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| Legislation Would Establish New ASC Payment System
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CMS would be required to pay ASCs 75 percent of the HOPD rate and to develop a list of those procedures that ASCs would not be paid for, rather than the current process of determining those they would be paid for, under legislation introduced Friday by U.S. Reps. Kendrick Meek (D-Fla.) and Wally Herger (R-Calif.). Reps. Meek and Herger were joined by 14 other members of Congress in introducing the bill.
H.R. 1823 has been referred to both the House Committee on Energy and Commerce and the Committee on Ways and Means. Similar legislation is expected to be introduced in the Senate. The bill is a response to Medicare's proposal to pay ASCs only 62 percent of what it pays hospital outpatient departments for the same services.
H.R. 1823 is patterned after the Medicare Payment Advisory Commission's recommendation that ASCs be authorized to perform and receive Medicare facility payments for any surgical services, except for those procedures for which the Secretary of Health and Human Services identifies a specific risk concerning a certain procedure being performed in an ambulatory surgical setting, or those for which an overnight stay is required.
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| HealthSouth Sells Surgery Division
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One of the biggest names in healthcare is no longer going to be a player in the ASC industry, but a company formed from its expertise and assets is slated to take its place. HealthSouth Corporation last week announced the sale of its surgery division to the private investment partnership Texas Pacific Group for about $945 million, effectively spinning the division off as an independent business. The purchase price included $902 million in cash, with the remainder an equity interest through which HealthSouth can participate in the newly formed company.
HealthSouth's surgery division included 139 outpatient surgery centers and three surgical hospitals located in 35 states, with most of the facilities concentrated in California, Texas, Florida, North Carolina and Alabama. According to the company, the transition enacted by this sale will be finalized in the third quarter of 2007, resulting in the creation of one of the nation's largest providers of outpatient surgical services.
Some members of HealthSouth's senior management team, including COO Mike Snow and surgery division president Joe Clark, will leave HealthSouth to join the newly formed company. Like HealthSouth, it will be headquartered in Birmingham, Ala., with HealthSouth initially providing selected corporate support services.
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| Shoulder Surgery Safer Than Other Joint Procedures
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Shoulder arthroplasty results in fewer complications and shorter hospital stays when compared to corresponding procedures performed on the hip and knee, according to a study published in February's online version of the journal Clinical Orthopedics. Researchers at the Johns Hopkins Hospital reviewed 625 shoulder arthroplasties performed between 1994 and 2001, comparing the patient outcomes to 34,471 knee procedures and 15,414 hip surgeries performed during the same period.
Patients who had shoulders replaced reported fewer post-op complications (7.5 percent) than those having hip (15.5 percent) and knee (14.7 percent) replacement procedures, according to the study.
"After looking at how all these patients fared, we concluded that, comparatively, total shoulder surgery is just as safe and effective as other types of arthroplasties," says the study's lead author, Edward McFarland, MD, director of the hospital's division of adult orthopedics. Dr. McFarland notes that the average expense of shoulder arthroplasty ($10,351) is also less than that of hip and knee procedures ($15,442 and $14,674, respectively).
A review of Medicare figures shows 6,700 shoulder arthroplasties were performed in 2003, compared to 106,887 hip and 199,195 knee replacements. This study's findings appear to dispel the concerns of those who have traditionally avoided shoulder arthroplasty because of alleged high costs and elevated risks. "Lower numbers of shoulder procedures may indicate that many people live with shoulder pain because they fear that the corrective surgery is too risky or costs more than similar procedures," says Dr. McFarland. "But we have found that this is just not true."
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| Study Examines C. diff Prevention Methods
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Researchers are looking at ways to thwart the growing threat of C. difficile, and a new study in the March Journal of Antimicrobial Chemotherapy reports how you can encourage physicians to stick to narrow-spectrum antibiotics to more effectively combat the microbial infection.
C. diff — once the domain of the elderly and immunocompromised and largely a problem for ICU staff — is gaining new life as a threat to young, healthy patients and those having ambulatory surgery, generally in the form of community-acquired C.diff-associated disease. There's not yet been a report of a C. diff outbreak in an outpatient surgery department or facility, but the CDC has reported an increasing number of cases of associated diseases in healthy individuals with minimal or no exposure to a healthcare setting, which is where C. diff is usually contracted.
In the study, researchers at the Royal Free Hospital in London investigated the best way to encourage doctors to comply with the hospital's policy to switch from broad-spectrum to narrow-spectrum agents. They found that giving physicians pocket-sized, laminated cards listing the best antibiotic choices and soliciting feedback on their antibiotics use and C. diff infection rates led to a significant drop in prescriptions of broad-spectrum agents and an accompanying fall in infections. (Prescriptions for antibiotics not specified by the policy didn't change during the study period, suggesting that the feedback and laminated card had had the desired targeted effect, according to the study.)
A history of using common broad-spectrum antibiotics such as ampicillin and amoxicillin is a risk factor for contracting the condition, according to the Institute for Safe Medication Practices. Researchers say taking action is especially important as C. difficile infection rates are rising rapidly and a new, more virulent strain has recently been identified.
"National guidelines recommend narrow-spectrum antibiotic policies and suggest a variety of methods to ensure these are implemented, but feedback is not mentioned in national guidelines as a way of addressing prescribing behavior," says senior author Sheldon Stone, MD, FRCP. "This is the first controlled prospective study to use feedback to reinforce antibiotic policy and reduce CDI. The quality of research in infection control [in the future] must be robust enough to influence policy and practice in the fight against hospital acquired infection."
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| News and Notes
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Researchers are looking at ways to thwart the growing threat of C. difficile, and a new study in the March Journal of Antimicrobial Chemotherapy reports how you can encourage physicians to stick to narrow-spectrum antibiotics to more effectively combat the microbial infection.
C. diff — once the domain of the elderly and immunocompromised and largely a problem for ICU staff — is gaining new life as a threat to young, healthy patients and those having ambulatory surgery, generally in the form of community-acquired C.diff-associated disease. There's not yet been a report of a C. diff outbreak in an outpatient surgery department or facility, but the CDC has reported an increasing number of cases of associated diseases in healthy individuals with minimal or no exposure to a healthcare setting, which is where C. diff is usually contracted.
In the study, researchers at the Royal Free Hospital in London investigated the best way to encourage doctors to comply with the hospital's policy to switch from broad-spectrum to narrow-spectrum agents. They found that giving physicians pocket-sized, laminated cards listing the best antibiotic choices and soliciting feedback on their antibiotics use and C. diff infection rates led to a significant drop in prescriptions of broad-spectrum agents and an accompanying fall in infections. (Prescriptions for antibiotics not specified by the policy didn't change during the study period, suggesting that the feedback and laminated card had had the desired targeted effect, according to the study.)
A history of using common broad-spectrum antibiotics such as ampicillin and amoxicillin is a risk factor for contracting the condition, according to the Institute for Safe Medication Practices. Researchers say taking action is especially important as C. difficile infection rates are rising rapidly and a new, more virulent strain has recently been identified.
"National guidelines recommend narrow-spectrum antibiotic policies and suggest a variety of methods to ensure these are implemented, but feedback is not mentioned in national guidelines as a way of addressing prescribing behavior," says senior author Sheldon Stone, MD, FRCP. "This is the first controlled prospective study to use feedback to reinforce antibiotic policy and reduce CDI. The quality of research in infection control [in the future] must be robust enough to influence policy and practice in the fight against hospital acquired infection."
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