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| Starting Later May Increase Anesthesia Complications
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Nearly 40 percent of patients who undergo bariatric surgery develop complications within six months, say federal researchers. According to a study published in August's Medical Care, readmissions and post-op emergency room visits for these complications can add tens of thousands of dollars to a patient's treatment costs.
Researchers examined 12 complications specifically related to bariatric surgery in the insurance claims of 2,522 procedures that took place between February 2001 and July 2002. A total of 10.8 percent of patients without 30-day complications developed a complication between 30 days and 180 days, the study shows.
The average health expenditures for bariatric surgery and the next 6 months of care was $29,921, according to the study's sample. The total risk-adjusted payments were $65,031 for patients readmitted due to complications and $27,125 for patients without readmissions, researchers found.
"Bariatric surgery is a growing procedure and I don't think it will slow down, but insurers might start looking at the readmission rate of physicians and choose providers more carefully," says William E. Encinosa, PhD, a senior economist with the Agency for Health Care Research and Quality and the study's lead author.
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| Pa. Lawmakers Focus on Physician Self-referrals
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A bill proposed in the Pennsylvania Senate aims to prohibit physicians from referring patients to facilities in which they have a financial interest. Sen. Pat Vance introduced SB 1293 to regulate physician self-referrals, which she says result in healthcare service overutilization, healthcare cost increases and, in some cases, dips in healthcare quality.
Jim Redmond, senior vice president of legislative services for the Hospital and Healthsystem Association of Pennsylvania, believes the loss of revenue-generating procedures to limited-service facilities weakens hospitals' financial standing, jeopardizing their ability to provide lower-margin care.
"The development of ASCs and imaging centers has put many of our community hospitals in a vulnerable position," says Mr. Redmond. "These centers take individuals who are well insured and relatively low-risk, leaving our hospitals with those who are uninsured or on Medicaid."
The Pennsylvania Medical Society calls the proposed legislation one-sided. "This is an anti-competitive bill and we need to be concerned with patients' access to care," says Chuck Moran, the society's spokesman. "Pennsylvania is a rural state and some services would not be available in some underserved communities if not for physician-owned facilities."
Ms. Vance's bill exempts physicians who make referrals to facilities they jointly own with a hospital, if the total financial interests of all physicians don't exceed 40 percent.
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| R.I. Surgery Center Settles State Charges
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Facing allegations from the Rhode Island Department of Health that it failed to meet a quota of charity care required by its certificate of need, a Providence, R.I., surgery center has agreed to settle the matter through charitable donations.
Over the next year, Wayland Square Surgicare will give $100,000 in cash and $100,000 worth of medical equipment and supplies to organizations that arrange medical care for low-income and uninsured patients.
One of the conditions of Rhode Island's CON law requires facilities granted a CON to administer five percent of the care they provide to indigent patients. The surgery center, which received its CON designation in 1992, was acquired by HealthSouth Corp. in 2000. In the following five years, it performed only 14 charity surgeries instead of the 1,312 it legally should have, authorities say. Records predating the HealthSouth acquisition were not available to the company or the state department of health.
"We're pleased to be in a position to honor our commitment to the Rhode Island Department of Health," says HealthSouth spokesman Andy Brimmer, "while providing needed resources to the community."
"This is a positive resolution that will benefit many people in Rhode Island who otherwise might not have received the care they need," says health department director David Gifford, MD, MPH, in a statement.
After protests from CON recipients over the burden of the charity care requirement, a health department committee has recommended lowering the quota from five percent to one percent. The proposed change remains under consideration.
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| News and Notes |
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ADOPTING INFORMATION TECHNOLOGY MAY BE EASIER now that the U.S. Department of Health and Human Services has established safe harbors and created self-referral exceptions to encourage physician adoption of electronic prescribing and electronic health records technology. "Electronic health records help doctors provide higher quality patient care, improved efficiency and with less hassle," says HHS Secretary Mike Leavitt in a statement. "By removing barriers, these regulation changes will help physicians get these systems in place and working for patients faster."
BLUE CROSS OF CALIFORNIA can continue to pay doctors differently for endoscopies performed at hospitals and outpatient surgery centers, a judge ruled last week. The insurer announced a policy change in July reimbursing doctors five percent more than the standard fee if the procedures were performed at outpatient facilities and 20 percent less if they took place in a hospital. The California Hospital Association sued to stop the policy change, arguing that it encouraged doctors' decisions on surgery location through financial incentives, not through patients' best interests. A judge denied the request, noting that it couldn't be proved that doctors' medical judgment would be affected.
MEN ARE TWICE AS LIKELY AS WOMEN to suffer recurring blood clots, according to a study published in July's The Lancet. Researchers discovered that men have a 50 percent higher risk of recurrent venous thromboembolism after stopping anticoagulant treatment. The study's authors believe that if these findings are confirmed by further prospective investigations, this difference in risk of recurrence should be considered when duration of anticoagulant treatment is determined in individual patients. |
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