Cardiologists for Tee

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
D

diceksox

Full Member
15+ Year Member
Joined
Feb 25, 2007
Messages
45
Reaction score
6
Points
4,531
  1. Attending Physician
Members do not see this ad.
Just curious about what goes down at your institution.... At my current place surgeons book cards to come do the tee for all mitral valves, despite having cardiac anesthesiologists. I'd never seen this in residency or fellowship or other places I've been. Thoughts?
 
******ed. The card anes should put a stop to this, esp if they are fellowship trained and tee cert.
 
I've seen it both ways. Sometimes happens for political reasons, i.e. cardiology might have a lot of sway in that particular institution.
 
GypsySongman said:
Kickback? Thank you for the CAD referral now here's some TEE money for you.
Click to expand...

I would think that it is not worth most cardiologists time. Being immediately available twice during a case with very little notice. Can't imagine the reimbusement would be worth it.

On the other hand there are still plenty of smaller hospitals that do hearts where not all of the anesthesiologists are qualified in TEE. They may have picked up the ball out of necessity.
 
dr doze said:
I would think that it is not worth most cardiologists time. Being immediately available twice during a case with very little notice. Can't imagine the reimbusement would be worth it.

On the other hand there are still plenty of smaller hospitals that do hearts where not all of the anesthesiologists are qualified in TEE. They may have picked up the ball out of necessity.
Click to expand...

There are definitely legitimate reasons for cardiologists to do intra-operative TEE: complex peds, lack of Anesthesiologist with TEE ability, history of problems not detected by anesthesiologist, long standing use of cardiologist since before cardiac anesthesiologist joined staff, etc.

With a cardiac anesthesiologist already available in the O.R. it is suspicious to call in cardiologist who may (or may not) have referred the patient to the CT surgeon. Whether it pays well enough for it to be worthwhile for the cardiologist depends on how busy he is I'd think. It's also possible that the cardiologist just wants to follow his own patient and money isn't the motivation at all.
 
diceksox said:
Just curious about what goes down at your institution.... At my current place surgeons book cards to come do the tee for all mitral valves, despite having cardiac anesthesiologists. I'd never seen this in residency or fellowship or other places I've been. Thoughts?
Click to expand...

Personally, I think the term cardiac anesthesiologist maybe somewhat misleading. The old timers may have done hearts but not necessarily be certified in or know how to perform a TEE.

I know a couple of cardiac anesthesiologists with no TEE training or credentials. You shouldn't call yourself a CT anesthesiologist unless you can do your own echos.
 
BLADEMDA said:
Sure. The cardiologist is losing money by doing that TEE. Instead, he/she could be seeing patients or doing other procedures. Intraop TEE is a money loser for cards
Click to expand...

Just a thought. I already listed several other possibilities. Anyway, I see a lot of what looks like kickbacks or piling on referrals/assists so it comes to mind as a possibility anytime something doesn't smell right.
For the sake of argument convince me-
What does it pay for them? How long are they spending? How busy is their schedule?
 
GypsySongman said:
Just a thought. I already listed several other possibilities. Anyway, I see a lot of what looks like kickbacks or piling on referrals/assists so it comes to mind as a possibility anytime something doesn't smell right.
For the sake of argument convince me-
What does it pay for them? How long are they spending? How busy is their schedule?
Click to expand...

We get $70 for a complete TEE exam including color flow, valve area, etc from Medicare.
Maybe, cardiologists Get a bit more but not enough to warrant their wasted time in the OR
 
I've seen a cardiologist in our CT OR once in the last 4 years.
I don't want them there getting in the way (a lot of academic programs) and they don't want to get in scrubs for a 15 minute procedure.
 
If you have a CT fellowship trained anesthesiologist who is certified in advanced perioperative echo, I don't see any reason for a cardiologist to be in the OR unless there is a congenital case (in which case if shouldn't be occurring in a community hospital) or the anesthesiologist has asked for a second opinion on a difficult case. Medicine folks have no business in the OR. We need to be assertive and make it clear that we are the physicians taking care of the operative patient. Otherwise what's the point of us being there? Anyone can turn the sevo dial.
 
All of us who did recent cardiac fellowships will feel it's ridiculous to have a cardiologist come to the OR to read an echo.

But a "cardiac anesthesiologist" who trained a while ago isn't necessarily an echo expert. They can do most of what needs to be done, but once you're talking about making borderline clinical decisions based on echo findings, the surgeon wants a true expert in there to make that call.

So if a NBE certified/testamured anesthesiologist is in the room, having a cardiologist come in is silly.

If not, it can make sense depending on the parties involved. As mentioned, they're not coming in for the money- intraop echo pays diddly squat.
 
I did not do a fellowship, but I did get the basic PTEE certification last year. I do TEE on all my cardiac patients, but don't bill or produce a report. 95% of the time, this is enough. occasionally (usually post-bypass mitral valve repair eval) the surgeon wants another set of eyes and we'll call in a cardiologist. This makes sense to me. I feel comfortable and confident in my TEE skills for most stuff, but I am not as good as a CV trained anesthesioloigst or a cardiologist. Why not get the best trained person to evaluate a critical situation? I work at a community hospital that does about 300 hearts a year (among 18 anesthesiolgists), so we're unlikely to attract a CV trained guy, and none of us individually does enough hearts to really stay excellent at TEE. Despite the relatively small number of hearts, we do redos, multiple valves, VADs, aortic arch repairs/replacements, TAAAs and other relatively complex cases which really benefit from TEE. So having cardiologists to back us up is nice and overall is good for patients (ego aside).
 
B-Bone said:
I did not do a fellowship, but I did get the basic PTEE certification last year. I do TEE on all my cardiac patients, but don't bill or produce a report. 95% of the time, this is enough. occasionally (usually post-bypass mitral valve repair eval) the surgeon wants another set of eyes and we'll call in a cardiologist. This makes sense to me. I feel comfortable and confident in my TEE skills for most stuff, but I am not as good as a CV trained anesthesioloigst or a cardiologist. Why not get the best trained person to evaluate a critical situation? I work at a community hospital that does about 300 hearts a year (among 18 anesthesiolgists), so we're unlikely to attract a CV trained guy, and none of us individually does enough hearts to really stay excellent at TEE. Despite the relatively small number of hearts, we do redos, multiple valves, VADs, aortic arch repairs/replacements, TAAAs and other relatively complex cases which really benefit from TEE. So having cardiologists to back us up is nice and overall is good for patients (ego aside).
Click to expand...

Why don't you bill? I didn't think you needed advanced certified or testamured to bill. Correct?
 
Correct. You do not need certification to bill for and be paid for TEE.

If I had my way, I wouldn't bill for it either. It doesn't pay enough to be worth the hassle of doing the typical computerized report. If I could do a handwritten report it would be worth it. If we had a system where I could do the computerized report in real time, it would be worth it.

PA catheters are faster, pay better and I don't have to do the damn report to get paid for them. Ridiculous.

-pod
 
All of you should be documenting. And if you're doing complex CT, you should be fellowship trained and TEE certified. Period.
 
ctsicu said:
All of you should be documenting. And if you're doing complex CT, you should be fellowship trained and TEE certified. Period.
Click to expand...

That is the standard to which you will be held. Even if doing echos for "routine" CV. I have known three highly disciplined and motivated anesthesiologists who were not fellowship trained who acquired this level of proficiency post residency without a fellowship. In reality most of those who acquire echo skills post residency without a fellowship have some versatility with TEE (myself included) but nowhere near the level of a fellowship trained and certified CV anesthesiologist or cardiologist. I no longer do them by myself except in an emergency when nobody else is available.
B-Bone's situation is not that uncommon.
 
ctsicu said:
All of you should be documenting. And if you're doing complex CT, you should be fellowship trained and TEE certified. Period.
Click to expand...

I know its odd but @ my hospital we do the exam in the o.r. and the recorded loops are later "read" by cards who puts a report in the chart. Surgeons make decisions based on what we tell them in the o.r. we can do our own reprort but we only bill for placement.
 
diceksox said:
Just curious about what goes down at your institution.... At my current place surgeons book cards to come do the tee for all mitral valves, despite having cardiac anesthesiologists. I'd never seen this in residency or fellowship or other places I've been. Thoughts?
Click to expand...
That's how it's done here.

Trisomy13 said:
I've seen it both ways. Sometimes happens for political reasons, i.e. cardiology might have a lot of sway in that particular institution.
Click to expand...
And this is why 😎
 
periopdoc said:
Correct. You do not need certification to bill for and be paid for TEE.

-pod
Click to expand...

Is this true? For some reason I thought medicare wouldn't pay you unless you are certified.

I believe this got implemented in 2012.
 
Last edited:
diceksox said:
Just curious about what goes down at your institution.... At my current place surgeons book cards to come do the tee for all mitral valves, despite having cardiac anesthesiologists. I'd never seen this in residency or fellowship or other places I've been. Thoughts?
Click to expand...

That's fine. Less responsibility for you, yet same salary. It means the surgeons don't fully trust an echo by the anesthesiologists. It also means the surgeons are not fully confident on their repairs either.

You have to understand that no matter how good, or experienced, you are, an echo attending sees about 50 echos in a day.
 
Maybe maybe not...if they're a general cardiologist that may or may not be true. Should be done by CT anesthesia.
 
Personally, if I am going to claim I can meet or exceed the standards of a cardiologist performing intraop TEE, part of that claim includes generating a report that looks identical to theirs.

I also find that generating a full report helps me keep on top of my skills and ability to recall the standards for calls like atrial enlargement, etc.
 
Sure, I guess. I don't really have any cardiologist friends and am not British but I don't see a problem with it.
 
iE33 is very nice. That's the only machine I've used.

Make sure you ask for this option.

ImageUploadedBySDN Mobile1367797894.317555.jpg
 
periopdoc said:
Any other 3d echo machines that folks would recommend? Anything new on the market?

- pod
Click to expand...

GE Vivid E9 is nice also. I think the images are better than in the iE33.

In all honesty I don't think 3d echo offers that much info over 2d. It might be of help for mitral valve repair sometimes, but other than that it has minimal benefit.

I like the xplane function, though.
 
Just as important as the machine, the archive needs attention too. We are in the process of transitioning to Xcelera, the Phillips product. Xcelera allows for post processing of the 3D images, where other archives like Prosolv do not.

As for the cardiologists coming to the OR, I don't see that happening here. My division is starting to do the ICU studies and also the studies in the EP lab prior to ablations. It's all about availability.
 
You must log in or register to reply here.

Similar threads

Bertelman
TEE privileges
Replies
20
Views
4K
itwasalladream
I
V
Share your cool TEE / echo cases
Replies
4
Views
1K
medicine2wallstreet
M
D
GE mini TEE
Replies
6
Views
2K
dchz
dchz
circleK
Anesthesia for TEE’s
2
Replies
78
Views
8K
Bertelman
Bertelman
V
Court Case: TEE, Surgeons and Defamation
2
Replies
56
Views
5K
vector2
V
Top Bottom