Some physicians are ill-prepared and unwilling to report incompetent or impaired colleagues even though they're required to do so by national professional organizations and state laws, according to a survey conducted by the Mongan Institute for Health Policy at Massachusetts General Hospital in Boston.

Of the nearly 1,900 surveys returned by physicians specializing in internal medicine, family practice, pediatrics, cardiology, general surgery, psychiatry and anesthesia, only 64% of the respondents said they believed they should always report colleagues who are incompetent or impaired by substance abuse or mental health disorders. Most physicians reported feeling unprepared to deal with impaired employees (69%) or incompetent ones (64%).

Even physicians with direct knowledge of an impaired or incompetent colleague failed to report their concerns: 309 physicians said they knew of a colleague that deserved to be reported, but only 204 did so, notes the report, which appears in the July 14 issue of the Journal of the American Medical Association.

The report's authors conclude that physicians don't report their colleagues' behavioral or job-performance issues because they think someone else will take care of the problem, they believe nothing will be solved or they fear retribution.

Eric G. Campbell, PhD, research director for the Mongan Institute and the study's senior author, believes the survey reveals a reporting system that is functionally inadequate. "Improvements to the system need to include helping physicians understand their professional responsibility to report impaired and incompetent colleagues, enhancing protections for reporting physicians," he explains, "and providing confidential feedback about outcomes."

Daniel Cook

While torn rotator cuffs can be successfully mended through both surgical and more conservative non-surgical means, a comparative effectiveness report was unable to crown 1 treatment option more successful than another.

Researchers at the University of Alberta in Canada also found little evidence to prove that undergoing rotator cuff surgery sooner rather than later results in better outcomes. They published their findings on the Annals of Internal Medicine's website this month.

"This report has good news: most interventions work," says Carolyn M. Clancy, MD, director of the federal Agency for Healthcare Research and Quality, which sponsored the research, in a statement. About 54% of adults over 60 years old are suffering at least a partial tear of their rotator cuffs, according to the report. "Rotator cuff surgery is a viable option for many patients but, as with any surgery, it is not for everybody," says Dr. Clancy.

In their systematic review, which analyzed data from 137 clinical studies of surgical and non-surgical rotator cuff injury treatment, researchers noted that the quality of the studies varied greatly and not all of them measured for the same outcome, making it difficult to determine the most effective option. "In general, the evidence was too limited to make conclusions regarding comparative effectiveness," write the authors, or promote one treatment's greater success over another's.

Kent Steinriede

ASCs with office-based services on the schedule between June 1, 2010, and Nov. 30, 2010, will have a little extra money coming to them. CMS announced last week that the office-based services ASCs have performed during that time will be adjusted by 2.2% to account for a positive update to the Medicare Physician Fee Schedule recently approved in Congress.

This update will apply only to office-based codes. ASC rates that are designated as office-based are paid the lesser of the HOPD or the office-based codes.

Contractors must modify their billing systems by July 28, but they're not required to reprocess all claims, since only those with office-based services will be affected by the change. For claims filed between June 1 and July 28, ASCs should contact their Medicare contractor (.ZIP file download, 60KB) to obtain the appropriate adjustments, says the ASC Advocacy Committee.

Dan O'Connor

A fluid-intensive procedure plus a hard, non-porous ground covering equals a potential safety hazard. Tell us which method or device you're using to keep your OR floors dry in this week's online poll, and check back next week for the results.

Last week's InstaPoll found that corded intstruments are not nearly as popular in today's ORs as they once were, with only 25% of our 57 respondents replying that they use pneumatic devices and 75% having gone to battery power.

"I personally believe that less cord in an operating field is better," says orthopedic surgeon Andrew J. Nelson, MD, of The Hand to Shoulder Center in Waterbury, Conn. "Do you know any carpenter that still uses a corded drill?"

Dan O'Connor