Tag Archives: surgery

Additional Incentives Tied to Maintenance of Certification Activities

The American Board of Surgery (ABS) has been approved by the Centers for Medicare and Medicaid (CMS) for the 2013 Physician Quality Reporting System (PQRS) MOC Incentive. This incentive allows physicians participating in PQRS reporting to earn an additional 0.5% on Medicare Part B charges by also participating in an approved Maintenance of Certification (MOC) program “more frequently” than what is required to maintain board certification. Surgeons must also participate in a patient experience of care survey to earn the incentive.

Surgeons not yet enrolled in the ABS MOC Program must pass a recertification exam in 2013 to be eligible. Even if certified by more than one board of the American Board of Medical Specialties , participants cannot receive more than one MOC incentive payment.

For more information about PQRS reporting, visit www.cms.gov/pqrs.

Is Remote Ischemic Postconditioning Cardioprotective in Children Undergoing Cardiac Surgery?

Children who undergo cardiac surgery may suffer predictable systemic inflammatory responses, myocardial depression, and pulmonary endothelial dysfunction, all related to ischemia-reperfusion (IR) injury and cardiopulmonary bypass (CPB). One therapeutic strategy to prevent these injuries involves remote ischemic preconditioning (RIC), whereby a remote organ (usually a limb) is made repeatedly ischemic and then reperfused over a short period before the more significant IR insult (like cardiac surgery). This practice has been shown to modify the expression of key proteins in cytokine synthesis and leukocyte trafficking. Cheung et al demonstrated that RIC, applied prior to the initiation of CPB, provided some myocardial protection in children who underwent cardiac surgery.

In the August issue of Pediatric Anesthesia Zhong et al applied the same principles, though the timing of ischemia was different. The authors recruited 69 subjects (35 in the control group and 34 in the ischemic group) between the ages of 3 and 12 years who underwent repair of their congenital heart diseases. Remote ischemia was achieved by inflating a blood pressure cuff located on a lower limb to a pressure of 200 mm Hg for 5 minutes, followed by deflation for 5 minutes; this was repeated for a total of 3 cycles. These maneuvers were performed after the aorta was unclamped. The primary endpoint the maneuver’s effect on cardiac troponin I levels over 24 hours. Secondary endpoints included clinical outcomes, adverse cardiac events and changes in other metabolic markers such as neuron-specific enolase. Read more…