January 24, 2018

Day one in Denver at ASRM

I’m currently attending the annual meeting of the American Society of Reproductive Medicine, where fertility specialists from all over the world come together, this year in Denver, to hear lectures and watch presentations. The first two days, there were small specific formal courses. Today is the first day of large general presentations.

An hour ago, I sat in a room with several hundred doctors, viewing a live large-screen broadcast of hysteroscopic surgery being done in Massachusetts by Dr. Keith Isaacson. While he performed the surgery, a panel of moderators asked him questions step-by-step. So we watched the same view that the surgeon saw as it was relayed from his office to all of us sitting in Colorado. This would be an amazing way to teach medical students and residents. Here is a sample video of a hysteroscopic procedure.

The next part of the lecture was a practical discussion of the practical economics of this procedure. Dr. Isaacson reminded us that patients greatly prefer the convenience of having the procedure in the comfort of the doctor’s office, a familiar setting where the staff will fully attend to her. This is in contrast with the traditional way of doing the surgery in a hospital setting, which necessitates going to a unfamiliar location and dealing with a tremendous mess of bureaucratic paperwork. The perverse thing is that insurance companies at present will not reimburse as much for this efficient everybody-wins approach as they do for the more wasteful and inefficient hospital version, thereby giving the wrong kind of incentives. Without a free market in healthcare, we’ll continue to see the waste and inefficiency of doctors having to do things to comply with the CPT coding and reimbursement system rather than doing what’s best for the patient and most cost-efficient.

Finally, there was a unique type of excitement as he did his third procedure live, a difficult tubal cannulation. The audience ooh’d and aah’d with suspense as he tried to snake the catheter into the tube and all cheered when he finally got it in. I’ve never thought of surgery as a spectator sport before.