Revisions to Medicare's ASC Conditions for Coverage that require verbal and written notification of patient rights and facility ownership before the day of surgery are scheduled to take effect on Monday, May 18.

The revisions, issued in October 2008 along with the Centers for Medicare and Medicaid Services' final rules on this year's ASC and hospital payment systems, mandate that:

ASC Association President Kathy Bryant predicts that outpatient surgery centers' payment rates will fall below 50% of HOPDs' rates within 5 years unless Congress passes the ASC Access Act, which would lock in ASC payments at Medicare's current 59% rate.

"It's incredibly frustrating," says Ms. Bryant, since Medicare's ASC payment rates have sunk lower and lower even as the number of ASCs and the number of cases they perform grow higher and higher. "More importantly, it's frustrating for the ASCs to provide high-quality care at a cheaper cost and to have to deal with CMS. Without legislation, we are in trouble. We'd like to see a higher percentage, but if we can stop the bleeding at 59%, we will have taken a significant step for the industry."

In 2003, Medicare paid ASCs 86.5% of the rate it paid hospital outpatient departments for the same procedures, but a 6-year payment freeze and additional cuts reduced the ASC rate to 59% of HOPDs' in this calendar year, the level at which the ASC Access Act aims to freeze them.

Dan O'Connor

The owner of a Las Vegas medical spa is suing retired plastic surgeon Charles Vinnik, MD, who developed the diazepam-ketamine technique of anesthesia for cosmetic surgery, and his wife, a registered nurse and employee of the spa, for performing thousands of after-hours, cash-only cosmetic cases over several years without the owner's knowledge, according to the Las Vegas Sun.

Nancy and Charles Vinnik reportedly reopened the spa at night and on Sundays for clients seeking discounted Botox injections, laser skin treatments and photofacials. Ms. Vinnik purportedly recruited a number of other plastic surgeons to perform breast augmentations and other cosmetic procedures. The Sun reports that the clandestine cases netted the Vinniks as much as $30,000 a day.

Tracy Hurst, the spa's owner, was unaware of the supposed illegal activity until last July, when a patient complained about the care she received from the Vinniks. Ms. Hurst is suing the couple for alleged interference with her business, violation of contracts and trespassing, according to the Sun. She claims the Vinniks were motivated by greed and the free use of the facility's state-of-the-art equipment, and says scores of image-conscious patients - including cocktail waitresses and strippers - helped fuel the after-hours business.

Michael Stein, the Vinniks' attorney, calls Ms. Hurst's allegations "absolutely preposterous." Says Mr. Stein, "Over several years, a multitude of docs come in after hours, no one ever sees them and the owner never forgets her purse or phone at work?" He adds that he finds it hard to believe that physicians would risk their licensure by performing off-hour surgeries away from their own facilities.

Daniel Cook

Nine of the 52 readers who answered last week's online poll reported that they'd experienced an outbreak of toxic anterior segment syndrome (TASS) at their facilities. TASS is a post-operative, acute inflammation of the anterior segment of the eye that has been linked to ophthalmic viscoelastic devices, intraocular lenses and irrigation solutions used during eye surgery. Other adverse events happened much less frequently: 1 poll taker reported a case of a retained object and 2 reported wrong-site surgeries. A majority of 69%, however, reported that their facilities had been free of these adverse events.

This week's poll wants to know if your surgical facility is partnered with a management company. Go to our front page to participate in the poll and view real-time results.

Dan O'Connor