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| Trends in the ASC Sector |
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Highlights from Deutsche Bank's second annual ambulatory surgery center survey, based on responses from more than 200 ASCs spanning 44 states:
Respondents expect case volume growth of about 3 percent in 2008, down from the 5 percent growth they forecasted in last year's survey.
Respondents expect revenue per case growth of about 2 percent in 2008.
Forty-five percent of respondents expect more competition to enter their local markets in 2008. However, assuming that the average ASC has 20 to 25 active surgeons, Deutsche Bank analysts argue that the supply of available surgeons currently not affiliated with an ASC could limit de novo development.
When asked about the pricing impact that the new Medicare ASC payment system would have in 2008, 35 percent expected it to be positive, 35 percent expected it to be neutral and 30 percent expected it to be negative.
The average number of ORs and procedure rooms per facility was 3.9. Chain-affiliated ASCs had an average of 4.3 ORs and procedure rooms versus 3.8 for the non-chains.
The average facility performs 360 surgical procedures monthly, which equates to about 4,200 annual procedures.
The average ASC partnership had 15.1 physician-partners and 24 total physician-users, a slight decrease from last year's 16.5 physician-partners and 28.2 credentialed physician-users.
Dan O'Connor |
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| Talking to Colonoscopy Patients May Ensure Follow-ups |
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Although many initiatives aim to increase patient awareness of the need for colon cancer screening, just a few words from a physician may be more effective than most efforts.
According to a study published in the online edition of the journal Cancer, having physicians raise the issue with patients can almost triple patients' compliance with undergoing future fecal occult blood tests, sigmoidoscopies or colonoscopies at the right intervals.
Researchers at UCLA's Jonsson Comprehensive Cancer Center surveyed 498 individuals aged 50 years or older in 2000 and 482 individuals of the same age group in 2003. They found that in 2000 only 38 percent reported having received any test. By 2003, however, 50 percent reported that they had.
The survey participants who discussed colorectal cancer screening with their physicians had significantly increased odds of undergoing screening (the odds ratios were 2.86 for any test, 2.33 for endoscopy and 2.09 for fecal occult blood test). Those who reported concerns about the screening - such as concerns over the cost or that cancer might be discovered - were less likely to seek screening (the odds ratios were 0.76 for fecal occult blood test, 0.74 for endoscopy and 0.66 for any screening test).
The study's authors suggest that this situation might be remedied through educational efforts that focus not only on patients, but on the physicians as well. They also note that the provider and healthcare system should include discussions and recommendations about preventing colon cancer during the screening visit.
Nathan Hall |
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| Donors' Deaths May Influence Corneal Transplant Outcomes |
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Patients undergoing corneal transplants with eye tissue from donors who died in a hospital or with cancer run a higher risk of contracting post-operative endophthalmitis, according to a study published in the February issue of the Archives of Ophthalmology.
Infection-related endophthalmitis is an uncommon but serious complication of penetrating keratoplasty, causing blindness or loss of vision in most cases. According to the study, the odds of a corneal transplant patient with endophthalmitis having received a tissue from a donor who died in a hospital were three times that of other transplant patients.
"Being in a hospital increases opportunity for infection," explains Kirk R. Wilhelmus, MD, PhD, a professor of ophthalmology at Baylor University College of Medicine in Houston. "The [donor's] infection most likely originated around the time of dying."
Most of the tissue in eye banks comes from donors who died in a hospital. About 19 percent comes from donors who died with cancer. The study found that endophthalmitis was more common in patients who received tissue donated by cancer patients or transplanted more than five days after donation.
Dr. Wilhelmus and colleagues studied the results of transplants that occurred between 1994 and 2003, when eye banks distributed more than 440,000 corneas for transplants in the United States and abroad. They investigated 162 cases of endophthalmitis voluntarily reported to an adverse event surveillance registry created by the Eye Bank Association of America.
At present, there are two main differences in the process of corneal transplantation as compared to the period that the researchers studied, says Dr. Wilhelmus. First, more than one media is now available for the preservation of collected corneas, perhaps offering different anti-bacterial capabilities. Previously only one, Optisol-GS, was used. Second, about 25 percent of current corneal transplants are performed through a newer procedure, corneal endothelial keratoplasty, which requires less transplanted material.
Kent Steinriede |
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| News and Notes |
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MOST CHILDREN SUFFERING FROM OBSTRUCTIVE SLEEP APNEA benefit from tonsillectomy and adenoidectomy, says Ron Mitchell, MD, professor of pediatric otolaryngology at Saint Louis University. In a study published in the October 2007 issue of the journal Laryngoscope, Dr. Mitchell reports that all 79 patients he studied showed significant improvement in OSA symptoms after surgery. However, only those with mild sleep apnea, marked by five to nine interrupted breathing incidents per night, experienced post-op resolution of the condition. Eighty-eight percent of children with moderate OSA (10 to 19 incidents per night) experienced resolution while 64 percent of those suffering severe OSA (20 sleep interruptions or more per night) had the condition resolved post-op. Dr. Mitchell defined resolution of OSA as experiencing less than five interrupted breathing incidents per night. He says approximately 2 to 4 percent of children 4 to 6 years old have OSA, although he suspects the number is actually higher because of unrecognized and undiagnosed cases.
SOME NEUROLOGY PATIENTS ARE AT HIGH RISK FOR ACCIDENTAL FALLS, warns the American Academy of Neurology. The authors of the guideline, published in the Feb. 5, 2008 issue of the AAN's official journal, Neurology, discovered that the presence of specific neurologic deficits can predict falls, including gait and balance disorders; deficits of lower extremity strength, sensation, and coordination; and cognitive impairments. Those who have fallen in the past year are also at increased risk for falling again, the authors note. David J. Thurman, MD, MPH, a member of the American Academy of Neurology, says identifying those at high risk of falling is a critical step in preventing future falls and suggests that physicians routinely use screening methods to determine if a person would benefit from appropriate fall interventions based on evidence-based guidelines.
BOTOX, BOTOX COSMETIC (Botulinum toxin Type A) and Myobloc (Botulinum toxin Type B) have caused respiratory failure and even death among some of the patients who have received it, reports the U.S. Food and Drug Administration in a communication stemming from an ongoing safety data review of the product's clinical studies and its post-marketing adverse event reports. While the FDA says that such adverse events do not indicate a defective product and that it is not advising a halt on the use of the product, the agency notes that overdosing may cause the toxin to move far from the injection site and give patients symptoms of botulism. |
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