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| All You Need to Know About the New ASC Payment System
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If you only read one article about Medicare's revised ASC payment system, we suggest you make it "Dissecting the Revised ASC Payment System" from Outpatient Surgery Magazine's August issue. This executive summary offers a to-the-point analysis by three Washington insiders, covering the 10 key elements of the sweeping reimbursement changes that take effect in January, when Medicare will pay ASCs in virtually the same method - though not at the same amounts - that it pays hospital outpatient departments. Find out why Medicare will pay an ASC $1,005 for a complex cataract procedure (CPT code 66982) while hospitals will earn $1,542 for the same procedure.
— Dan O'Connor
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| A New Way to Test Prosthetic Joint Infections
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Mayo Clinic researchers have developed a test for sampling bacteria that adheres to prosthetic hip and knee joints, which they say is more accurate than the traditional method of testing tissue samples taken from around the joints during surgery.
The new test, outlined in the Aug. 16 issue of The New England Journal of Medicine, calls for surgeons to place removed joints in a special container for transportation to a lab. There, clinicians add a patented solution to the container, shake it and expose it to ultrasound, a combination treatment that removes biofilm from the joint. The removed bacteria are collected in the solution, which is then quantitatively cultured.
The researchers believe this direct test of the biofilms that adhere to the prosthesis surface will improve the diagnosis of prosthetic joint infection. Their clinical data appear to back that belief. In their study, the researchers tested 331 patients having prosthetic hip or knee joints removed for infection or another cause. Clinicians used the new testing method to detect infected joints in 78.5 percent of the patients, as compared to the 60.8 percent discovered with the conventional tissue sample method.
"The problem with the conventional method is that you need multiple tissue specimens, because the sensitivity of a single specimen is not good - in other words, the infection might be missed with just one sample," says Robin Patel, MD, professor of medicine at the Mayo Clinic in Rochester, Minn., and leader of the research team.
Dr. Patel explains that patients with prosthetic joint infections experience pain but not the fevers or leaking wounds that typically indicate surgical infections. "The bacteria that cause infection on prosthetic joints are the same as bacteria that live harmlessly on our skin," she adds, "(but) on a prosthetic joint they can stick, grow and cause problems over the long term."
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| A Safer Surgical Glue?
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As a surgical adhesive for stopping moderate bleeding, bovine plasma-derived thrombin may be the current standard, but it's not unknown for patients to develop antibodies to the therapy, leading to more bleeding and thrombic complications. But surgeons may soon have a new option that offers the same benefit without these potential problems.
A new recombinant thrombin derived from humans proved as effective as the current bovine thrombin in a randomized, double-blind comparative trial involving 401 patients that was published in the August issue of the Journal of the American College of Surgeons.
The researchers also found that while 43 patients in the bovine thrombin group (21.5 percent) developed antibodies to their treatment, only three patients (1.5 percent) in the human group did so. Otherwise, the two agents' safety profiles proved similar, say researchers.
"The results from this phase III trial show that we can stop bleeding in 95 percent of patients within 10 minutes and do so without introducing foreign proteins that can carry greater risk of development of antibodies," says William C. Chapman, MD, professor of surgery at Washington University in St. Louis and the study's lead author. "I'm most encouraged by the increasing evidence that recombinant technology is safe and effective because it means that we may be able to avoid using blood or blood products from other people or animals and automatically diminish the risk of infection and the associated immunologic responses that have been noted in the past."
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| News and Notes
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As a surgical adhesive for stopping moderate bleeding, bovine plasma-derived thrombin may be the current standard, but it's not unknown for patients to develop antibodies to the therapy, leading to more bleeding and thrombic complications. But surgeons may soon have a new option that offers the same benefit without these potential problems.
A new recombinant thrombin derived from humans proved as effective as the current bovine thrombin in a randomized, double-blind comparative trial involving 401 patients that was published in the August issue of the Journal of the American College of Surgeons.
The researchers also found that while 43 patients in the bovine thrombin group (21.5 percent) developed antibodies to their treatment, only three patients (1.5 percent) in the human group did so. Otherwise, the two agents' safety profiles proved similar, say researchers.
"The results from this phase III trial show that we can stop bleeding in 95 percent of patients within 10 minutes and do so without introducing foreign proteins that can carry greater risk of development of antibodies," says William C. Chapman, MD, professor of surgery at Washington University in St. Louis and the study's lead author. "I'm most encouraged by the increasing evidence that recombinant technology is safe and effective because it means that we may be able to avoid using blood or blood products from other people or animals and automatically diminish the risk of infection and the associated immunologic responses that have been noted in the past."
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