In a measure of how the sour economy is affecting the outpatient surgery industry, 60 percent of facilities report a decrease in demand for services over the past 12 months, with 11 percent of those suffering a decrease of 20 percent or more, according to a survey conducted by the Accreditation Association for Ambulatory Healthcare's Institute for Quality Improvement.

The survey, which can be ordered through the institute's Web site, also says that 76 percent of the 985 ASCs, office-based practices and other outpatient facilities polled had seen the economic crunch hamper their patients' ability to cover their co-pays or deductibles. Forty percent of responding facilities say they've had to increase their collection practices.

"The medical specialties seeing the greatest decreases included not only those providing non-essential or elective services, such as cosmetic surgery, but also those that offer basic services such as pediatrics, obstetrics/gynecology, urology, general or oral surgery, ENT, pain medicine, gastroenterology and orthopedics," said Naomi Kuznets, PhD, the institute's managing director. Midwestern, southeastern and southwestern states showed a higher proportion of facilities reporting decreased demand for services.

Slightly more than two-thirds of facilities said their operations have suffered under the economic downturn. In terms of specific negative impact, 44 percent of those respondents cited the ability to make capital purchases, 31 percent cited supply purchasing, 29 percent cited hiring and retaining staff, 12 percent cited purchasing services and 9 percent cited payroll expenses.

David Bernard

Despite industry claims that specialty hospitals cherry-pick profitable patients and procedures, a new study suggests that general and "safety-net" hospitals in selected metropolitan areas have been able to overcome competition from specialty startups.

Researchers surveyed and interviewed 43 physicians, government officials, hospital administrators and hospital employees in Little Rock, Ark., Phoenix, Ariz., and Indianapolis, Ind., to find out what impact the arrival of specialty hospitals had on the community hospitals there. The results of the study were published this month by the Center for Studying Health System Change.

General hospitals in these areas described considerable competition for physicians, insured patients and less acute cases, but they reported little increase in the acuity of the patients. Those that saw increased numbers of uninsured patients often attributed the rise to an increase in the number of uninsured people living in the area, says the study.

Safety-net hospitals were less likely to report a negative impact from specialty hospitals because most employed their own physicians. The study notes that physicians and nurses attracted to safety-net academic hospitals are drawn by the organizations' missions and the learning opportunities that emerge from the complex cases that end up there.

In order to stay competitive, the study says, hospitals have to become more aggressive in hiring and contracting with specialists who will agree to bring cases to its ORs. "This strategy also helped general hospitals rebound from initial losses in service volume," write the authors.

Kent Steinriede

Washington is set to become the sixth state to require hospitals to test patients who are at high risk for methicillin-resistant Staphylococcus aureus infections. If Gov. Chris Gregoire signs the bill, as expected, Washington hospitals will be required to have a MRSA testing program in place by Jan. 1, 2010.

The bill also requires hospitals to screen intensive care patients within 24 hours of being admitted; notify patients of MRSA diagnosis and disclose MRSA isolation policies to patients. The MRSA bill passed unanimously in the state legislature, with votes of 97-0 in the House in March and 45-0 in the Senate earlier this month.

Rep. Thomas Campbell, who introduced the bill in the House, told the Seattle Times that he plans to introduce a bill later this year that would require MRSA testing for patients scheduled for elective surgical procedures.

Currently California, Illinois, New Jersey, Tennessee and Pennsylvania require screening for MRSA among patients. Screening bills have been introduced in New York, Nevada, Kentucky, South Carolina, Massachusetts and Maine, according to the Consumers Union's Safe Patient Project. The Veterans Administration requires MRSA screening in all of its hospitals, as does Australia and a handful of European countries.

Most hospitals use nasal swab tests that deliver results in 72 minutes to 24 hours, depending on the test. The tests cost $10 to $42 each, according to a press report.

Kent Steinriede