Healthcare collection professionals and medical organizations have joined forces to create the Accredited Healthcare Business Association, an accreditation program for the companies that collect unpaid medical bills. Their goal is to help healthcare institutions find compassionate collection agencies with experience in the growing medical accounts receivable sector, which frowns on the strong-arm tactics of the credit card and banking industries.

In order to join the association, a collection agency must have at least five years' experience in healthcare collections and generate at least 80 percent of its business from healthcare. Accredited members must agree not to resell their debt or subcontract with offshore collection firms, according to an article in insideARM, an electronic newsletter for the collections industry.

"The need for a barometer to gauge the integrity of healthcare collectors' business processes is the elephant in the corner for hospital A/R executives," says Michael Klozotsky, an analyst at Kaulkin Ginsberg Co. and a member of the association's advisory board, in his blog.

To become accredited, firms will also have to show proof that their employees are certified in healthcare bill collection and that the company has liability insurance to protect clients, who are subject to HIPAA and the Fair Debt Collections Practices Act. The association plans to begin accreditation site visits in September.

Kent Steinriede

The negative impact of preventable medical errors goes well beyond patient harm and ruined reputations in the OR. According to data released by the Department of Health & Human Services' Agency for Healthcare Research and Quality, avoidable mistakes cost employers close to $1.5 billion a year in excess insurance payments.

Research published in the online edition of the journal Health Services Research last month shows healthcare insurers paid $19,480 more for patients who experienced post-op infections compared to patients who did not.

Additionally, the AHRQ discovered that nursing care oversights that led to pressure ulcers and hip fractures cost insurers $12,196 in excess payments; metabolic errors resulted in added expenditures of $11,797; vascular or pulmonary complications cost $7,838 extra; and wound-opening errors increased payments by $7,838.

The study, which was based on a review of 161,000 patients between 18 and 64 years of age with employer-based health insurance who underwent surgery between 2001 and 2002, also revealed that 10 percent of deaths occurring within 90 days of surgery were caused by preventable errors, with one-third of those deaths occurring after initial discharge.

"Like the physical and emotional harm caused by medical errors, the financial consequences don't stop at the hospital door," said AHRQ director Carolyn M. Clancy, MD, in a statement. "Eliminating medical errors and their aftereffects must continue to be top priority for our healthcare system."

Daniel Cook

In the future, physicians may be able to treat patients' obesity and remove their gallbladders without taking a single scalpel to their skin, if two recent procedures are any guide.

Surgeons at Washington University School of Medicine in St. Louis have performed a successful trial of the TOGA ( for "transoral gastroplasty") system. According to the university, this non-surgical procedure uses a flexible stapling device to create a restrictive pouch in the patient's stomach. The surgery team made no external incisions, but rather inserted all the instruments (including endoscopic cameras) through the patient's mouth and esophagus.

"If this technique provides results close to those achieved with more traditional surgery, it may be an option for people who need to lose a great deal of weight but don't want to have surgery," says J. Christopher Eagon, MD, assistant professor of surgery and investigator for the study.

This spring, physicians at New York-Presbyterian Hospital/Columbia University Medical Center removed a patient's gallbladder through her uterus with external incisions to aid visibility. Last month they performed the same procedure without a single external wound.

The physicians made a one-inch incision behind the patient's uterus and removed her gall bladder through this opening. A release from the university says this natural orifice procedure took approximately three hours to complete.

"Internal incisions, such as in the uterus, are less painful and may allow for quicker recovery than incisions in the abdominal wall," says Marc Bessler, MD, director of the New York-Presbyterian Center for Obesity Surgery and the center's director of laparoscopic surgery.

Nathan Hall