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| Software-aided Sedation?
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New technology currently undergoing investigational trials could take the guesswork out of administering propofol to endoscopy patients. Computer-assisted personalized sedation — or CAPS — combines continuous physiological and sedation monitoring through an electronic interface and software to facilitate precise control of drug delivery, says Ethicon Endo-Surgery, the system's developer.
CAPS keeps real-time records while continually monitoring seven patient parameters (oxygen saturation, respiratory rate, heart rate, blood pressure, end-tidal carbon dioxide, patient responsiveness and ECG), delivering oxygen and automatically reducing propofol delivery when it senses clinical signs of oversedation, says the company.
In a U.S. feasibility study that used CAPS to administer propofol during 12 colonoscopies and 12 EGDs, the anesthesiologist operating the system agreed with its decisions in more than 9,000 instances. In the three instances the anesthesiologist didn't agree, the system's decisions were deemed more conservative than the ones the anesthesiologist would have made. Researchers were scheduled to present the study results at Digestive Disease Week in Los Angeles on Sunday.
"This study tested the logic of the system's drug dosing, as well as its response to the changing physiology of the patients throughout each procedure," says Daniel Pambianco, MD, FACG, medical director of Charlottesville (Va.) Medical Research and principal investigator for the feasibility study. "If we are going to meet the need for more colorectal cancer screenings, we need enabling technologies that will address patient needs while maintaining a high quality procedure. This system has shown early capability as a means to bring more scientific rigor to the art of sedation, which will help achieve that end."
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| Manufacturer Sued Over Price Transparency
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Describing price transparency as a First Amendment issue, nonprofit healthcare researcher ECRI has filed a federal lawsuit against manufacturer Guidant Corp. in order to retain the ability to publish comparisons of the prices hospitals paid for medical devices.
While the dispute at hand encompasses only prices for Guidant's cardiac rhythm monitors, the court's ruling could likely affect the independent publishing of prices for all medical devices.
"ECRI believes there is a pressing national interest in allowing the healthcare community to engage in comparative shopping based on the safety, performance and cost of medical products," says the research agency. "Keeping this information secret is not acceptable in other industries and Guidant's policy comes at a time when there is a growing belief that transparency in prices can make a strong contribution toward permitting patients, physicians and hospitals to assess the value of the products and services they purchase."
Guidant, which claims that pricing confidentiality is standard practice that lets the company negotiate more fairly with hospitals, argues that the publication of prices should be blocked as it interferes with purchasing contracts.
"Our CRM customers overwhelmingly prefer negotiated prices to fixed ones, and our ability to offer negotiated prices depends on confidentiality," says Paul Donovan, the company's director of corporate communications. "Through negotiation, we are able to reach mutually beneficial terms best suited to each customer's individual needs and circumstances. We simply don't want the price negotiated privately with one hospital based on one set of circumstances used against us in negotiations with another hospital with an entirely different set of circumstances."
ECRI obtains and publishes pricing data on single-use medical products, including disposables, implants and consumables, from information provided voluntarily by hospitals. ECRI standardizes the vendor names and item descriptions and organizes the information into PriceGuide, its online database for member hospitals seeking to benchmark supply costs.
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| Federal Regulators May Pull Hospital's Medicare
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A San Diego hospital faces the possibility of exclusion from Medicare, Medicaid and other federal healthcare programs after regulators accused the hospital of Anti-kickback Statute violations.
The Office of Inspector General of the U.S. Health and Human Services Department alleges that between 1992 and 2003 Alvarado Hospital Medical Center, a Tenet Healthcare-owned facility, funneled money to physicians who'd recently relocated to the area and to their practices in an attempt to buy referrals.
While Alvarado was twice indicted on felony kickback charges for these payouts, both of the federal trials emerging from the indictments ended in hung juries. Last week's announcement by the OIG is an administrative action independent of the criminal investigation, says Greg Demske, assistant inspector general for legal affairs. "We have a strong case to pursue administratively and it's appropriate to pursue it," he says.
Tenet issued a response last week calling the OIG's action "unfair and unwarranted." The company argues that there is a "lack of any evidence that any physician compromised his or her medical judgment when referring a patient to Alvarado." Tenet and Alvarado have 30 days to appeal the OIG's decision.
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| News and Notes
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A San Diego hospital faces the possibility of exclusion from Medicare, Medicaid and other federal healthcare programs after regulators accused the hospital of Anti-kickback Statute violations.
The Office of Inspector General of the U.S. Health and Human Services Department alleges that between 1992 and 2003 Alvarado Hospital Medical Center, a Tenet Healthcare-owned facility, funneled money to physicians who'd recently relocated to the area and to their practices in an attempt to buy referrals.
While Alvarado was twice indicted on felony kickback charges for these payouts, both of the federal trials emerging from the indictments ended in hung juries. Last week's announcement by the OIG is an administrative action independent of the criminal investigation, says Greg Demske, assistant inspector general for legal affairs. "We have a strong case to pursue administratively and it's appropriate to pursue it," he says.
Tenet issued a response last week calling the OIG's action "unfair and unwarranted." The company argues that there is a "lack of any evidence that any physician compromised his or her medical judgment when referring a patient to Alvarado." Tenet and Alvarado have 30 days to appeal the OIG's decision.
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