Province Wide Referral Service for Abdominal Wall Reconstruction

omponent-separationMessage forwarded from Dr. Peter Blair:

“we should set up a province wide referral service for abdominal wall reconstruction. I am talking here about elective massive/recurrent/infected mesh incisional hernia not about closure after trauma/peritonitis. We need surgeons interested in this work in PG, Kamloops, Kelowna, RCH, SMH, St [Paul’s], and VGH.”

Dr. Laurence Turner and Dr. Peter Blair have done many from the north.  Dr. Turner has retired and Dr. Blair will be retiring soon.  Please post a comment if you are interested in this type of work.

Canada’s First Integrated 3D OR Suites

Richmond surgeons perform bariatric surgery using new 3D laparoscope.

Surgeons in Richmond perform bariatric surgery using new 3D laparoscopic equipment.

In October 2013, the Richmond Hospital opened two new operating rooms integrated with 3D laparoscopic technology, a first in Canada.  Surgeons can now perform advance minimally invasive surgery with 3D precision.

Dr. Sampath, Head of the Department of Surgery at the Richmond Hospital, prefers 3D video over traditional 2D video for more complex laparoscopic cases: “I like the 3D equipment, particularly when there is laparoscopic suturing involved.”  3D technology restores depth perception allowing for improved assessment of the spatial relationship between organs as well as more precise tissue handling.

These multipurpose rooms can function in 3D mode (used for general surgery, urology, and gynecology) as well as in 2D mode and open surgery mode with a HD camera built into the light handle.  There are also significant benefits for surgeons teaching laparoscopic techniques to surgical residents and fellows.

2013 Minutes of AGM

MINUTES
ANNUAL GENERAL MEETING
Delta Sun Peaks
Friday, March 21, 2013

1. Call to Order – Dr Karimuddin called the meeting to order with 20 surgeons in attendance.

2. Minutes of Previous AGM – May 5, 2012 – The previously circulated minutes of the 2012 AGM were adopted as circulated.

3. President’s Report – DR AHMER KARIMUDDIN

The Year in Review – Dr Karimuddin informed the members that the Section Executive had had a busy year. He said 90% of the surgeons of BC belong to the Section.

Negotiations – Update – Dr Karimuddin reported that the 2012 negotiations reopener is about to begin. It is not expected to that the profession will make major gains. He said General Surgery has done well in that its earnings used to be in the bottom 10 Sections and now we are in the top 10. He felt a good portion of those gains were made through the introduction of the lysis of adhesions fee and the 07001 fee for patients greater than 75 years old.

MOCAP review – Dr Karimuddin reported that he sits on the redesign panel for MOCAP. The final report will be coming end of April, but he said General Surgeons will remain at Level 1 for MOCAP. He said the Interior Health Authority decision to not pay for MOCAP between 3 – 5 am was a complete surprise to the panel, and he advised members not to sign contracts within IHA until directed by BCMA.

Provincial Privileging Project – This province wide initiative is underway and Radiology has been completed. General Surgery is next and the Section has been engaged in suggesting names for large panel who will oversee a set of core and non-core procedures that will become the template of what general surgeons will be privileged to performed. It is important that the breadth of our specialty is protected and input will be needed from all members. It is strongly encouraged for all who can to be engaged. Case volumes will be part of the decisions.

Pamphlets and Posters – Dr Karimuddin asked the members to pick up copies of the newly produced pamphlet to distribute to patients in their offices. Also a poster for displaying in their office. The hope is to bring more awareness to the general public about general surgery practice and the issues facing us, mainly lack of resources.

Members were reminded that the website www.generalsurgeons.ca has all documents on it including a letter to patients about the waitlist situation. Members can access the site by using their first initial and last name and their MSP number.

4. Treasurer’s Report – Tanyss Bugis presented the financial statement for 2012 which showed a year end profit of $225. She presented a deficit budget for 2013 and explained that the assets of the Section would easily cover the deficit. The membership approved the recommendation of the Executive that the annual dues remain at $650 for 2014.

It was moved and seconded

“That the financial statement for 2012 be approved.
That the budget for 2013 be approved.
That dues for 2014 remain at $650”

CARRIED

5. Economics Representative Report – Dr Karimuddin gave the Economics Update. He reviewed all new fees, pending fees and changed items. The report forms part of these minutes. A summary of the fees covered in the report:

New New upper GI fees (see 2012 Billing Seminar on generalsurgeons.ca)
71630 Use of mesh for hernia repair
72794-98 Laparoscopic liver resection fees
72673 Transanal endoscopic microsurgical resection of rectal tumour
78717 Discharge planning fee (SSC)

Pending Consultation for management of malignancy $125.50
Special office visit for malignancy $47.64
Laparoscopic distal pancreatectomy +/- splenectomy

Proposed Laparoscopic internal drainage pseudocyst
Laparoscopic hepatotomy for drainage of abscess or cyst
Bill 70169 x3 ($369.90) for VAC changes
Special hospital visit for malignancy $40.56

Changes
07010 Increased to $99.21 April 1, 2012 – back to $97.77 April 1, 2013
71700 Closure of congenital or acquired anal fistula with rectal advancement flap
07005 Emergency visit – not paid within 10 days post-op

Estimated cost to fund Laparoscopic internal drainage of pancreatic pseudocyst and Laparoscopic hepatotomy for drainage of abscess or cyst (single/multiple) is $6,000

Moved and seconded “ that the Executive of the Section of General Surgery are enabled use money allocated to the Section to fund the above fees at 25% the open fee value”
CARRIED

Estimated cost to fund Temporary or delayed abdominal closure with VAC is $32,000
Moved and seconded “ that the Executive of the Section of General Surgery are enabled use money allocated to the Section to change the fee schedule so that fee code 70169 can be billed x3 for VAC changes under GA”

CARRIED

DISCUSSION OF ECONOMIC ISSUES

The specialist discharge planning fee is severely underutilized. This is for patients only received through the emergency room.

The hernia fee with mesh continues to be negotiated at MSP and the Section will be informed once it is clarified.

The new consultation fee for malignancy and office visit for malignancy will be effective April 1. Some members had concerned about the necessity of histologically confirmed malignancy as often there is no pathology report accompanying the patient. It was suggested that if this was the case, once the pathology was confirmed, on the next visit a new consult (limited consult) could be billed.

Dr Chung raised an issue he hoped the Section could help with. When two surgeons are working together, ie, one on the liver and one on the colon, it is felt that both should be paid for their special expertise and not have one of the fees reduced as a second procedure. He requested that the Section make a submission to MSP for this scenario.

Dr Karimuddin reported that the Section will organize a billing seminar for this fall. It will likely be held in the lower mainland. Both surgeons and MOAs should attend.

6. Representatives Report – Dr van Heest submitted a written report from the CAGS Provincial Reps meeting held in February 2013 – for information

Dr Brosseuk raised the issue from his Health Authority about the patient prioritization codes. A review is being conducted currently and while some section members have been involved, Dr Brosseuk felt it was important that ALL general surgeons complete the review. He pointed out that the time component is very important because if it is accepted as a target time, and the target times are not met, Health Authorities potentially lose funding from the Ministry of Health and this then results in cut backs in OR because of lack of funding. He felt it was important to push back to the Health Authorities about this issue and to be sure that we get all our members involved. He asked that the Section send a letter of complaint about this further penalization to the Ministry of Health and the Health Authorities with copies to the BCMA.

It was noted that the Ministry’s response to the waitlist issues is to blame the surgeons.

Dr Karimuddin reminded the members that there is a letter on our website which can be given to patients which addresses the waitlist. The patient letter, the new brochures are all part of the same awareness campaign. Our next push will be to the MLAs and the media.

7. Election of Officers – Slate for 2013 – 14

It was noted that all officers will remain in their current positions except the Resident Rep who will be replaced by Dr Dan Jenkins. Dr Karimuddin called for nominations from the floor. There being none coming forward, the slate was presented and elected as follows:

PRESIDENT …………………………………………. DR AHMER KARIMUDDIN
PAST PRESIDENT ………………………………….. DR RARDI VAN HEEST
PRESIDENT-ELECT ………………………………… DR SHARADH SAMPATH
ECONOMICS REP ……………………………………DR HAMISH HWANG
TREASURER ………………………………………….DR NAM NGUYEN

MEMBERS AT LARGE:
NORTHERN HEALTH REGION – DR BRIAN DUBOIS
INTERIOR HEALTH REGION – DR STEPHEN HISCOCK
VANCOUVER ISLAND HEALTH REGION DR DARREN BIBERDORF
FRASER HEALTH REGION DR DAVID KONKIN
VANCOUVER COASTAL HEALTH DR ADAM MENEGHETTI
RESIDENT MEMBER DR DAN JENKINS
ECONOMICS COMMITTEE DR HAMISH HWANG(Chair)
DR MARK DICKESON
DR SAMAAD MALIK
DR SHARADH SAMPATH

There being no business from the floor, Dr Karimuddin adjourned the meeting at 1130 am.

TBugis
23.3.13

General Surgeon uses 3D laparoscopic technology.

Dr. Sharadh Sampath (right), a Richmond general surgeon, utilizes the power of 3D laparoscopic equipment in bariatric (obesity) surgery and colon cancer surgery.

The images on the screen looks blurry to the naked eye but with special glasses, the surgeon and assistant can have depth preception.  “This technology is useful in complex laparoscopic surgery where suturing or extensive dissection is required.”

April 2 economic update

Dear members,

New MSP fees take effect on April 1, 2013. Please download these from teleplan if you haven’t done so already on your EMR. There are several other minor fee increases you may notice.

71630 – use of mesh for hernia repair – extra
This is now $27.22 but can be billed with 71606, 71607 and 71608, effective immediately.

P71630      Use of mesh for hernia repair – extra………………………………………… $27.22

Notes:
i)    Paid only with hernia repair fees, unless specifically excluded elsewhere in  the Fee Guide/Payment Schedule.
ii)   Not paid in addition to fee items 71600, 71601, 71602, 71603, 71604, 71605, 71616, 71621, 71622, 71623, 71624, 71625 and 71650.

The following fees are effective immediately. They will not appear on the MSP broadcast until April 15 but should download from teleplan onto your EMR.

P71010 – complex consultation for management of malignancy ……………………….. $125.50

P71017 – Special office visit for new diagnosis or recurrent malignancy …………….. $47.64

Please bill only for histologically proven malignancy, not including non-melanoma skin cancer. If this fee is overbilled the fee value will be decreased after the 18 month monitoring period.If you see a patient with “suspected” cancer bill 07010. You can then bill 71017 for the subsequent office visit when cancer is proven. Please see the attached “minute of the commision” for the fee descriptions.

MOC%2013-035[1]

Please use one of the following appropriate diagnostic codes with the new fees:
151 stomach cancer
153 colon cancer
154 rectal cancer
155 liver cancer
156 bile duct cancer
157 pancreas cancer
171 sarcoma
172 melanoma
174 breast cancer
193 thyroid cancer
195 misc cancer
199 misc cancer
202 lymphoma

You will notice the fee for 07010 has gone back down to $97.77. The reason it was temporarily increased was because 71010 could not be billed retroactively to April 1, 2012. Now that the new fee 71010 is in effect the money has been transferred to the new fee.

Regards,

Hamish Hwang

Economics, Section of General Surgery