March 2011: 3-D Technology in the OR

Julie Lancaster, Editor

The same technology that Hollywood uses to make images leap off the screen is now being used in the operating room. Neurosurgeons at the University of Pennsylvania recently conducted a new procedure, 3-D endoscopic brain surgery, in which a 3-D endoscope is inserted through a patient’s nose. The surgeons put on polarized glasses to see a 3-D image of the brain.

“The 3-D helps me to be safer with resection around critical structures,” said John Y.K. Lee, a neurosurgeon at the University of Pennsylvania Hospital System.

Click to read the report and a research summary.

Gary Hargreaves of NIFA Medical Billing (a separate entity from NIFA/National Institute of First Assisting) has spoken to the students at both of our first two SutureStar Summits on reimbursement–a topic critically important to those who plan to work as self-employed or surgeon-employed RNFAs.

Hargreaves is an expert on reimbursement. His company is currently billing in 30 states for reimbursement for RN First Assistants.

“This year–2011–is a pivotal year because of the aging baby boomers,” he said. “For each of the next 20 years, 10 million baby boomers will qualify for Medicare. This will have a huge impact on healthcare.” It also has a huge impact on your potential income, because RNFAs–unless they are also NPs–cannot bill Medicare for reimbursement. Even for NPs, Medicare pays lower reimbursement than private insurance companies can.

To compensate for the tidal wave of Medicare cases coming our way, Hargreaves says, RNFAs need to “work smarter”:

• Take a business approach to get into the reimbursement game. Don’t sell yourself short. You’re a professional, and you deserve to get paid for your work. Nobody will appreciate it unless you know the value of your work and have that air of deserving it.

• What makes the most impact on your reimbursement as an RNFA is the percentage of your caseload that is Medicare. Look for surgeons who take fewer Medicare cases.

• Zero in on a couple of specialties where the reimbursement tends to be higher. Neurological and spinal surgery reimbursement can be excellent. Other good specialties for reimbursement are plastic surgery and sports medicine. At the bottom of the list in terms of reimbursement are many ob/gyn and general surgery procedures.

• Take a look at the American College of Surgeons list of cases that require an assistant at surgery–one of NIFA’s favorite links in this and every issue of our e-newsletter. This report lists hundreds of surgical procedures that have been evaluated by the American College of Surgeons and various surgical specialty organizations as requiring an assistant at surgery “Almost Always,” “Sometimes,” or “Never.” “Get procedures that are in the ‘almost always’ column,” Hargreaves counseled.

NIFA Medical Billing welcomes your questions. You will find phone and email contact information at their website.

Name: Terri Shade
Credentials: RN, BSN, CNOR, RNFA
City and State: Hastings, Michigan
Graduate Status: Graduated May 2010, NIFA
Current Job: RNFA at St. Mary’s Hospital, Grand Rapids, MI: general surgery, ortho, ob/gyn, neuro.Path toward RNFA: I started nursing school right out of high school, a 22-month diploma program. But when I was about halfway through, I met a boy and left school.     When the boy didn’t work out, I went back to school and got a human resources and labor relations degree from Lake Superior State College, Sault Ste. Marie, MI. I went to work for Target as a personnel manager. I was working in Florida, opening stores for Target, when my dad had cardiomyopthy and ended up on the transplant list in Indiana. I came back to Indiana to help take care of him just as Target was closing stores, so I decided to go to Indiana University-South Bend and pick up with nursing where I’d left off eight years earlier.
I went to nursing school with a 4-year old and a 2-year old at home. It was tough, but my loving husband was so wonderful. For the first couple of years of nursing school I really couldn’t work, and he held down two jobs for a while. We also lived with my dad and stepmom until we got on our feet again. Eventually we got our own house and by the third year I was able to work as an intern.
I was the very first intern they let into the surgery department back in 1997 at Memorial Hospital, South Bend, IN. After a lot of talking and multiple meetings, they decided I had the right personality and mentality for the job. The OR tends to be full of strong personalities; you have to be able to let things roll off and not take them personally.
Recently, after many years in the OR, I finally realized the action wasn’t in circulating, scrubbing, or being an instrument jockey. I started investigating First Assistant programs and found that NIFA had the best hands-on program, so I enrolled.
In January of this year, I moved from Pennock Hospital in Hasting, MI, a small, 60-bed community hospital where I had worked for the past seven years, to St. Mary’s in Grand Rapids, a Level 1 trauma center with 234 beds. I moved from 3 ORs to 18! It’s been exciting.

Instructing for NIFA: I loved being one of the instructors at NIFA’s first SutureStar Summit. It was a lot of work! I often work long days but I don’t do them all in a row, and that 10-day stretch of 16-hour days just about did me in. But I loved it and I look forward to doing it again. I loved seeing who’s out there and what they’re interested in doing. It could be an advanced practice nurse or someone like me who’s been in the OR for 15 years and is tired of sitting on the stool. They’re motivated!