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| CMS Proposes Elimination of "Under Arrangements" Joint Ventures
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Proposed changes to the federal Stark regulations would eliminate hospital-physician "under arrangements" joint ventures, those oft-criticized models in which a hospital pays an ASC a per-procedure fee for the facility component of ambulatory surgery and then bills payors under its own provider and tax identification number. Payors reimburse hospitals about 40 percent more per surgical case than ASCs, so the joint venture and its investors get richer quicker. The proposed changes appear on page 38186 of the July 12 issue of the Federal Register.
CMS says "there appears to be no legitimate reason" for certain hospital-physician joint ventures "other than to allow referring physicians an opportunity to make money on referrals for separately payable services" that "were previously furnished directly by the hospitals, and in most cases, could continue to be furnished directly by the hospitals."
To undermine "under arrangements," CMS proposes to change the definition of entities that are prohibited from receiving referrals from physician-owners to include not just the hospital that bills Medicare for the services provided under arrangement but also the entity that performs the services under arrangement to the hospital.
In previous Stark rulemakings, CMS expressed concern that these joint ventures could be abused, but declined to prohibit them. CMS has viewed under arrangements between hospitals and physician-owned entities as "compensation and not ownership relationships," and therefore permissible so long as "an appropriate compensation exception" could be met, which many under arrangements are structured to do, says Mark Manigan, a healthcare lawyer at WolfBlock Brach Eichler in Roseland, N.J.
"The proposed changes, however, appear to collapse the physician-owned entity into the hospital outpatient department such that any referral to the hospital outpatient department would be an impermissible self-referral under Stark," says Mr. Manigan.
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| Ambulatory Abdominoplasty Deemed Safe and Effective
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Surgical facilities that have ventured into hosting abdominoplasties as outpatient cases can continue to do so with renewed confidence in the procedure's efficacy and safety, thanks to a study appearing in the May/June 2007 issue of the Aesthetic Surgery Journal, the official publication of the American Society for Aesthetic Plastic Surgery.
Researchers reviewed 519 cases performed over a 10-year span at a single outpatient facility. They discovered that the most common complication was seroma (found in 10.6 percent of cases), followed by unacceptable scarring of the abdominal or umbilical incisions (7.9 percent). Those complication rates compare favorably to published reports of the results of abdominoplasties performed as inpatient procedures, according to the ASAPS.
"Even though these procedures are commonly performed on an outpatient basis, we had few large, published studies to support outpatient abdominoplasty as a safe and effective operation," says the lead author of the study, W. Grant Stevens, MD, in a statement. "This large, long-term study clearly illustrates that these procedures may be safely performed in an accredited outpatient facility."
Despite the promising data, the researchers warn that the tummy tuck's success in the outpatient setting requires proper follow-up care for patients who must ambulate on the day of surgery and remain adequately hydrated immediately following the procedure.
"Embolism precautions must be taken, and patients with a higher risk for medical complications may still need to be treated as inpatients," says Dr. Stevens.
Abdominoplasty is one of the top five cosmetic surgery procedures performed in the U.S., says the ASAPS. In 2006, about 172,500 American tummies were tucked, according to the society, a significant increase from the 34,000 procedures done in 1997.
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| Study: Electronic Records Do Not Improve Outpatient Care
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Although electronic medical records have been touted as a way to make healthcare more efficient, a study in the July issue of the journal Archives of Internal Medicine found that using them makes no significant difference in the quality of outpatient health care.
For the study, researchers from Stanford University School of Medicine analyzed data from the 2003 and 2004 National Ambulatory Medical Care Survey. They examined 17 indicators of quality care, including the prescription of recommended antibiotics, avoiding the prescription of potentially inappropriate drugs for elderly patients, diet and exercise counseling for high-risk adults and screening tests.
The researchers found that, for 14 of these measures, there was no difference in results whether the facility did or didn't use electronic records in tracking. Physicians who used electronic record systems did better than those using conventional records in not prescribing benzodiazepine tranquilizers to depressed patients and also in avoiding routine urinalysis during general medical exams. But physicians using paper records still did better when it came to prescribing statins to patients with high cholesterol.
The study's senior author, Randall Stafford, MD, PhD, associate professor of medicine at the Stanford Prevention Research Center, said he and his colleagues expected to find better quality from doctors with electronic records than the overall mediocre performance of physicians in the quality indicators they selected. He says the study doesn't discount the value of electronic records but rather points out that the entire healthcare system needs to improve the quality of care given during patient visits.
"It's not sufficient to have an electronic health record system that provides readily available patient data and decision-making guidance," says Dr. Stafford. "Physicians have to be receptive to that input and willing to act."
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| News and Notes
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Although electronic medical records have been touted as a way to make healthcare more efficient, a study in the July issue of the journal Archives of Internal Medicine found that using them makes no significant difference in the quality of outpatient health care.
For the study, researchers from Stanford University School of Medicine analyzed data from the 2003 and 2004 National Ambulatory Medical Care Survey. They examined 17 indicators of quality care, including the prescription of recommended antibiotics, avoiding the prescription of potentially inappropriate drugs for elderly patients, diet and exercise counseling for high-risk adults and screening tests.
The researchers found that, for 14 of these measures, there was no difference in results whether the facility did or didn't use electronic records in tracking. Physicians who used electronic record systems did better than those using conventional records in not prescribing benzodiazepine tranquilizers to depressed patients and also in avoiding routine urinalysis during general medical exams. But physicians using paper records still did better when it came to prescribing statins to patients with high cholesterol.
The study's senior author, Randall Stafford, MD, PhD, associate professor of medicine at the Stanford Prevention Research Center, said he and his colleagues expected to find better quality from doctors with electronic records than the overall mediocre performance of physicians in the quality indicators they selected. He says the study doesn't discount the value of electronic records but rather points out that the entire healthcare system needs to improve the quality of care given during patient visits.
"It's not sufficient to have an electronic health record system that provides readily available patient data and decision-making guidance," says Dr. Stafford. "Physicians have to be receptive to that input and willing to act."
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