If you live in Seattle, you may recall a major news story several years ago regarding Swedish Hospital’s neurosciences department where, among other things, it was alleged that spine surgeries were often “double-booked.” This involves setting two or more surgeries, to be performed by a particular surgeon, so that they overlap. The surgeon then does portions of each surgery, with other parts being handled by others, often surgical fellows or residents. This had been a common practice for years at teaching hospitals, and was defended as part of the system of training doctors. That news story led to major changes at Swedish, including the termination of the neurosurgery chief physician and new rules regarding overlapping or double-booked surgeries. Double-booked surgeries are still a problem, however.
A recent lawsuit against Massachusetts General Hospital (MGH), alleging that surgeons at MGH performed overlapping surgeries, resulted in the hospital paying a $14.6 million settlement. The claim was that the double-booking violated Medicare and state Medicaid rules. Besides the money settlement, MGH changed its informed consent policies to emphasize to patients when and how this might occur.
The lawsuit arose from a whistleblower anesthesiologist complaint that it was common to run “concurrent surgeries” where the primary surgeon may participate in two or more surgeries being done concurrently. When that happened, Medicare or Medicaid were often billed for the surgeries as if the primary surgeon performed the total procedures. Since services provided by residents and fellows are seldom billed, this resulted in a financial windfall for the hospital and for the surgeon.
It isn’t clear how common this procedure is. Hospitals often allow a primary surgeon to leave the operating room, with the assisting doctor closing up a surgical site, so that the surgeon can speak with the patient’s family. But the issue in the Massachusetts case involved major parts of a surgery being performed by someone other than the surgeon that the patient was told would perform, and fraudulently billing the government as if the surgeon was present during the entire procedure.
Commentators noted that the new rules arising from the government lawsuit would increase transparency, from the patient’s perspective. It was noted that litigation can be a “catalyst to do better,” which was the case here because patients are now more clearly informed about how a surgical procedure will be done.
