Physicians who have strong relationships with physician-owned ASCs send nearly half of their Medicaid patients to hospital outpatient departments for surgery instead of to ASCs, according to a study published online by the journal Health Affairs last week.

With ASCs accommodating the higher-paying, commercial payor cases, hospitals are as a result missing out on the profitable cases that would help to subsidize the cost of treating Medicaid and uninsured patients, said Jon Gabel, a senior fellow at the University of Chicago's National Opinion Research Center and one of the authors of the study, which was funded in part by the Blue Cross and Blue Shield Association.

Mr. Gabel and his colleagues reviewed more than a million discharge abstracts from hospitals and ASCs in the Philadelphia and Pittsburgh metropolitan areas. They studied Pennsylvania because of its many physician-owned ASCs and a state law requiring ASCs and hospital outpatient departments to complete detailed discharge abstracts.

They found that 11 percent of the state's population is covered by Medicaid, but that only 3 percent of the cases handled by physician-owned ASCs in the metropolitan areas involved Medicaid patients.

While the researchers weren't able to definitively determine whether referring physicians had financial interests in ASCs where they sent their patients, they noted that physicians among the top 50 percent of referrers to a physician-owned ASC were likely investors. These physicians were found to have sent 92 percent of their private-payor patients to physician-owned ASCs and only 55 percent of their Medicaid patients there.

Conversely, physicians who sent most of their patients to hospital outpatient departments did so regardless of the patients' payors, sending 96 percent of privately insured and 98 percent of Medicaid patients there.

Mr. Gabel suggests that universal healthcare coverage - or amending Medicaid reimbursement rates to better reflect the costs of procedures - could resolve the issue.

Kent Steinriede

Seven Nevada ASCs were cited for "major infection control problems," such as reused syringes or single-use vials, during recent inspections by the state's Department of Health and Human Services.

Two facilities exhibited "medium-level" violations, such as sterilization concerns, and 17 others showed minor violations, such as insufficient documentation. The remaining 22 facilities inspected were free of infection control issues. (One ASC closed for renovation and another that had lost its business license went uninspected.)

The department's inspection of the state's 50 ASCs follows a hepatitis C outbreak in which six patients contracted the disease after undergoing procedures at the same Las Vegas endoscopy clinic. The outbreak is believed to have spread as the result of staff members' reuse of syringes or anesthesia vials. According to news reports, the violations were corrected during the inspections.

One of the facilities cited for major violations, the Desert Shadow Endoscopy Center in Las Vegas, was also linked to a seventh case of hepatitis C. The Las Vegas Review-Journal reports that this clinic is owned in part by Dipak Desai, MD, the majority owner of the Endoscopy Center of Southern Nevada, where the hepatitis outbreak allegedly originated.

In a statement issued on March 10, Dr. Desai said he shares the community's sorrow and concerns about the situation, but added that he will not answer any questions on the advice of his legal counsel. "These unfounded allegations will be addressed in a court of law, when facts have been presented and substantiated," he says.

Nathan Hall

Stainless steel walls in a surgical suite? The idea, popular in European hospitals for 20 years, is coming to Spartanburg Regional Medical Center in Spartanburg, S.C., which will become the first hospital in North America to have stainless steel walls installed in its ORs.

The walls are expected to promote a more sterile environment and make reconfiguring rooms easier, according to a published report.

The article notes that changes in technology sometimes make it necessary to take down walls to expand rooms. It takes two or three weeks to take down a traditional OR wall made from sheetrock, and nearby rooms often can't be used because of dust and other debris, says the hospital's facilities manager. Stainless steel walls can be dismantled and remounted within a couple of days as nearby rooms remain in use.

The wall installation is part of a $26 million surgical suite construction project scheduled for completion in August.

Dan O'Connor