Letters: Leapfrog surgery standards miss the mark

As covered in the article, “Providers notch wins in House surprise billing legislation,” Congress has taken a step in the right direction by accepting an independent dispute resolution amendment, but there is still a long way to go. The overwhelming majority of emergency medicine claims are lower than the $1,250 threshold in the amendment.

This amendment amounts to arbitration in name only. Without a legitimate recourse to arbitration, doctors will be forced to accept insurer-controlled rates and lose their ability to negotiate.

Under this rate-setting mechanism, facilities that serve low-income rural and urban communities will struggle to survive. A comprehensive and independent dispute resolution process is the only way to ensure every American can access life-saving emergency medical services when they need them most.

As a physician-led organization, we remain committed to fighting for patients and working with Congress to improve upon this legislation and pass a solution that protects patients’ access to crucial care.

Dr. Rebecca Parker
Chief medical affairs officer and a practicing emergency physician
Envision Physician Services
Chicago

In regard to “Most hospitals fail to meet Leapfrog’s surgery volume standards,” I hope that Leapfrog will look at the unintended consequences of those standards.

I am responsible for completing the Leapfrog survey for a hospital system with nine acute-care hospitals, ranging from bed sizes of just over 100 to almost 700. We are struggling with the best way to reach the standard, but are not even reporting this measure because of these issues illustrated:

1. What if a small hospital in a rural area has an excellent thoracic surgeon who has taken care of the community’s lung cancer patients for years and probably saved many lives, but only has about six lung cancer patients a year? Are we to tell that surgeon s/he can no longer do those surgeries because it doesn’t meet Leapfrog’s arbitrary standards? Where should those lung cancer patients go? 
2. Under the Leapfrog standard, if two surgeon partners work together on difficult cases, such as abdominal aortic aneurysms, only one can be credited with the case volume.
3. Under the Leapfrog standard, there are hospital minimum volumes and physician minimum volumes. If a surgeon works at two or more hospitals, s/he will get credit for the surgeon volumes at all the hospitals, but the hospital volume may still be low because the surgeon’s cases are spread out among the hospitals.
4. Is Leapfrog proposing that their standards lead to a nationwide system where all patients needing high-risk surgeries be funneled to major medical centers that may be miles—even states—away from their homes and families?

Our state already has medically underserved patients due to low population density regions with a lack of acute-care hospitals. Many small hospitals in those rural areas are closing or have already closed due to regulatory and financial burdens. Are we going to force these small hospitals and their surgeons to stop providing necessary, life-saving procedures within their communities for the sake of getting four “cell phone bars” on the Leapfrog Hospital Survey? I hope not.

These are my personal opinions and do not represent those of my employer.

Melissa Cornwell
Marietta, Ga.