Could the Concierge Medicine Model Work in Surgery?

How much would patients pay for on-demand surgical care? A group of Los Angeles-based surgeons are betting they'd pay a pretty penny for an online concierge service that provides 24/7 access to top surgeons and priority scheduling for appointments and procedures.

Prime Surgeons is now offering orthopedic, spine, gynecologic and robotic procedures at a premium price. For a basic annual membership of $99 a year, patients get access to Prime's online, statewide network of participating surgeons and a guaranteed appointment within 2 weeks of requesting it. The VIP package runs $495 a year for access to the service's national surgeons network, appointments within 1 week of scheduling, assistance in finding rehab services and direct communication with surgeons over the phone. Full concierge service runs $2,500 per quarter for access to Prime Surgeons' national and global network of surgeons, 24/7 access to surgeons via text or e-mail, rehab referral assistance, individualized 90-day post-op follow-up care, a personal assistant for scheduling and handling the logistics of pre- and post-op care, and a personalized rehab program.

The service promises access to "elite master surgeons" who care for professional athletes, celebrities and successful professionals. It's also selling "excellent surgical outcomes that minimize recovery time." Prime Surgeons says it will also provide transparent upfront pricing for all procedures.

The founding surgeons are hoping to capitalize on the rapid rise of surgery, particularly orthopedics, and the expected decline in the number of surgeons by 2020. The group of 16 surgeons will initially specialize in orthopedic sports, spine surgery, gynecology and robotics procedures.

"For too long, patients who want the best care have struggled to find and engage with top-level surgeons," says Gil Tepper, MD, a spinal surgeon and CEO and founder of Prime Surgeons. He says his group is committed to delivering the best care and outcomes in a fair and transparent manner, so patients can return to normal life activities as soon as possible.

Daniel Cook

Red Flags for Readmission

When researchers study hospital readmissions after surgery, they usually look at co-morbidities or post-op complications as some of the top reasons why patients return to the hospital within 30 days of discharge. However, a range of lifestyle factors could better predict a patient's chance of readmission, according to a study appearing in JAMA Surgery.

Researchers found that issues related to substance abuse and homelessness were responsible for a larger number of readmissions than surgical complications or deteriorating medical conditions. Additionally, they found that female patients, those with diabetes or sepsis, and those insured by Medicare or Medicaid instead of commercial payers had a higher risk.

In the study, researchers looked at 173 general surgery patients who were readmitted to the hospital within 30 days of surgery, among 2,100 total discharges. They looked at both medical complications and lifestyle factors that impacted a patient's chance at readmission. They found that the most common reason for readmission, at 17%, involved patients who had been initially admitted with soft tissue infections from injection drug use that required operative drainage, and were then readmitted with new soft tissue infections at other sites.

Just over 14% of the readmissions studied involved a lack of social support. These patients may have been homeless and lacked a post-discharge telephone number, or had no way to return to the facility for follow-up appointments. Both substance abusers and those lacking social support made up nearly a third of total readmissions.

"Many cases of readmissions may truly be unavoidable in our current paradigms of care because we found socially fragile populations to be at as high risk as those that are medically fragile," the authors write. "Because interventions to reduce the risk of readmission for any group of patients can be costly and labor intensive, identification of the highest risk cohort for readmission can allow more targeted intervention for this population of socially vulnerable patients."

Kendal Gapinski

Task Force Reaffirms Value of Colorectal Cancer Screenings

Periodic colorectal cancer screenings are still substantially underused in the United States, but they offer substantial net benefits to patients, beginning at age 50 and continuing to age 75, says the United States Preventive Services Task Force (USPSTF). The group recently reviewed evidence and updated its recommendations on the screenings for the first time since 2008.

Noting that multiple screening strategies "with unique advantages and limitations" are available, the USPSTF concluded "with high certainty" that screening average-risk, asymptomatic adults pays off. Whether or not to screen patients between ages 76 and 85 should be an individual decision, it says, taking overall health and screening history into the consideration.

The task force's review covered colonoscopy, flexible sigmoidoscopy, virtual colonoscopy, the guaiac-based fecal occult blood test, the fecal immunochemical test, the multi-targeted stool DNA test and the methylated SEPT9DNA test.

Jim Burger

InstaPoll: Trump or Clinton?

If the 2016 presidential election were being held today, who would get your vote: Donald Trump or Hillary Clinton? Tell us in this week's InstaPoll.

Nearly half (48%) of the 325 respondents to last week's poll don't use a local anesthetic before starting an IV. Of those that do, most (43%) use lidocaine over topical sprays or creams. The results:

What kind of local anesthetic do you use for IV starts?

  • lidocaine injection 43%
  • topical antiseptic spray 3%
  • topical anesthetic cream 2%
  • more than 1 anesthetic 4%
  • no anesthetic 48%

Dan O'Connor

News & Notes
  • Standardized supervision for N.J. surgery centers? New Jersey lawmakers are weighing a proposal that would license and supervise multiple-OR and single-room ASCs under the same standards, by the same state agency. The bill would also allow the growth, merger or hospital acquisition of single-room ASCs. The Senate Health Committee approved the bill last week, sending it on to the Budget and Appropriations Committee. A similar bill passed the Assembly's Health Committee in February.
  • Measuring a vital sign from across the room A camera-based system that monitors the imperceptible (to human eyes) changes in skin color that accompany heartbeats can accurately measure the oxygen saturation of arterial blood (SpO2) without touching the patient, say researchers. The contactless pulse oximeter, manufactured by Philips, is described in the June issue of the journal Anesthesia & Analgesia.
  • There's a robot at the front desk The da Vinci is great for surgery, but it doesn't have much in the way of personality. A 4-foot-high robot named Pepper, however, started greeting patients, providing information and guiding visitors to floors and rooms at a Belgian hospital this month. Pepper, who walks at just under 2 miles an hour, works 20 hours between recharges, and speaks 19 languages, cost $33,850 to add to the hospital's staff.