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| Docs Bring Medicare Patients. Handle the Payments Carefully
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Physicians are the main decisionmakers when it comes to where Medicare patients will have elective surgery, according to the results of a survey published in the March Archives of Surgery. The survey of Medicare patients who had undergone major elective surgery also reported that most patients claimed they'd participated in the determination, so facilities' efforts to distribute data on quality and performance aren't necessarily for naught.
"These efforts are especially relevant to patients who need major elective surgery, which has a substantial risk of morbidity and mortality, and who have time to make a considered decision," the authors write. Further, physicians have many choices when determining where to send patients for their surgical care, and there are steps facilities can take to retain them as customers.
Watch your step, though, when billing and collecting after those Medicare patients have left your facility. Tax fraud on Medicare payments is coming under federal scrutiny. In a report issued last week, the Government Accountability Office estimates that over 21,000 of the physicians, health professionals, facilities and suppliers who received Medicare Part B payments over the first nine months of 2005 — about 5 percent of all such providers — had tax debts greater than $1 billion.
Because the Department of Health and Human Services doesn't participate in the Internal Revenue Service's continuous levy program, the GAO says the government "lost opportunities to collect between $50 million and $140 million" in the first nine months of 2005. As a result, the GAO plans to look closer at the issue and will report any needed recommendations, potentially including whether Medicare contractors should consider tax debts when making a decision about whether to enroll a physician or provider in the Medicare program.
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| Patient Index Measures Risk Factors for Post-op Admission
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Researchers at the University of Pennsylvania School of Medicine have proposed an outpatient surgery index to help identify patients at risk for hospital admission following day surgery. The index, published in the March issue of Archives of Surgery, is based on a review of 783,558 same-day surgery patients undergoing procedures in ambulatory surgery centers and hospital outpatient departments. Of that group, 4,351 were admitted to a hospital following surgery and 19 died, equating to one death per approximately 50,000 patients, according to the report.
Based on these findings, the researchers developed a summary score to identify patients at elevated risk for post-op hospitalization, assigning one point each for patients being 65 years or older; having an operating time longer than 120 minutes; cardiac diagnoses; peripheral vascular disease; cerebrovascular disease; malignancy; HIV-positive status; and regional anesthesia. Due to increased risk factors, patients receiving general anesthesia were assigned two points.
The researchers report that patients with an index score of three points have 21 times the odds for hospital admission than patients receiving a score of zero or one. Patients with scores of four, five and six, meanwhile, have 32 times the odds of admission.
This index should not dictate care and the level of surgical risk should be weighed based on individual patients and procedures, says Lee A. Fleisher, MD, FACC, FAHA, chair of Anesthesia and Critical Care for the University of Pennsylvania Health System and the study's lead author. But, he notes, "as outpatient facilities continue to push the envelope, we need to take steps to match the location of care with the risk factors of patients."
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| Study: Inhaled Anesthetics Could Lead to Early Alzheimer's
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Common inhaled anesthetics increase the number of amyloid plaques in the brains of animals, which might accelerate the onset of such neurodegenerative diseases as Alzheimer's, say researchers at the University of Pennsylvania's School of Medicine in a study published in the March 7 online edition of the journal Neurobiology of Aging.
Inhaled anesthetics clearly affect cognitive ability, at least in the short term, but the growing concern is that inhaled anesthetics may affect a person well beyond the perioperative period, even permanently. The specific effect of these drugs on dementias like Alzheimer's disease, though suspected for many years, has only been recently supported by data. This new study provides the first evidence that the predicted effect occurs in animals.
"This animal study data suggests that we have to at least consider the possibility that anesthetics accelerate certain neurodegenerative disorders," say researchers. "In the field of Alzheimer's research, most effort is focused on delaying, not curing the disease. A delay in the onset of Alzheimer's disease of only three to five years would be considered a success. Therefore, if commonly used drugs, like anesthetics, are accelerating this disorder, even by a few years, then a similar success might follow even small changes in the care of the operative patient."
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| News and Notes
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Common inhaled anesthetics increase the number of amyloid plaques in the brains of animals, which might accelerate the onset of such neurodegenerative diseases as Alzheimer's, say researchers at the University of Pennsylvania's School of Medicine in a study published in the March 7 online edition of the journal Neurobiology of Aging.
Inhaled anesthetics clearly affect cognitive ability, at least in the short term, but the growing concern is that inhaled anesthetics may affect a person well beyond the perioperative period, even permanently. The specific effect of these drugs on dementias like Alzheimer's disease, though suspected for many years, has only been recently supported by data. This new study provides the first evidence that the predicted effect occurs in animals.
"This animal study data suggests that we have to at least consider the possibility that anesthetics accelerate certain neurodegenerative disorders," say researchers. "In the field of Alzheimer's research, most effort is focused on delaying, not curing the disease. A delay in the onset of Alzheimer's disease of only three to five years would be considered a success. Therefore, if commonly used drugs, like anesthetics, are accelerating this disorder, even by a few years, then a similar success might follow even small changes in the care of the operative patient."
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