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| CMS Publishes ASC Procedure Payment Data
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As part of the federal government's continuing efforts toward price transparency in healthcare, CMS is making Medicare payment information available for 61 procedures commonly performed in ASCs. The payment listings are geographically based, as was the Medicare payment information for 41 hospital inpatient procedures that was released in June. The posting, "Commonly Performed Procedures in ASCs," is the result of a presidential directive that more data be made available to the public.
The new information, meant to help patients undergoing surgical procedures select the most appropriate setting for their care, contains charge and Medicare payment data for ASC facility costs for a limited number of services administered in states and counties. The data is broken down into county, state and national levels. CMS is concurrently releasing data on "Other Commonly Performed Procedures in ASCs," which contains similar charge and payment data for facility costs related to services of high utilization.
"The new information on services performed in ASCs adds to the information that people can use to make better decisions on their care," said CMS Administrator Mark B. McClellan, MD, PhD, in a statement. "In all areas of care -- hospitals, physicians, nursing homes, health plans, and prescription drugs -- we are supporting collaborative efforts that are providing unprecedented information to help people get the best quality care for the best price."
CMS also announced that it is "working with a number of national and local organizations" on a pilot project for quality measurement that would build on similar private sector efforts. The project would initially be conducted in Massachusetts, Indiana, Minnesota, Wisconsin, Arizona and California, with the goal of producing comprehensive and personalized data that will help improve the quality of Medicare-covered services and provide information to Medicare beneficiaries that will assist them in making more informed choices among their health care options. CMS already posts such information for hospitals.
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| Prostate Medications May Complicate Cataract Surgery
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Patients taking alpha-blocker drugs for enlarged prostate conditions should notify their ophthalmologists before cataract surgery, warn the American Urological Association and the American Society of Cataract and Refractive Surgery.
Physicians commonly treat prostate enlargement with tamsulosin (Flomax), a drug that may cause the sudden constriction of the iris during surgery, says Daniel F. Chang, MD, chairman of ASCRS's Flomax Task Force, and John R. Campbell, MD, a partner at Marin Ophthalmic Surgery Center in San Rafael, Calif.
Drs. Chang and Campbell identified the condition, called intraoperative floppy iris syndrome, during a study published in the April 2005 Journal of Cataract and Refractive Surgery. Their research showed that IFIS occurred in approximately 2 percent of the 1,600 patients studied. The results also suggest that Flomax blocks the iris dilator muscle, leading to difficulty in maintaining adequate pupil dilation during surgery.
Dr. Chang says there is no need for cataract patients who take Flomax to stop the therapy; instead he advises patients to inform their ophthalmologists prior to surgery that they are taking prostate drugs. With proper notification, ophthalmologists will be able to adjust operating techniques to avoid surgical complications, notes Dr. Chang.
"I'm glad [the professional societies] have come out with this warning," says Paul Arnold, MD, FACS, owner of Arnold Vision in Springfield, Mo. Dr. Arnold screens all patients for the use of prostate medications during pre-op consultations. He then flags patients' charts with red ink to identify individuals taking alpha-blocker therapy.
Dr. Arnold administers atropine drops pre-op and intracameral epinephrine during surgery, and uses Healon 5, a thick viscosurgical device. Surgically, he employs a one-handed phaco technique to keep the flow turbulence to a minimum and sets phaco parameters to low-flow and low vacuum settings.
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| Pre-surgical Anxiety Slows Children's Recoveries
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Children who are anxious before surgery experience a slower, more complicated and more painful postoperative recovery, according to a study published in the August edition of the journal Pediatrics.
The study explores a vital area, says lead author Zeev N. Kain, MD, MBA, chief of pediatric anesthesiology at the Yale University School of Medicine. More than 5 million children undergo surgery in America every year and up to 45 percent experience significant stress and anxiety beforehand.
In a five-year study supported by the National Institutes of Health, Dr. Kain and his team recruited 241 children between the ages of 5 and 12 who were scheduled to undergo elective tonsillectomies and adenoidectomies. The personality characteristics of the children and their parents were assessed before surgery. All of the children were admitted to a research unit at Yale following the surgery and postoperative pain and analgesic consumption were recorded every hour. After 24 hours in the hospital, the children were discharged and followed up at home for the next 14 days.
The researchers found that the most anxious children experienced more problems emerging from anesthesia and significantly more pain both during the hospital stay and over the first three days at home. During home recovery anxious children also consumed significantly more codeine and acetaminophen and had a higher incidence of postoperative anxiety and sleep problems.
"The results of our study indicate that decreasing the anxiety of children before surgery will result in improved recovery after surgery, reduced pain and lower hospital costs," says Dr. Kain.
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| News and Notes |
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PATIENTS WHO UNDERGO INTESTINAL SURGERIES that adversely affect their vitamin A absorption may suffer ocular complications later in life, researchers report in the August edition of the British Journal of Ophthalmology. In a study conducted at the Baylor College of Medicine in Houston, the researchers reviewed the cases of patients with vitamin A deficiency and eyesight complaints such as dry eyes, night blindness, corneal softening and retina damage. Four of the patients had undergone gastrointestinal procedures, three of which were performed more than 18 years before. In a related editorial, two physicians note that "the remarkable rise in gastric bypass surgical procedures" may make the possibility of widespread vitamin A deficiency "an alarming reality."
NEEDLE-PHOBIC PATIENTS MIGHT BE CALMED by visual distractions, two recent studies suggest. Researchers at the University of New Mexico's Health Science Center found that decorating needles, syringes and IV bags with images of butterflies, flowers and happy faces reduced aversion, fear and anxiety among a group of patients. Their study, published in the August edition of the Journal of Family Practice, attributed the phenomena to neurophysiological interference when the visualization of a perceived threat (the needle) and the resulting response (anxiety over approaching pain) were interrupted by activity in a different part of the brain sparked by the brightly colored decals. Another study in the British journal Archives of Disease in Childhood reports that children who watched cartoons in an exam room suffered less pain from a needle taking a blood sample than those who weren't watching television. Researchers at the University of Siena in Italy found that the television-watching children even reported less pain than those whose mothers tried to calm them, since parental attempts at calming sometimes caused more anxiety.
FORTY-TWO PERCENT OF AMERICANS say they've received poorly coordinated, inefficient or unsafe measures during visits to healthcare providers over the past two years, according to a survey by the Commonwealth Fund's Commission on a High Performance Health System. The survey, conducted in June via telephone by polling firm Harris Interactive, tapped more than 1,000 adults for their opinions on the affordability, accessibility, safety and efficiency of healthcare. The Commonwealth Fund, a private, independent foundation for health and social research, reports that many American patients complained of unnecessary care or treatment, medical errors, duplicate tests or failure of providers to supply other providers with patient information or test results. |
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