There's been a lot of arguing about how significant of a competitor freestanding ASCs are to hospitals, but a study published in the summer 2007 edition of Inquiry, a quarterly journal published by Rochester, N.Y.-based Excellus Blue Cross Blue Shield, suggests that the big buildings may have valid cause to fear that the smaller facilities are stealing their outpatient business.

Researchers used data from the 2002 Medicare Online Survey Certification and Reporting Systems and the American Hospital Association's annual survey of hospitals to find out how much of an impact ASCs had in 317 metropolitan areas. They found that each ASC per 100,000 people seemed to lead to a 4.3 percent reduction in hospital outpatient surgical volume.

"This study suggests that ASCs are meaningful competitors to hospitals," write the study's authors, John Bian, PhD, a health scientist at the Atlanta Veterans Medical Center, and Michael Morrisey, PhD, a professor at the University of Alabama at Birmingham. "Markets with more ASCs per unit population had fewer hospital outpatient surgeries."

The number of ASCs established during the time period that framed the study skyrocketed. Between 1993 and 2001 the number of ASCs per 100,000 persons in metropolitan areas increased by 150 percent.

"ASCs appear to be significant players in the ambulatory surgery market," the authors write. "Much more effort needs to be expended on obtaining data on ASCs and on understanding ASCs' effects on prices and quality of medical care."

The researchers also found that the ASCs' presence had essentially no impact on the hospital's inpatient case volume. However, other hospitals in the metropolitan area slightly decreased the numbers for both outpatient and inpatient surgeries.

Removing most, but not all, tonsil tissue during a tonsillectomy results in less post-op bleeding and pain as compared to the complete removal of a traditional tonsillectomy, according to a study published in the September issue of the journal Archives of Otolaryngology - Head & Neck Surgery. The newer procedure, called the intracapsular technique, shaves approximately 90 percent of the tonsil tissue, leaving a thin layer to cover the throat muscles.

Researchers examined the medical records of 1,212 patients who underwent traditional tonsillectomies and compared their post-op results with 1,731 intracapsular cases. They discovered that the intracapsular technique resulted in less post-op bleeding and pain - two common complications of the traditional technique.

However, Shish Sheth, MD, an ENT surgeon from Rhinelander, Wisc., is skeptical. "Tonsillectomy is commonly performed for two reasons - recurrent infections or because [the tonsils] are large enough to cause obstructive symptoms like snoring or sleep apnea," he says. "If the tonsils are removed for recurrent infections, it would be bad medicine to leave any tonsil tissue behind. If the tonsils are removed because of their size, you can consider doing intracapsular tonsillectomy, but patients need to be warned of the risks of tonsil regrowth leading to persistent symptoms."

Dr. Sheth says he believes the intracapsular technique may be the latest tonsillectomy fad, like the laser and cold ablation techniques before it, that promises to remove tonsils while minimizing pain and the risk of post-op hemorrhaging. "They're abandoned due to various increased risks with no actual benefit," he says. "At this point I would not alter my current practice based on this study."

Certified coders earn an average of 17 percent more than their non-certified counterparts, according to a survey of more than 5,100 coding professionals conducted by the American Academy of Professional Coders.

On average, the survey reports, non-certified coders earn $25,000 to $30,000 annually, certified coders earn $30,000 to $35,000 and specialty-certified coders earn $35,000 to $40,000. Other findings: