Jarrod Shapiro, DPM Practice Perfect Editor Assistant Professor Dept. of Podiatric Medicine Surgery & Biomechanics College of Podiatric Medicine Western University of Health Sciences St. Pomona, CA

SCIP To My Loo

Do you know your SCIP measures? Do you know what SCIP is? Sounds like someone's nickname. For those of you who may not know, SCIP is the Surgical Care Improvement Program. This is one of the Centers of Medicare and Medicaid Core Measures, which is a national program with the intent of improving patient care in healthcare facilities, which began implementation in 2001. These Core Measures are now a national standard of care. Anyone who spends any time at all in a hospital is aware of these Core Measures, and it's likely that most patients are also aware of this. For the podiatric surgeon, one of the most important Core Measures is SCIP.

When I do surgery, I'm usually only vaguely aware of the SCIP measures, being more concerned about my patient's health rather than a list of "must do's." However, more recently, I've noticed a more focused and consistent conscious emphasis on these rules.

Of course, the reason is obvious:

1. Hospitals lose Medicare reimbursement money if they don't follow these measures.
2. Hospitals are now being graded and compared with other hospitals on a national scale.

I had a personal "run-in" with SCIP recently during a couple of my surgical cases. Prior to the start of my first case, I was asked no less than three times by three different people what kind of antibiotic I wanted given preoperatively. When my answer each time was, "none, thanks" (the patient had no medical reason to be given antibiotics), I received uncomfortable looks until the OR manager told me it was now a hospital requirement. It turns out that this is an overly broad interpretation of SCIP measures 1 and 2 (see below), but the point is, I am now being pushed to change my practice methods because of this program. This is, of course, despite the fact that the medical evidence, which the core measures are supposedly created from, states clearly that in patients with no significant risk for infection (short case, no medical comorbidities, no implant) preoperative antibiotics are not necessary.

		Tonight's Premier Lecture is Amniotic Membranes - Experience in Lower Extremity Disorders by Marie Williams, DPM

What are the current SCIP measures you might ask? Funny you should ask, since I have them right here in my back pocket! See below for the current 9 SCIP measures. Notice which of these apply to you as a podiatric surgeon and how they might affect your practice.

The current SCIP measures:

The second "run-in" for me had to do with measure 3. I had a cellulitic patient with 3^rd toe gangrene that required amputation. He had been admitted the day before, and after the surgery, I ordered for antibiotics to be continued in the postoperative period.

The admitting physician asked me why I wanted to continue the antibiotics postoperatively. In actuality, he asked if I followed SCIP measures that were different from the rest of the country. I know this physician well, so didn't take his sarcasm personally. As it turns out, his resident had not communicated to him that the patient continued to have infection requiring the antibiotics. With appropriate documentation, SCIP measure 3 was easily covered.

This brings up an important point in regards to Core Measures: when a physician must breach one of the measures, he needs to explain his medical reasoning. This is not the government trying to control how we treat our patients. On the contrary, this is a national guideline of appropriate care, which allows us to practice as we see fit by simply providing our reasoning – no different than what we should already be doing in our charts. As such, I don't feel threatened at all by the SCIP guidelines. It is important, though, for us to know what these guidelines are so we are aware when we break the rules. In this situation knowledge is power, at least so we don't have to be accused of having our own SCIP guidelines!

Best wishes.

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]

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