Page 10-B
Office Surgery Incentive Pilot Program
DURHAM Blue Cross
and Blue Shield of North
Carolina has launched a
pilot program that gives
physicians a financial in
centive for performing
certain surgical procedures
in their offices rather than
in ihe more expensive
settings offered by hospitals
and outpatient surgical
facilities.
Known as Office Surgery
Incentive Pilot Program,
the project is designed to
evaluate the cost con
tainment effect to the
consumer of providing
financial incentives to
doctors for performing
certain surgical procedures
in their offices. Plan of
ficials believe that the in
centive program can
moderate health care costs
for consumers in the long
run.
The 18-month program
begain July 1 and will
continue through December
31, 1983. Over 8,000 doctors
in North Carolina are
eligible to participate in the
program.
“We have promoted the
use of ambulatory or out -
patient surgery for several
years as a cost - con
tainment measure but there
has been no specific en
couragement of office
surgery when that setting is
medically appropriate,”
said Jim Brady, director,
upto‘3s
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Professional Affairs, and
project coordinator.
“For several years North
Carolina physicians have
indicated the need for this
type of program,” Brady
said. “Based on that in
terest, we expect a
tremendous reception from
the physicians.”
The program allows
physicians to receive ad
ditional benefits of up to 25
per cent of the usual,
customary and reasonable
allowance for 88 selected
surgical procedures per
formed in the office. The
minimum incentive
allowance will be paid in
addition to the basic
surgical benefit allowance
for the specific surgical
procedure as specified by
the subscribers’s coverage.
The 88 procedures were
identified by the Plan in
consultation with the
Committee on Blue Shield of
the North Carolina Medical
Society, a statewide ad
visory group of 30
physicians. The procedures
- all of which can be safely
performed in the office
settings -- are currently
performed less than 50 per
cent of the time in doctors’
offices.
Examples of the 88
procedures are incisional
and needle biopsies,
vasectomy, dilation and
currettage, removal of
ganglion and procedures
performed with fiber optics
equipment such as
diagnostic and surgical
procedures of the stomach
and bowel.
To participate in the
Office Surgery Incentive
Pilot Program, a doctor
must agree to accept the
usual, customary and
reasonable Blue Shield UCR
maximum allowance
determination for the
combined surgical fee and
office surgery incentive
allowance as the basis for
charges.
This agreement between
Blue Shield and North
Carolina physicians will be
on a claim by claim basis
and means that the doctor
agrees not to charge the
patient for an amount which
exceeds the Blue Shield
UCR maximum allowance.
To indicate participation
in the program and to
receive the incentive
allowance, the doctor must
report on the professional
claim form both the specific
surgical procedure codes
and the description of
service provided, and the
special office incentive
code. The separate listing is
not only required to indicate
participation but also to
gather statistics to deter
mine the cost effectiveness
of the program, Brady said.
The pilot program will
cost approximately $250,000
to implement. If there is a
shift of 6 per cent from in
stitutional to office surgery
for the selected procedures,
the program will “break
even,” Brady said. A 10 per
cent shift would result in a
net savings of $250,000, he
added.
“As people become more
educated about this change
that offers service in a less
expensive appropriate
medical setting we’ll see
increased cost savings,”
Brady said.
“For the consumer, the
office surgery program can
save health care dollars
and make the delivery of
that health care more
convenient,” Brady added.
“It is easier to schedule a
surgical procedure in a
doctor’s office than to
THE CHOWAN HERALD
compete for time with other
surgical patients on hospital
surgical schedules. In ad
dition, the trauma, anxiety
and disrupcion of lifestyle
that accompany a day at the
hospital are removed.
“All the accolades for
ambulatory surgery - and
more - are applicable
here,” Brady concluded.
Leukemia Chairman
Continued From Page 9-B
University of North
Carolina-Chapel Hill.
The Leukemia Society of
America is also providing
financial assistance to 310
patients in the state of North
Carolina. In spite of
remarkable medical ad
vances in the last ten years,
leukemia remains a
Number 1 killer disease of
children. Leukemia is no
longer a hopeless disease.
Years ago over 90 per cent
of everyone with leukemia
died within six months but
today the picture is much
brighter for children and
adults due to the research
that has helped in treatment
and diagnosis. When a boy
or girl comes by your home
asking you to sponsor them
in the upcoming Cycle for
Life, please consider that
the funds will be used right
here in the state of North
Carolina in research and
patient-aid.
Anyone wishing in
formation or entry blanks
can contact Mrs. Covington
at 482-2568 in Edenton.
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Chemical Burns Os The Eye - Serious
Chemical burns of the eye
are very serious and may
lead to blindess if im
mediate action is not taken.
Speed in removing the
burning chemical is all
important. Drain cleaner,
bleach or other cleaning
solutions are some chemical
agents that can burn the
eye.
Flush the eye im
mediately with large
quantities of cool running
water for about 10 minutes
to rinse out the offending
chemical. Hold the victim’s
head under a faucet, prop
the eyelids open and allow
the water to run from the
inside (near the nose) to the
outside. If both eyes are
affected, let the water flow
over both or quickly
alternate from one eye to
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the other. Pull back eyelids
so all parts of the eye will be
cleansed.
The “American Medical
Association’s Handbook of
First Aid and Emergency
Care” and the North
Carolina Medical Society
suggest that if no faucet is
available, fill a sink or large
pan with water and have the
victim immerse his face and
blink frequently.
After flushing thoroughly,
cover the injured eye with a
pad of sterile gauze or a
clean folded handkerchief
and bandage in place. Do
not allow the victim to rub
eyes. Get medical attention
promptly, preferable from a
ophthalmologist, or at the
nearest hospital emergency
room.
Never attempt to remove
a foreign body that is
sticking to the eyeball.
Particles of eyelashes or
specks that are resting or
Boating on the eyeball or
inside of the lid may be
carefully removed.
If the foreign body, is
sticking to the eyeball or
into the eye, let it alone and
get medical attention
promptly. If it is floating on
the eyeball, gently pull
upper eyelid down over
lower eyelid and hold for a
moment. This causes tears,
which will hopefully wash
out the particle.
If this doesn’t
work, fill a medicine
dropper with warm
water and flush out
the particle. If this
fails, carefully lift the
particle out with a
Thursday. August 26, 1982
moistened corner of a clean
handkerchief or cloth.
Any cuts to the eye can be
very serious. Cover the
injured eye with a sterile
pad or gauze or clean folded
cloth, bandage in [dace and
get to a doctor quickly.
For a hard blow to the eye
from a ball, fist, etc., apply
cold compresses, keep the
victim lying down if
possible, and get to the
doctor.
Th« baby dou
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