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| Survey: Most ASCs Still Physician-Owned
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While hospitals and corporate partners continue to make inroads into surgical center ownership, a recent survey indicates that nearly half of the nation's ASCs are solely owned by physicians, as compared to one-third that have some form of hospital ownership, percentages that have not significantly changed in the past two years.
For the survey, conducted in December, the American Association of Ambulatory Surgery Centers mailed questionnaires to 500 ASCs nationwide, asking about their ownership and the ownership of other ASCs in their areas. They tabulated their results from 90 responses received within a week.
According to the survey, 47 percent of ASCs are entirely physician-owned — the most prevalent type of ownership — down 1 percent from a similar 2004 survey. Physician-and-corporate-partner ASCs made up 21 percent, down from 23 percent two years ago, and physician-hospital joint ventures came in as 20 percent, a 2 percent increase.
ASCs owned entirely by hospitals counted for 5 percent of the total, down 1 percent from 2004, and physician-hospital-corporate ventures made up seven percent, up two percent from the previous survey.
"This informal survey provides important guidance on the trends in ASC ownership," says Craig Jeffries, executive director of the AAASC. "There's still a lot of competition out there, but the ownership dynamic of the industry is changing."
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| News and Notes |
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MEDICARE WILL REIMBURSE FOR THE USE OF ON-Q PAIN PUMPS for post-op pain relief under the hospital outpatient prospective payment system effective Jan. 1, according to the pumps' manufacturer, I-Flow. Hospitals will need to list the ON-Q device code (A4306) and its cost on outpatient claims so that ambulatory payment classification rates can be adjusted accordingly. "We believe and are excited that the benefits of ON-Q, which include providing significantly better pain relief than narcotics after surgery and significantly reducing the need for narcotics, have been recognized by Medicare," says Donald M. Earhart, the chairman president and CEO of I-Flow. "We expect that Medicare's recognition will positively influence private insurance companies to follow suit and, thus, get more patients back to normal faster following their surgery."
TWO RECENT STUDIES OF NEW JERSEY'S HOSPITALS place the blame for the industry's fiscal woes on a market glut, competition from ASCs, and uneven reimbursement. According to a study jointly commissioned by Horizon Blue Cross Blue Shield of New Jersey and the Robert Wood Johnson Foundation and conducted by healthcare consultants Avalere Health, LLC, certain regions of the state have too many hospital beds and duplicated services and could benefit from a geographical limiting and redistribution of services. The New Jersey Hospital Association's study pointed out that Medicare, Medicaid and state-sponsored charity care cover more than half of all hospital patients but only pay 73 to 92 percent of hospital costs for their care, while private insurers negotiate lower reimbursements and surgery centers tap into insured patient populations. New Jersey Gov. Jon Corzine created a commission last year to assess the state's hospital needs and perhaps recommend closings.
THE U.S. FOOD AND DRUG ADMINISTRATION HAS APPROVED pharmaceutical manufacturer Merck's antibiotic Invanz (ertapenem) for use in preventing surgical site infections following colorectal surgery among adult patients. According to the company, a clinical trial showed that a single 1g injectable dose administered within one hour of incision reduced the incidence of SSIs after elective GI surgery. The trial, which compared Invanz to the drug cefotetan in the prophylaxis of post-GI SSIs, used the absence of evidence indicating infections, post-op anastomotic leaks or unexplained antibiotic use among patients in the four weeks after surgery as endpoints. |
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| Are Patients Fully Aware of Anesthesia Awareness?
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The damaging psychological effects of anesthesia awareness are less common than previously believed, even though emotional reactions to this medical phenomenon may be long lasting, say researchers at Sweden's Linkoping University. Results published in the January issue of the journal Anesthesiology also suggest that patients mistakenly identified pre- or post-op nightmares as intraoperative memories, resulting in the false reporting of true occurrences of anesthesia awareness.
Researchers interviewed 2,681 patients who had undergone general anesthesia between January 2001 and May 2003. The interviews were designed to determine if awareness actually occurred and to identify lingering psychological effects in cases where awareness did occur.
Ninety-eight patients believed they had experienced anesthesia awareness during a previous surgery. Further questioning of those 98 patients revealed that four cases were actually performed under regional anesthesia and 29 were not considered awareness by researchers. Nineteen other patients were excluded because of medical reasons, refusal to participate or their deaths.
Of the remaining 46 patients, 30 reported acute emotional reactions to their awareness, 20 patients experienced pain and 15 experienced lingering psychological symptoms. Only one patient was diagnosed with post-traumatic stress disorder.
Adam Dorin, MD, MBA, believes the study touches on issues of past research that used skewed data to include patients who were not under general anesthesia. He also believes the American Society of Anesthesiologists' 2005 Practice Advisory for Intraoperative Awareness and Brain Function Monitoring was correct in taking an even-handed approach to this issue and in their suggesting of the selective use of brain function monitors.
In another study published in the journal's January issue, researchers concluded that patients often dream during anesthesia and may confuse this common side effect with awareness. They conducted two interviews each with 300 patients who underwent elective surgery with general anesthesia; one interview occurred when the patients first awakened from anesthesia and the second took place two hours to four hours post-op. Measurements of the effect of anesthetics and sedatives on the brain were also recorded for each patient. Of the 300 patients, 86 reported dreaming in one or both of the interviews, but no significant difference between dreamers and non-dreamers existed based on depth of anesthesia, the study reports.
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