Sarah Kliff at Vox highlights the problem of readmissions after kidney stones are busted:
That makes the removal of a kidney stone one of the most basic, most common procedures in the United States – not the type of thing that you’d think would land you in the emergency room a few weeks later.
Except it turns out that, after the extremely routine surgery, one in seven patients actually do make an unexpected trip back to the doctor – and that can cost upwards of $30,000….
how many of these unplanned visits are preventable….Scales, for his part, thinks a good number might be preventable. He points to the fact that people seen at really high volume facilities – places that do lots of kidney stone removals – tend to have 20 percent fewer unplanned follow-up visits than people seen at places that do fewer procedures. That suggests having some kind of expertise in the procedure can lead to better outcomes.
This makes sense. As someone or a team does a task more often,they get better. Their technique gets better, their recognition of that odd little detail which could lead to problems gets better, their supplies are better suited for a particular task and their ability to recognize and recover from an error gets better. It is a simple division of labor and skill.
Right now, the scope of practice for a specialist can be fairly wide. A general surgeon can go to town from neck to ankles. She might have a gallbladder operation on Tuesday, a bile duct repair on Wednesday, a hernia repair on Thursday. An orthopedic surgeon might rebuild on ankle on Monday morning, insert pins into the elbow after lunch, and replace a hip before dinner.
This could change in the future. The broad scope of practice is a necessary skill base, and it can be a necessity in more remote areas, but insurance companies may modify their payment models for better and in the long run, cheaper care in urban areas.