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Trauma US Scans
pererap
Posted: Tuesday, May 6, 2014
Joined: 8/31/2011
Posts: 231


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We here in Richmond have all of a sudden found ourselves in an interesting situation since our trauma surgeons have become RVU based. They now want to take over performing FAST exams during trauma, and of course bill for them.

So I began to wonder what is truly happening at most trauma centers when it comes to the FAST exam, who's performing these studies. Until this year trauma has seemed not to care much about the exam and left it to us ED folks to perform. So if you work at a trauma center, who is performing the FAST exam at your institution, the ED or Trauma? Please respond to me directly for this informal poll.


Thanks in advance,



Dave Evans



David Evans, MD RDMS RDCS FACEP
Medical Director of Ultrasound
Emergency Ultrasound Fellowship Director
Assistant Professor, Department of Emergency Medicine
Virginia Commonwealth University School of Medicine
pererap
Posted: Tuesday, May 6, 2014
Joined: 8/31/2011
Posts: 231


Dave,

At our facility, the trauma team tends to perform them when their team is "activated" based on pre-set criteria. All other trauma patients that are seen by the EM staff would have the FAST exams performed by the EM staff. The trauma machine still uses thermal paper and they rarely print/save their images, and thus rarely bill.  My understanding is that they are not RVU based.

The EM staff are RVU based. Our machines can save images, and these studies are billed. On some cases no images are saved, and these are not billed.

Best,

Drew


Andrew Shedd, MD
Emergency Physician
Emergency Ultrasound Director
Baylor University Medical Center
Dallas, TX
pererap
Posted: Tuesday, May 6, 2014
Joined: 8/31/2011
Posts: 231


i love it!  no further comment necessary.  at texas tech in el paso the em residents perform......trauma surgeons slowly coming around.  i imagine if there was a re-imbursement incentive that came around the corner our procedurally based colleagues would want to jump into the game!
 
 ciao, bk
pererap
Posted: Tuesday, May 6, 2014
Joined: 8/31/2011
Posts: 231


We are a Level 3 center no residents and the ED performs FAST.

Jennifer Bradstreet, MD
ED Medical Director
CaroMont Regional Medical Center
pererap
Posted: Tuesday, May 6, 2014
Joined: 8/31/2011
Posts: 231


HI All,

Such a great topic!

Comes down to:

1) More and more ED's are starting comprehensive billing programs for their US scans to capture reimbursement (including the FAST scan).
2) More surgeons are learning point of care US and will be trying to get into the billing arena.
3) Traditionally, I think the FAST scan has been performed by EP's during a trauma. I actually remember when Radiologists would be called to trauma activations to do the FAST scan. Since that did not work out so well, they were pretty OK with passing the US probe over to the ED...
4) Since EP's are pretty much the acknowledged leaders in the FAST scan arena at this time, I think it would be more typical across our nation to have us do the FAST scan on the arrival of the trauma patient.
Surgeons are becoming so CT based in their evaluation of trauma, that I wonder how many places will have them rushing to grab the probe and perform a FAST scan during a trauma resuscitation?
5) A related, but different topic, is what each institutions trauma surgeons do clinically with the information gained from a FAST scan.
This may be a good discussion for another time as different places seem to do different things with both positive and negative FAST exams in the continuum of trauma patients, from hemodynamically stable to unstable.

I have archived this discussion thread on the ACEP EUS section, as it seems to be an issue that will arise more and more in the future.
The link is at:
http://www.acep.org/forum.aspx?param=218483&ACEPCN=vde2sgelj20th45wchpfrkoxA412482&tid=97440&g=posts&t=97444&page=-1

While we have decided that important EUS topics warrant a more prolonged discussion on the E-mail list-serve, I will also try and archive all these in the ACEP EUS website forum section.
Folks can then look at this database for lots of info on topics that seem to be particularly important to the group and those that also tend to come up on a regular basis.

Take care,

Phil Perera
ACEP EUS Website Committee
Clinical Associate Professor
Division of Emergency Medicine
Stanford University Medical Center
pererap
Posted: Wednesday, May 7, 2014
Joined: 8/31/2011
Posts: 231


Busy Level 3 trauma center (we choose not to have a Level 2 designation), volume 51,000/yr.  Also non-academic - no residents.
The E-FAST exam is expected to be done for all Level I and other traumas per the ED physician discretion.  Only the ED physicians are privileged in EUS, and our general surgeons rely on us to perform the exam accurately, and make clinical decisions based on our E-FAST interpretation.
 
Thanks,
Eric Ketcham, MD
San Juan Regional Medical Center
Farmington, NM
pererap
Posted: Wednesday, May 7, 2014
Joined: 8/31/2011
Posts: 231


Our shop is in the process of getting certified as a level III center, and the ED residents perform FAST. 

The two-hospital group I used to work for covered a Level I center where the trauma residents did the FAST, and a Level II center where the ED attendings did the FAST.

Michael Pallaci, DO, FACEP
Director, Emergency Medicine Residency Program
Grandview Medical Center
Dayton, OH


pererap
Posted: Wednesday, May 7, 2014
Joined: 8/31/2011
Posts: 231


Dave,
Are your "trauma surgeons" claiming that they will perform trauma ultrasound exams and do real-time interpretations 24/7 ?  I doubt it.  I think you should demand that all of their FAST exams be supervised and interpreted by faculty surgeons in real time, even in the middle of the night. They should not be allowed to bill for them during convenient hours if they can't do it 24/7 in real time. In my experience "trauma surgeons" like to manage trauma patients during bankers hours but in the middle of the night we manage almost all trauma and only their residents show up to trauma pages.
We all know that "trauma surgery" is a dying specialty, so they need to do stuff like this to justify their existence. Emergency physicians should remind them that nationwide we manage over 95% of trauma patients without their input. Also, ACEP should do a better job of demanding that EPs be an integral part of the trauma system (like the ACS does for surgeons). Until the leadership of ACEP has the guts to stand up to the ACS ridiculous situations like this will continue to occur.
Good luck.
Rob Reardon
 
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