The Centers for Medicare and Medicaid Services' final rule on ASC payment for 2009 includes 27 procedures not previously covered for ambulatory surgery.

Among the additions are endothelial corneal transplants (CPT 65756; $1,532); tongue base volume reduction (CPT 41530; $695.85) and injections for common digital blocks (CPT 64632; $34.26).

The final rule, issued on Oct. 30, takes effect on Jan. 1. Calendar year 2009 is the second year of the four-year transition period to bring Medicare reimbursement for ASCs in line with the hospital-based Outpatient Prospective Payment System.

Kent Steinriede

Patients are more likely to undergo endoscopy screenings if they receive propofol sedation monitored by an anesthesiologist, as opposed to intravenous conscious sedation administered by a nurse, according to research presented by Steven M. Frank, MD, at the American Society of Anesthesiologists' annual meeting last month.

About one-half of all eligible candidates never undergo screening endoscopies because of concerns over possible pain and discomfort, according to Dr. Frank, an anesthesiologist at the Greater Baltimore (Md.) Medical Center. His research team polled 155 patients who underwent upper or lower GI endoscopy procedures at the facility in 2003 and again in 2007, surveying them on their experiences with IV midazolam and fentanyl delivered by endoscopy nurses and propofol sedation administered by anesthesiologists.

The researchers discovered a seven-to-one patient preference for propofol's deeper sedation and rapid clearance. They also determined that four times as many patients said they would be more likely to undergo endoscopy screening if they were unconscious and under the care of an anesthesiologist.

"Given that anxiety, pain, and discomfort are major deterrents to colorectal cancer screening, our findings suggest that the routine use of propofol anesthesia may improve cancer screening rates, disease detection, and reduce mortality from the second leading cause of cancer death in the United States," says Dr. Frank, adding that while most patients did not feel pain with either sedation method, they reported feeling safer under the care of an anesthesia-trained provider.

Daniel Cook

If a patient believes that an outsourced anesthesia provider is a hospital employee, is the hospital liable for the contract provider's mistakes? In New Jersey, yes. Last month, a state appeals court overturned a lower court's ruling in which a hospital was dismissed from a wrongful death suit against a contract anesthesiologist.

The ruling may open the door for more malpractice liability exposure for healthcare facilities that outsource anesthesia and other clinical services. To avoid exposure, the contractor must identify himself to the patient as a contractor who doesn't work for the facility.

"When a hospital provides ... a medical specialist for a patient without taking action to dispel the appearance of authority implied by the specialist's position and action, courts generally treat the hospital's inaction as additional conduct manifesting the hospital's assent to having the specialist care for the patient it its behalf," wrote Appellate Division Judge Jane Grall in the majority opinion. If the contract physician does not identify herself, the hospital has in effect granted "apparent authority" to the contractor, according to the appellate court.

The appeals court judgment stems from a 2003 incident in which a contracted anesthesia provider from the Hudson Anesthesia Group inserted a catheter into a diabetic patient at Christ Hospital in Jersey City. After insertion, the patient's heart rate and blood pressure dropped. The anesthesiologist, Selvia Zaklama, MD, was unable to stabilize the patient, according to an article in the New Jersey Law Journal. The patient never regained consciousness and suffered brain damage. After more than three years in a vegetative state, the patient died. The family sued on wrongful death grounds and settled with the physician and anesthesia group for $975,000. The appellate ruling reinstates the family's previously dismissed claim against Christ Hospital.

Kent Steinriede