The Medicare Payment Advisory Commission has recommended that Congress raise payments for ambulatory surgery center services by 0.6 percent in 2010 and is also calling for ASCs to submit cost and quality data "that will allow for an effective evaluation of the adequacy of ASC payment rates."

"If you only examine changes that have occurred to ASC payment rates, you could come away with a very bleak picture of their payment adequacy," says MedPAC's Dan Zabinski, PhD, in a transcript of the independent congressional agency's Jan. 8 public meeting.

But "if you only examine the empirical trends on the growth in the number of Medicare-certified ASCs, the volume of services provided to Medicare beneficiaries in ASCs and Medicare spending on ASCs, you could come away with a very favorable view of" their payment adequacy, he said.

Dr. Zabinski says MedPAC based the 0.6 percent figure on "the difference between the most recent published estimates of input price increases, which is measured by the CPI-U, as required by law, and the Commission's productivity goal."

The ASC Association's John McManus followed up Dr. Zabinski's remarks with a comment that he was "heartened to hear the Commission recognize that the CPI is not an adequate index," and a recommendation that MedPAC consider "using the market basket of HOPD, since that's a better reflection of ASC costs."

Irene Tsikitas

Researchers at Harvard University and eight hospitals around the world report that using a single-page checklist designed to increase communication reduced the incidence of post-surgical deaths and complications by more than one third.

The checklist requires that the surgical team stop and orally confirm a total of 19 items on the checklist before anesthesia is administered, before the incision is made and before the patient leaves the OR.

Researchers reported the results of the study, which involved 7,688 patients in the U.S., Canada, Great Britain, New Zealand, Jordan, India, Tanzania and the Philippines, online at the New England Journal of Medicine on Jan. 14. Information from 3,733 surgeries performed without a checklist and from 3,955 surgeries performed with one was collected from one hospital in each country.

The rate of deaths occurring within 30 days of non-cardiac surgery was 1.5 percent without the checklist and 0.8 percent with the checklist. For complications within 30 days, the rate was 11 percent without the checklist and 7 percent with one.

"I cannot recall a clinical care innovation in the past 30 years that has shown results of the magnitude demonstrated by the surgical checklist," says Donald M. Berwick, president and chief executive of the Institute for Healthcare Improvement, in a statement. The organization is encouraging hospitals to begin using the checklist.

Kent Steinriede

Texas nurses might soon have more control over setting patient care protocols thanks to proposed state legislation calling for hospitals to establish nursing committees and, more importantly, to listen to what the committees have to say.

HB 591 and SB 476 would create a legal framework for implementing and enforcing a statewide nursing policy that empowers nurses to have more of a say in how patients are cared for in hospitals.

Specifically, the bills - which have the backing of the Texas Nurses Association and the Texas Hospital Association - would require hospitals to create and maintain nurse staffing committees. The committees' memberships must be at least 50 percent registered nurses involved in direct patient care, and those members should be selected by their peers rather than appointed.

The committees would be charged with evaluating the effectiveness of their hospitals' patient care regimens by analyzing patient outcomes, relating those outcomes to staffing levels and reporting their findings to the Texas Department of State Health Services.

The proposed bills would also prohibit mandatory overtime and extend the protections enjoyed by nurses in private hospitals to those in public facilities, in particular allowing them to voice concerns or opinions on patient care without fear of retribution from their superiors.

"[The Texas Nurses Association] knows that when direct care nurses are allowed to use their own professional judgment regarding the level of care their patients need, taking into account the variables that can impact care, then each patient benefits," says Susan Sportsman, president of the Texas Nurses Association, adding that nurses are in the best position to improve direct care for their patients at their hospitals.

Daniel Cook

If you're like most of the readers who answered last week's online poll, you've put plans to buy that new, big-ticket capital expenditure on hold - at least for now. When we asked if the economy had led you to postpone a capital equipment purchase, 69 percent of the 35 readers who responded said yes.

This week's poll question asks whether your surveyor was too picky or not picky enough during your last accreditation survey. Go to our front page to participate in the poll and view real-time results.

Dan O'Connor