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| Report Criticizes Pennsylvania ASCs' Discharge Instructions
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Outpatient surgery centers in Pennsylvania can do a better job of giving patients more detailed discharge instructions, say state officials.
Patients who required hospital-level care within hours or days after treatment at an ASC may have benefited from more detailed discharge instructions and more structured patient-provider communication, according to reports submitted to the Patient Safety Authority through its mandatory, statewide Pennsylvania Patient Safety Reporting System.
While it appears that most ASCs provide appropriate discharge instructions, reports to PA-PSRS from ASCs identify a number of strategies healthcare providers can take to improve their discharge protocols, including
providing the patient or family members with well-defined, objective criteria for seeking follow-up care or physician contact;
discussing pain management expectations, trade-offs and alternatives with the patient;
addressing incisional bleeding, dressings and pressure dressings and clearly explaining to the patient or caregiver when to contact the physician for further intervention;
reviewing pre-operative medications and post-operative resumption of medications, with special attention paid to anticoagulants;
reinforcing the risks related to specific instructions, such as driving within 24 hours postoperatively or lacking a supportive caregiver; and
developing a comprehensive discharge checklist.
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| Hospitals Saw Higher Profits in 2004
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Buoyed by lucrative Medicare reimbursement rates and private payer contracts, the continuing increase of outpatient procedures and a slowing of the cost of major expenses such as malpractice insurance, U.S. hospitals' profits rose to a six-year-high in 2004, reports USA Today in its Jan. 4 edition. While one-fourth of the nation's hospitals failed to make a profit in 2004, the average profit margin reported for that year was 5.2 percent, according to the American Hospital Association.
An analyst at credit rating agency Moody's Investors Service saw similar numbers and forecast even higher profits for the just-elapsed and still-under-review 2005, the newspaper reports. The analyst dates a previous nationwide slump in hospital profits to the reduction in Medicare's payment rates brought on by Congress's 1997 Balanced Budget Act.
The American Hospital Association's Rick Wade cautions that change may be coming, however. While reimbursement rates are currently high and the industry is experiencing its largest construction boom in half a century, with nearly $100 billion spent on new building and expansions in the past five years, he says he fears that Medicare payments will be cut in the face of growing budget deficits, the newspaper reports.
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| Parental Induction Not for Every Child (or Parent)
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Deciding which child-and-parent pairs will benefit from parental presence during induction of anesthesia needs to be done on a case-by-case basis, according to a study in the January 2006 issue of Anesthesia and Analgesia. The researchers, led by Zeev N. Kain, MD, MBA, chief of pediatric anesthesiology at the Yale University School of Medicine, suggest that healthcare workers need to implement a decision-making process that takes into account the anxiety levels of both parent and child.
The study looked at data for 568 child-parent pairs over the past seven years to determine whether parental presence during induction of anesthesia for the child's procedure reduced children's anxiety. Children's and parents' baseline anxiety levels were assessed pre-op and children were again assessed during induction.
Results show that parental anxiety (or lack thereof) is transferred to the child. Anxious children with calm parents were found to be significantly less anxious during induction as compared with anxious children who did not receive parental induction. In addition, calm children with anxious parents showed more anxiety than calm children who did not receive parental induction. Children whose attitudes matched their parents' did not show a change either way.
"The presence of a calm parent does benefit an anxious child during induction of anesthesia, and the presence of an overly anxious parent has no benefit," the researchers write.
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| News and Notes
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SILICONE BREAST IMPLANTS WILL GAIN FDA APPROVAL and men will make up a greater share of the cosmetic surgery market, according to the American Society for Aesthetic Plastic Surgery's predictions for 2006. Also among the group's top 10: Cosmetic surgery among racial and ethnic minorities will continue to increase; states will abandon proposals to tax aesthetic surgery procedures due to "New Jersey's negative experience with the cosmetic surgery tax"; large-scale clinical studies will be implemented to validate the safety and effectiveness of minimally invasive, non-surgical treatments such as barbed sutures and fat melting; and cosmetic fillers will dramatically increase in popularity as products continue to evolve and new players enter the market.
THE GOVERNMENT WILL BEGIN REIMBURSING MORE FOR RECHARGEABLE IMPLANTABLE NEUROSTIMULATION DEVICES to treat pain. CMS last week approved Boston Scientific's application for a transitional pass-through payment category that will provide hospitals additional device payments when rechargeable neurostimulators such as the Precision Implantable Pulse Generator are implanted in the hospital outpatient setting. Effective Jan. 1, the new device pass-through code (C1820) includes both the rechargeable neurostimulator generator and the charging system. This code is only intended for use in the hospital outpatient setting under Medicare. CMS also released the 2006 Medicare payment rates for the new neurostimulator HCPCS codes (L8680-L8699) that are used in ASCs. The 2006 payment rate for the Precision rechargeable generator (L8687) represents a significant increase over the 2005 rate (around $17,000) that didn't differentiate between rechargeable and non-rechargeable neurostimulators. The device and surgery can cost around $50,000, says Boston.
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