"Hand surgeons probably don't starve": Patient's perceptions of physician reimbursements for performing an open carpal tunnel release.

BACKGROUND: The purpose of this study is to evaluate patient's perceptions of physician reimbursement for the most commonly performed surgery on the hand, a carpal tunnel release (CTR). METHODS: Anonymous physician reimbursement surveys were given to patients and non-patients in the waiting rooms of orthopaedic hand physicians' offices and certified hand therapist's offices. The survey consisted of 13 questions. Respondents were asked (1) what they thought a surgeon should be paid to perform a carpal tunnel release, (2) to estimate how much Medicare reimburses the surgeon, and (3) about how health care dollars should be divided among the surgeon, the anesthesiologist, and the hospital or surgery center. Descriptive subject data included age, gender, income, educational background, and insurance type. RESULTS: Patients thought that hand surgeons should receive $5030 for performing a CTR and the percentage of health care funds should be distributed primarily to the hand surgeon (56 %), followed by the anesthesiologist (23 %) and then the hospital/surgery center (21 %). They estimated that Medicare reimburses the hand surgeon $2685 for a CTR. Most patients (86 %) stated that Medicare reimbursement was "lower" or "much lower" than what it should be. CONCLUSION: Respondents believed that hand surgeons should be reimbursed greater than 12 times the Medicare reimbursement rate of approximately $412 and that the physicians (surgeons and anesthesiologist) should command most of the health care funds allocated to this treatment. This study highlights the discrepancy between patient's perceptions and actual physician reimbursement as it relates to federal health care. Efforts should be made to educate patients on this discrepancy.

Fixation strategies to prevent screw cut-out and malreduction in proximal humeral fracture fixation.

Fixation of proximal humerus fractures with precontoured, fixed angle devices has improved operative management of these difficult injuries, particularly in patients with osteoporosis. However, recent data has revealed that fixation with these constructs is not without complications, particularly screw cut-out and loss of reduction. Multiple strategies have been developed to decrease the number of complications. We offer a surgical technique combining suture augmentation of the proximal humerus with locked plate fixation utilizing short screws.

Patient perception of outcomes following failed spinal instrumentation with polyetheretherketone rods and titanium rods.

STUDY DESIGN: A structured questionnaire. OBJECTIVE: The purpose of this study was to determine whether material rod composition and its imaging characteristics can determine patient perceptions of pain, outcome, and need for revision surgery in the context of the failure of spinal instrumentation following lumbar arthrodesis. SUMMARY OF BACKGROUND DATA: Patient perceptions of radiographic images in the context of failed spinal instrumentation may influence clinical outcomes and patient satisfaction. Due to radiolucency, failed polyetheretherketone (PEEK) rods may be perceived differently by patients than more traditional materials. METHODS: Patients presenting primarily with chief complaints of back pain completed a 2-page, 22-question questionnaire containing 3 alternative radiographic images of failed rod instrumentation following posterolateral lumbar arthrodesis. The images represented failed rods composed of either PEEK, PEEK with a longitudinal radio-opaque marker, or traditional titanium. Statistical analysis with the Cochran Q test was performed to determine whether there were statistical differences in the responses. RESULTS: The responses suggested a preference for the images representing PEEK instrumentation as being associated with superior clinical outcomes, the least pain, the most comfort, and the least likelihood of required revision surgery. CONCLUSION: PEEK rods possess radiolucent properties that can alter patient perceptions of clinical outcomes when compared with images of other equally unfavorable scenarios. The significance of these patient perceptions must still be demonstrated. However, they may play an important role in clinical outcomes and patient satisfaction.

Organosoluble copper clusters as precatalysts for carbon-heteroelement bond-forming reactions: microwave and conventional heating.

The coupling of aryl iodides with alcohols under mild conditions has been explored using self-assembled octanuclear copper clusters as catalysts. Reactions involving tetrahydrofurfuryl alcohol were typically complete in 4-8 h at 110 degrees C using an oil bath or 1-3 h with microwave heating. High yields of alkyl aryl ethers were obtained with catalyst loadings as low as 0.4 mol % cluster.