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Study Suggests Sigmoidoscopy is Inadequate
A study in the New England Journal of Medicine suggests sigmoidoscopy, which examines only the lower part of the colon, misses many precancerous growths that could be detected by colonoscopy. Gastroenterologists at the Oregon Health Sciences University conducted the study, which involved performing colonoscopies on 3,000 patients between 50 and 75. They found that patients with polyps in the lower portion of the colon (up to the descending colon) were more likely to have cancer or pre-cancerous polyps in the section of the colon which would have been beyond a sigmoidoscope's reach. They also found that 52 percent of the 128 patients with no polyps in the lower colon had advanced colonic neoplasms that could not have been detected with a sigmoidoscope.
John Popp, MD, a gastroenterologist in Columbia, S.C., says the study validates what gastroenterologists have known for years. "It's nice to have scientific documentation and proof of the inadequacy of sigmoidoscopy," he says. "This study should help prove that screening colonoscopy should be the method of choice to detect colon cancer in all patients, not just high-risk patients." Moreover, Dr. Popp says that in his experience, patients who have had flexible sigmoidoscopy and colonoscopy prefer the latter test because the practitioner usually uses conscious sedation.
Medicare covers sigmoidoscopy for all eligible patients every four years; colonoscopy is only covered once every two years for high-risk patients. "The insurers are only looking at the up-front costs," says Dr. Popp. "But if you can remove precancerous polyps early on, you can save hundreds of dollars long-term." One way Medicare could even out the upfront costs would be to cover the cost of a colonoscopy every 10 years; this would cost about the same as the current benefit, but would detect far more incidences of colon cancer, he says.
PPS: Hospitals Hunker Down, Tighten Belts
Most hospital OR managers project lower reimbursements as a result of
the new outpatient prospective payment system that went into effect this
month, and are already at work tightening their belts. That's the indication
of a limited, informal survey of hospitals by this magazine.
Mary Frey, Director of Surgical Services of St. Anthony's Medical Center
in St. Louis, says the PPS will decrease reimbursement to her hospital
"for sure." To adjust, her hospital is working to save money on packs
by having fewer items in them and getting surgeons to standardize so that
the hospital can consolidate its buying. She says the hospital is also
using a contract reprocessor. She says dropping some procedures would
not be out of the question "if it becomes clear that we can't recoup our
money on them."
Mariano Catbagan, Director of Surgical Services for the Community Hospital
of Monterey Peninsula, says an analysis shows his hospital will also lose
revenues overall due to PPS. A big loser is lithotripsy. "Last year, we
broke even. This year, the reimbursement is $1,000 less." He says the
hospital will also lose because under PPS, implanting a pacemaker will
no longer be reimbursed as an outpatient procedure. This will force Monterey
to admit these patients, raising costs and occupying beds in a hospital
that during flu season is sometimes filled up. He says his hospital also
plans to work to reduce case costs, adding that the PPS gives the facility
leverage with physicians. "They already got cut once, and now they are
getting it from the hospital side," he says. "A lot of them are just shaking
their heads."
Ed McKillit, a senior support analyst at Main Line Health, says the
new system poses a challenge for his three-hospital group in terms of
information management. "It's like trying to hit a moving target because
it's constantly updating and changing. But overall, he says, "I think
it's a good thing. It gives us an incentive to code better and get paid
for our services."
Karen Kilian, OR supervisor at Fayette Memorial in LaGrange, Texas,
says the managers at her hospital are confused and somewhat anxious about
the PPS. "We know it's going to put pressure on our bottom line, we just
don't know how yet," she says. She too is examining supply costs, and
doing a lot of worrying, she says.
Cindy Richardson, OR Director at Pocatello Regional Medical Center in
Pocatello, Idaho, says she's not sure how the PPS will affect her hospital,
but predicts more of the same. "We've felt pressure for several years,
and already look at our per-case costs every two to three months. Today,
it's the only way to be successful with surgery."
"It's very difficult to be a hospital these days," she adds, a sentiment
likely shared by hospitals nationwide.
HealthSouth's Struggles Continue
The nation's largest provider of outpatient surgery reported lower revenues
and sharply lower profits for the second quarter of 2000, blaming the
Balanced Budget Act of 1997 for most of the troubles. It was the second
quarter in a row that revenues were lower and the fifth quarter in a row
that profits were lower than the year before.
HealthSouth, owner of numerous hospitals and ambulatory surgery centers
nationwide, reported a 1 percent drop in its overall revenues and a 3
percent decline in same facility revenues as compared to last year. The
company also reported a decline in revenues for the first quarter of this
year.
The biggest reason for the revenue drop was a decline in Medicare revenues.
In 1999's second quarter, the company gleaned $357 million from the program.
This year, it collected $304 million.
As with many other health care facilities, operating expenses rose,
from $650 million to $700 million.
The net result: Profits of $135,655,000, compared to $212,450,000 for
second quarter 1999. It was the fifth quarquarter in a row that profits
were lower than those of the year before.
The price of the company's stock continues to be depressed, at between
$5 and $6. Two years ago, shares traded at between $20 and $25.
In what Healthsouth indicates is an unrelated development, President
James Bennett stepped down, citing personal reasons. Chairman and CEO
Richard Scrushy has no plans to replace him, however.
The company's CFO was replaced about six months earlier.
New Organization Lobbies for Surgical Hospitals
Stymied by state certificate of need regulations and Medicare's refusal
to reimburse care provided in 72-hour recovery care centers, a group of
physicians and healthcare industry executives are lobbying for acceptance
of a relatively new health care facility model-the surgical hospital.
A new association for these facilities, the American Surgical Hospital
Association (ASHA), will serve as an educational and networking resource,
help set standards and guidelines, and advance the agenda of the surgical
hospital industry.
There are only about 20 to 30 surgical hospitals, or acute care hospitals,
in the United States, according to Alan Pierrot, MD, Chief Executive Officer
of FSC Health, an ambulatory surgery center and surgical hospital development
company and one of the founders of ASHA. These facilities focus on providing
surgical services (they do not accept medical, obstetric, or trauma cases).
Typically they maintain about 50 beds. Cases performed include minor outpatient
procedures as well as complex cases such as neurosurgery, spine surgeries,
and total joint replacement.
The growth of surgical hospitals, according to Dr. Pierrot, grew primarily
out of Medicare's refusal to reimburse for complex cases provided in ASCs
with 72-hour facilities. "In a surgical hospital, we get rid of any maximum
length-of-stay restrictions," he says. "Ambulatory surgery centers have
gained market share because they are dedicated to taking care of healthy
outpatients. Healthy inpatients deserve the same model."
Dr. Pierrot says that surgical hospitals are definitely "the next step
up from surgery centers, rather than a step down from hospitals. We subscribe
to the surgery center culture, with the focus on customer satisfaction,
turnover time, and efficiency," he says.
One of ASHA's first orders of business will be to lobby state governments
to eliminate what Dr. Pierrot calls "inappropriate standards." Most states
require hospitals to have trauma care centers, intensive care units, and
obstetric units. As a result of these barriers, says Dr. Pierrot, "surgical
hospitals are at the same stage of development as surgery centers were
in the 1970s."
The need for ASHA arose because there was no organization specifically
dedicated to surgical hospitals, he says. "Organizations like the Federated
Ambulatory Surgery Association are dedicated to ASCs, while the American
Hospital Association is dedicated to large hospitals," says Dr. Pierrot.
"There really is no organization that speaks for surgical hospitals."
The group's first meeting will be in September in Salt Lake City. |
