Question: When is merely agreeing to accept what an insurance company pays considered abuse? Answer: When you waive out-of-pocket costs to your patients, and then submit out-of-network claims to an insurer that pays you considerably more than it would a participating provider.

Audits released yesterday by New York's state comptroller say four of the state's largest ASCs did just that from January 2001 through December 2006, costing taxpayers $8 million and possibly committing insurance fraud.

Here's how the audits describe the abuse. When the four ASCs treated members of the state-run Empire Plan, a plan designed specifically for government employees, they would routinely waive out-of-pocket costs and then submit inflated out-of-network claims to the plan, inappropriately billing United HealthCare, the state's insurance administrator, for the higher reimbursement rates. The patients who were treated at these facilities all saw physicians who participated in the Empire Plan and also worked at these various surgical facilities, says the comptroller's office. However, none of these facilities were participating providers in the plan, it adds.

State Comptroller Thomas DiNapoli identified the providers as:

It's official. The first day of 2008 will mark the beginning of the new Ambulatory Surgery Center Association now that members of AAASC and FASA have independently approved the proposed merger of the two groups.

"The new ASC Association will provide a unified voice for ASCs and enhance the value of all the benefits and services that both AAASC and FASA currently offer their members," says FASA president Kathy Bryant, who will become the ASC Association's chief executive officer after the merger. "While both AAASC and FASA were legally required to obtain the approval of their members for the merger to occur, we were pleased to find that approval of the merger was nearly unanimous and the members of both associations are clearly looking forward to the advantages the new ASC Association will offer them."

The ASC Association's board of directors will be comprised of 10 current FASA board members and five board members from AAASC. Two additional members without current FASA or AAASC affiliations will be chosen from at-large nominations.

Here's a rundown of the ASC Association's new board leadership:

Computerized patient tracking systems don't always communicate as well as the traditional whiteboard, according to a study presented at the annual meeting of the Human Factors and Ergonomics Society in October.

Although each system presents information in a similar format, with rows and columns of patient information, users found that computerized tracking systems had less flexibility and communicated information less effectively than the messy dry-eraser whiteboards did. "The way it looked had a visual cue," says Ann Bisantz, PhD, associate professor of industrial systems engineering at the University of Buffalo.

Dr. Bisantz was one of several researchers who studied how whiteboards and patient tracking systems worked in the emergency departments of two university-related hospitals that had switched to the computerized system. Walking into a room, a staffer or physician could immediately assess the sense of urgency in the department based on the notes scribbled on the whiteboard. With the computerized system, this was less obvious, write the researchers in their study.

Because staffers have to write on a whiteboard, rather than find a more isolated computer terminal, the whiteboard also serves as a meeting place where information is exchanged verbally. "The whiteboard was the one place people would be all the time," says Dr. Bisantz, who plans to continue studying patient tracking systems in order to help the designers of computerized versions. "They need to take seriously how the old system worked."

Obese patients who are recovering from gastric bypass surgery may be too big for common diagnostic equipment. According to a study presented at the annual meeting of the Radiological Society of North America last month, patients who weigh 450 pounds or more are simply too large for CT scans or other imaging devices commonly used to check for post-surgical complications.

Reviewing eight years of patients' electronic health records at Massachusetts General Hospital in Boston, researchers found that 12 percent of the patients who weighed more than 450 pounds needed post-surgical imaging due to clinical conditions, but were above the weight restriction for the equipment. Four of these patients needed additional surgery for suspected bypass leaks. Two patients with suspected blood clots in their lungs could not undergo a chest CT scan. For two others, who presented with non-specific abdominal pain, one was evaluated with an ultrasound and the other had a barium swallow test.

"In these cases, physicians must resort to other means of diagnosis such as exploratory surgery or using less accurate or more invasive techniques," says Raul N. Uppot, MD, an assistant radiologist at MGH and instructor of radiology at Harvard Medical School. "Patient care may be ultimately affected due to a compromised diagnosis."