like penalizing a high school student for getting a B in an Advanced Placement course instead of settling for the easy A.

Besides discouraging surgeons to shy away from more difficult and complicated high-risk patients, lest they incur higher mortality rates, critics claim ProPublica's analysis of surgical complications, while well-meaning, is flawed. Take readmissions, for example. They don't always arise from surgical complications and they're often not a result of a surgeon's skill.

In a recent Forbes article, urologic oncologist Benjamin Davies, MD, the chief of urology at UPMC Shadyside Hospital in Pittsburgh, writes: "Patients will use this product to guide their choice of surgeons, I suspect. But what if the real endpoints are not being measured here?"

InstaPoll
Do you believe that an eye drop can dissolve cataracts?

• yes43%
• no26%
• unsure31%

SOURCE: Outpatient Surgery Magazine, July 2015, n=179

With prostate cancer surgery, Dr. Davies says 3 goals rise above all else: cancer removal, erectile function and urinary continence. "Those are the principal reasons you want a good surgeon to do your surgery. Are these issues measured? No. Would you trade a bad bout of constipation for an erection? I would. Would you trade an ileus for prostate cancer remission?"

Surgeon report cards are not a new idea. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) has been issuing report cards on the quality of surgical care since the early 2000s. But it's senseless to use such a narrow band of statistical outcomes to measure a doctor's true skills.

At 16 pages, "Breaking Bad," a gripping first-person account of how thin the line between right and wrong can be in life and in business, is by far the longest story this magazine has ever run. It's also one of the most compelling pieces we've ever published. Beginning on page 24, you'll find the story of David Applegate, a former surgical device marketing executive who got swept up in a massive accounting fraud. Mr. Applegate wrote it from federal prison, where he's serving a 5-year sentence.