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| How Did CMS Settle on 62 Percent?
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Many observers were surprised last week when the Centers for Medicare and Medicaid Services announced their proposal to pay surgery centers 62 percent of what they pay hospital outpatient departments for providing the exact same procedures, beginning in 2008, even as they planned to eradicate ASC procedure groupers and link ASC payments to those that hospitals receive under OPPS. The 62 percent amount was considerably less than the 75 percent for which the ASC community had been lobbying. How did CMS settle on 62 percent?
Under the proposal, ambulatory payment classifications, or APCs, would be the mechanism for grouping ASC procedures. APC relative payment weights would be the basis for calculating payment rates under the revised system, explains Eric Zimmerman, JD, a partner in the law firm McDermott Will & Emery LLP.
CMS is obliged by statute to implement the new payment system in a budget-neutral manner so that payments under the new payment methodology neither increase nor decrease aggregate Medicare spending for ASC services. As such, CMS proposes to use a conversion factor of $39,688 multiplied by the ASC relative weights to determine the payment for an individual procedure. In comparison, CMS's proposed conversion factor for hospitals under the outpatient prospective payment system is $64,013, says Mr. Zimmerman.
Mr. Zimmerman notes that the final ASC conversion factor taking effect in 2008 will likely change as variables such as hospital outpatient relative weights and utilization data do and as CMS revises its overall methodology in response to the comments it receives.
"It's important to note that the 62 percent relationship wouldn't be permanent," says Mr. Zimmerman. "Under the proposed methodology, CMS would recalculate the two conversion factors each year, and the hospital-ASC payment relationship would vary accordingly."
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| Botox Injections Appear to Decrease Scarring
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Facial wounds heal with less scarring when treated with botulinum toxin (Botox), according to a study published in the August issue of Mayo Clinic Proceedings. Researchers discovered that an injection of Botox improves final scarring by paralyzing the area around the wound, preventing muscle movement from wrinkling the site and creating a flat surface for improved healing.
The study involved 31 patients who presented with traumatic forehead lacerations or elective excisions of forehead masses between February 1, 2002, and January 1, 2004. Researchers treated patients with Botox or saline placebo injections adjacent to the wound site within 24 hours of wound closure. Facial plastic surgeons analyzed post-op photographs and measured outcomes using a 10cm visual analog scale.
Patients treated with Botox received a median visual analog score of 8.9 as compared with the placebo group's 7.2 score. The researchers suggest these results indicate improved healing and appearance among the Botox-treated scars.
Holger G. Gassner, MD, the study's lead author, says he believes that Botox injections could eliminate the need for later surgeries to improve a scar's appearance, and that the treatment has the potential to improve the look of older scars that are surgically removed.
However, the use of Botox to improve wound healing is not at present FDA approved. Researchers say additional tests are needed to determine the proper dosage and the effects of the injections on wounds on other areas of the body.
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| Study: Ketamine May Have Antidepressant Effects
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If your anesthesia providers use ketamine, you might have noticed that your patients emerge from anesthesia in great spirits, even euphoric. There's a reason for this. Researchers now believe that the drug may have rapid antidepressant effects.
People with treatment-resistant depression experienced relief in as little as two hours after a single intravenous infusion of ketamine, according to a study of 18 patients published in the August issue of Archives of General Psychiatry. What's more, ketamine may remain effective for up to one week, say researchers.
Conventional antidepressants work only after eight to 10 weeks of treatment, but with ketamine the effect was visible within hours. Traditional drugs work by increasing the levels of chemicals in the brain known as monoamines, including serotonin and dopamine, the authors write. Over time, this accumulation of chemicals acts to improve a patient's mood. Ketamine directly targets a different brain pathway — the glutamatergic system, which is important to learning and memory.
Ketamine was initially invented as an anesthesia in 1962. The drug is well known for causing hallucinations and out-of-body experiences. But these effects are mild; hence, ketamine is legally used as an anesthetic as well as a veterinary tranquillizer.
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| News and Notes |
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NEW JERSEY HEALTHCARE OFFICIALS may set up a commission to assess the need, location and state funding of the Garden State's 81 acute care and 34 specialty hospitals. In his proposal of such a commission, Gov. Jon Corzine said that state hospital officials have suggested that as many as 25 facilities, which weren't identified, are not needed. While no hospitals would be forced to close, Corzine says the commission's findings would provide solid reasoning for the allocation of state funding and other resources based on the population and location need of a hospital.
MORE THAN 1 IN 5 AUTOMATED EXTERNAL DEFIBRILLATORS were likely to have been recalled for hardware malfunctions in the past decade, say the authors of a study in the August 9 issue of the Journal of the American Medical Association. The authors, both physicians at Boston's Beth Israel Deaconess Medical Center, reviewed FDA advisories on adverse events involving AEDs between 1996 and 2005 - of which there were 52, affecting 385,922 of the devices - as well as 370 incidents in which malfunctions prevented the devices from starting, charging or successfully operating. Comparing AEDs to defibrillator implants, which are registered upon use, the authors urge the creation of a better system for notifying the owners of AEDs in the event of recalls or necessary repairs.
A BRAZILIAN COUPLE WHO RAN AN ILLEGAL COSMETIC SURGERY CLINIC in the basement of a Framingham, Mass., condominium face criminal charges after one patient died and another was hospitalized as a result of liposuction procedures, prosecutors say. Luiz Carlos Ribeiro, 49, was charged with distribution of narcotics and practicing medicine without a license. His wife, Ana Maria Miranda Ribeiro, 49, was also charged with narcotics distribution, as has the condominium's owner, Ana Celia Pena Sielemenn, 40. |
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