Cleveland Clinic queries in U.S. Senate review of concurrent surgeries
The Cleveland Clinic says it will cooperate with a U.S. Senate review of concurrent surgeries. The Clinic is one of 20 hospitals to receive a letter from a Senate committee requesting information on its use of the practice, which involves one surgeon operating on separate patients at the same time. (Tracy Boulian/The Plain Dealer)
The Cleveland Clinic is being queried about its use of concurrent surgeries - one surgeon operating on two patients simultaneously - as part of a U.S. Senate inquiry into the effectiveness and transparency of the practice nationally, a spokeswoman at the hospital confirmed.
The U.S. Senate Finance Committee has asked the Clinic to provide detailed information on how many concurrent surgeries its physicians have performed during each of the last five years, as well as internal surveys on the safety and effectiveness of the practice.
A copy of the committee's letter obtained by The Plain Dealer also asks whether the hospital tells patients that their operations will be performed concurrently, and how it tracks the location of surgeons during the procedures.
Clinic spokeswoman Eileen Sheil said the Clinic will cooperate with the review.
The committee, chaired by Utah Republican Orrin Hatch, calls its inquiry a fact-finding mission, not a full-blown investigation. The Clinic is one of 20 hospitals that have been asked to provide information.
Committee spokesman Aaron Fobes declined to identify the other hospitals, or say how they were selected.
The committee's letter indicates it is focused on whether hospitals and surgeons are being transparent about their use of concurrent surgery.
"We are concerned about reports of patients not being informed that they may be sharing their surgeon with another patient, and we are especially concerned by reports that in some cases, steps have been taken to actively conceal this practice from patients," the committee's letter states.
The letter adds, "It appears that frequently, patients are unaware that their surgeon may not conduct part or all of their surgery, thus, calling into question the patients' ability to give informed consent to the procedure which will be performed."
The committee's letter cites stories by the Boston Globe last year about the use of concurrent surgery at Massachusetts General Hospital. The newspaper reported that the practice has generated conflict within the hospital about the safety and transparency of performing surgeries simultaneously.
There is little consensus among hospitals about how concurrent surgeries should be carried out, how much they can overlap, or how patients should be informed about the practice.
The Centers for Medicare and Medicaid Services allows surgeons at teaching hospitals to bill for concurrent surgeries as long as certain rules are followed. CMS requires, for example, that teaching physicians be "present for all critical and key portions of both operations." If they cannot be present for all critical portions, the rules say, another surgeon must be "immediately available" to assist the resident should the need arise.
However, the Senate committee notes that the rules give hospitals plenty of room to interpret the meaning of "critical portions" and "immediately available."
The committee's letter asks the Clinic and other hospitals to indicate how they define those terms for themselves and how much they allow surgeries to overlap.
Fobes, the committee spokesman, said the panel has not set a firm deadline for receiving answers and will work with the hospitals to generate the information over the next several months. No hearings have been scheduled to take testimony on the issue.