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| GAO Report: ASCs' Costs Are 84 Percent of OPPS Rates
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ASCs may have just gotten a boost in their quest to get more than the proposed 62 percent of hospital rates under CMS's proposed restructuring of the outpatient prospective payment system. A long-awaited GAO report that backs the linking of ASC and hospital rates, "taking into account the lower relative costs of procedures performed in ASCs compared to hospital outpatient departments," also reveals that ASCs' costs are 84 percent of hospital payments and that hospital costs are 104 percent of payments.
"The GAO report clearly shows that for the services currently performed in ASCs, 62 percent of the hospital rates falls woefully short of the cost of providing ASC services to Medicare beneficiaries," says Craig Jeffries, executive director of AAASC.
The GAO surveyed ASCs for cost data and found that, overall, ASCs operate at just 39 percent of hospitals' costs. However, notes AAASC, many of those procedures are rarely or never performed, and it is the "analysis that account[s] for the procedures actually performed in an ASC, or the weighted costs," that is most important. That weighted figure is 84 percent of payments — and about 81 percent of hospital costs for the same procedures.
"If the government gives us the 75 percent of hospitals rates that we've been asking for, it'll still be getting a bargain," says Kathy Bryant, the president of FASA.
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| Major Changes Suggested for Struggling N.Y. Hospitals
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In its highly anticipated analysis of New York's struggling hospital system, released last week, the state's Commission on Healthcare Facilities in the 21st Century made recommendations that, if enacted, will result in sweeping changes to the state's acute care facilities, including the closure of nine hospitals, the construction of two new ones and the restructuring of 48 others, resulting in a reduction of about 4,200 inpatient beds.
The commission points out that New York's hospitals are financially unstable due to the widespread duplication of services, too much institution-focused care, too few primary care resources and excess capacity. The statewide hospital occupancy rate has fallen from 82.8 percent in 1983 to 73.4 percent in 1994, below the targeted rate of 85 percent, the report claims. Since 1983, 70 hospitals have closed, including 34 facilities since 1994.
The restructuring will mean significant changes in the services that some hospitals offer. Long Beach Medical Center on Long Island is being asked to downsize by 55 beds and reconfigure itself into a smaller facility focused on emergency and ambulatory services. J.T. Mather Memorial Hospital in Port Jefferson, meanwhile, should "convert all 37 of its psychiatric and alcohol detoxification beds to medical/surgical beds," the commission's report recommends.
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| Study: Bariatric Surgery Holds Risks for Older Patients
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In the continuing debate over the safety of weight-loss surgery among older patients, a new study reports that the procedure's adverse outcomes increase in a nearly linear fashion as a function of age. Patients over the age of 60 show a significantly increased risk, researchers write, and those over 65 years of age show an adverse effect rate of more than 32.3 percent with 3.23 percent mortality. In contrast, younger patients had an eight percent rate of adverse effects and 0.2 percent mortality.
The study, a large-scale review of data from 25,428 adult patients who underwent the procedure in 2001 and 2002, was published in the November Archives of Surgery.
"Limiting bariatric surgical procedures to those younger than 65 years is warranted because of the high morbidity and mortality associated with these operations in older patients," writes Edward H. Livingston, MD, chair of GI and endocrine surgery at the University of Texas' Southwestern Medical Center in Dallas and the study's lead author.
Male sex, electrolyte disorders and congestive heart failure were also named as independent factors that could heighten a patient's risk of death from the procedure or lead to more complications. Conditions identified as leading to adverse effects and longer hospital stays included depression, diabetes and chronic pulmonary disease.
In an invited critique of Dr. Livingston's study, Clifford W. Deveney, MD, of Oregon Health and Science University in Portland notes that while elderly patients may face raised risks from the surgery, they may also benefit significantly from the resulting weight loss. "It is not certain when the risks outweigh the potential gains," he writes. "We need to look at benefits in the vast majority of patients who survive their bariatric procedure to determine what is an appropriate risk for a given patient."
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| News and Notes |
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COULD MILK REPLACE BARIUM SULFATE FOR GASTROINTESTINAL IMAGING? Researchers at St. Luke's-Roosevelt Hospital in New York City observed 168 patients who were scheduled to undergo CT scans of their GI tracts. Sixty-two of the patients were given the standard barium solution to distend the organs. The remainder were given whole milk to drink. Because the milk's fat content slowed the digestive process, it hollowed the milk-drinking patients' intestines nearly as much as the barium drink did among the other patients. Not only did patients better tolerate the milk, researchers say, it also proved less expensive than the barium solution. Their research was presented at last week's annual meeting of the Radiological Society of North America and reported in the New York Times.
FOUR NEW REQUIREMENTS IN THE HOSPITAL CONDITIONS OF PARTICIPATION were published last week by CMS. The time frame for completion of histories and physicals has been expanded, as has the number of permissible professional categories of individuals who may perform them. All orders, including verbal orders, must now be dated, timed, and authenticated by the prescribing practitioner — though there is a five-year ramp-up to this requirement. All drugs and biologicals must be kept in secure areas and locked when appropriate. Finally, post-anesthesia evaluation for inpatients is to be completed and documented by any individual qualified to administer anesthesia instead of only the individual who administered the anesthesia. The final rule was published in the Nov. 30 Federal Register and will be effective Jan. 26.
WERE CONTAMINATED INSTRUMENTS USED? A patient undergoing an outpatient procedure to repair an umbilical hernia at the Jacksonville Naval Hospital in Florida says she received a post-op call from her surgeon to inform her that contaminated instruments were used in the procedure, according to published reports, a charge that Navy officials deny. While refusing to discuss the specifics of the case, Capt. Raquel Cruz Bono, commander of the Jacksonville Naval Hospital, says in a statement that "in no instance have we used instruments contaminated by one patient on another patient." |
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