The Centers for Medicare and Medicaid Services won't pay for virtual colonoscopies after determining that "the evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test," the agency announced last week.

CMS is taking public comments on the proposed coverage decision before making a final ruling, but a former Medicare official says he expects the decision to stand.

A government assessment of the cost-effectiveness of virtual colonoscopy as a screen for colon cancer concluded that it "does provide a benefit in terms of life-years gained compared with no screening but the cost, relative to the benefit derived and to the availability and costs of other CRC tests (such as colonoscopy without polypectomy at $500), would need to be in range of $108 to $205 to be a non-dominated strategy." Virtual colonoscopies currently cost about $488, according to a published report.

CMS' own analysis recognizes several studies showing virtual colonoscopy to be an effective alternative to other, more invasive types of colon cancer screenings. But, the agency concludes, "while it is a promising technology, many questions on the use of CT colonography need to be answered with well designed clinical studies that focus on health outcomes for the Medicare population."

Irene Tsikitas

The American Academy of Ophthalmology has introduced two tools to help ophthalmologists avoid operating on the wrong eye and implanting the wrong intraoperative lens during surgeries.

A new safety checklist and CME course have been designed to establish a consistent pre-op and operative protocol, says H. Dunbar Hoskins Jr., MD, the AAO's executive vice president. He says the tools will "help reduce preventable surgical errors," and he hopes they make wrong-site and wrong-IOL errors even less common than they are now.

The AAO's Wrong Site/Wrong IOL Task Force developed the pre-op and operative checklist in conjunction with the American Board of Ophthalmology and the Ophthalmic Mutual Insurance Company. It reminds surgeons to perform a timeout before draping that verifies a patient's:

The type of anesthesia used in a surgery has no bearing on the incidence of intraoperative awareness, but the condition is more likely to occur among young, female patients undergoing cardiac or obstetric procedures who've been administered overly light sedation, according to a pair of studies.

Both studies appeared in the February issue of the journal Anesthesia & Analgesia. One notes that 10 out of 44,006 patients (an incidence of 0.023 percent) who received general anesthesia experienced intraoperative awareness. In comparison, seven of 22,885 patients (0.03 percent) who received other forms of anesthesia reported awareness.

The other study attempted to determine risk factors for awareness by comparing 271 incidences of it against 19,504 incident-free cases. Researchers said the use of light anesthesia and a history of awareness seemed to be common risk factors.

Obesity and nitrous oxide, conventionally believed to increase the risk of awareness, appeared to have no impact. The study concludes that providers should perform proper maintenance on anesthesia equipment, ensure patients receive adequate levels of sedation and keep in mind that the "increased anesthetic requirement of some patients may be detected by the use of brain function monitoring."

Daniel Cook

Nine percent of the 43 readers who answered last week's online poll say the economic downturn has forced them to lay off staff. Nearly half (47 percent) say they haven't noticed a significant drop-off in volume and report that they're doing just fine, thank you. Another one-third (34 percent) say having more part-time and per diem staffers than full-time employees has helped them avoid layoffs. A small minority of respondents says they've compressed their schedules and expanded the length of their surgery days (5 percent) or closed the center for one to two days per week (5 percent).

This week's poll asks whether you prefer to read trade magazines such as Outpatient Surgery in print or online. Go to our front page to participate in the poll and view real-time results.

Dan O'Connor