Breaking down concurrent surgeries — can a practice thrive without them?

As controversy around concurrent surgeries continues to brew, The Washington Post ran a Kaiser Health News story breaking down concurrent surgeries.

Here's what you should know:

1. Concurrent surgeries became the subject of heightened debate after The Boston Globe examined the practice in-depth at Boston-based Massachusetts General Hospital. Hospital officials disputed the story, but the topic was brought into the zeitgeist.

The practice is allowed throughout the industry in hospitals, outpatient surgery centers and in non-teaching hospitals. Patients who are not covered by Medicare can also be part of a concurrent surgery.

2. Physicians take definitive stances on the issue. Some believe it is unethical, others think it is a way to augment income, while still others take issue with the open-ended interpretation of critical defining moments.

Rules defining overlapping surgeries dictate surgeons must be present during the "critical" portions of an operation. Deciding what is considered critical, however, is left to a surgeon's discretion; which is a subject of debate.

3. For proponents of overlapping surgeries, the practice is seen as a way to ease scheduling pressure and help shape the next generation of surgeons. Robert Cima, MD, the medical director of surgical outcomes research at Rochester, Minn.-based Mayo Clinic, said the Mayo Clinic has used overlapping surgery techniques since the clinic was founded. Dr. Cima was part of a study on 11,000 overlapping operations, which found the operations' death rates were no higher than those related to standard surgery.

4. Doctors Company, a malpractice insurer, has begun tracking claims related to overlapping surgeries. Robin Diamond, the organization's senior vice president for patient safety and risk management, believes claims will continue to rise in the future.

5. The practice was banned at Charlottesville, Va.-based UVA Health System. It was commonly practiced in orthopedics. At the time officials argued that the decision would "disadvantage" orthopedic surgeons.

For the study, the hospital edited surgery schedules, eliminating "most" concurrent procedures. The end result was an increase of 560 surgeries from 2015 to 2016, using the same number of operating rooms.

UVA Executive Vice President of Health Affairs Richard Shannon, MD, said to The Post, "Concurrency was masking an efficiency problem. There was a lot of waste. This debunks the urban legend that overlapping surgery is more efficient."

UVA will publish the results of the study in the future.

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