ASCs can breathe a big sigh of relief now that Medicare has established exceptions to a condition of coverage that, beginning on May 18, would have prevented surgical centers from scheduling and performing procedures on the same day, effectively prohibiting add-on and emergency cases.

According to the revised conditions, ASCs were required to provide notification of patients' rights and of the center's ownership before the day of surgery. But on the day the conditions were to take effect, CMS announced that it is allowing 2 exceptions to its notification requirement. The requirement will be waived, the agency says, if:

In the wake of its fourth wrong-site surgery incident since 2007, Providence-based Rhode Island Hospital has entered into a consent agreement with the state's department of health to evaluate and improve its safety policies.

The agreement followed a May 11 incident in which an oral surgeon correcting a child's cleft palate at Hasbro Children's Hospital, the pediatric division of Rhode Island Hospital, began operating on the wrong side of the patient's mouth before discovering the error.

Once corrected, the surgery was performed "with good results," says Timothy J. Babineau, MD, MBA, FACS, president of Rhode Island Hospital, in a statement. The attending physician in the case has been referred to the state's board of medical licensure and discipline, according to the Department of Health, which has been interviewing surgical staff members to investigate the cause of the error.

"Preliminary findings of the hospital's surgery program," the department says, "include failure to follow hospital policies, inconsistent interpretation of the time out policy, inadequate ongoing physician and nurse training about policy revisions, inadequate hospital-wide prospective assessment of the time out policy as it applies to specific surgeries (e.g. oral surgery, multi-site surgery, vaginal surgery) and inadequate identification and reporting of 'near misses' by physicians, nurses and OR staff."

Says state health director David R. Gifford, MD, MPH, "As in most cases, this is not the fault of one individual nor is this fixed by just introducing a checklist."

The consent agreement requires the hospitals to undertake the following remedial steps:

The Centers for Medicare and Medicaid Services won't fund virtual colonoscopies for Medicare recipients, despite lawmakers', providers' and industry groups' calls for coverage of the minimally invasive colorectal cancer screening test.

"The evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test," says CMS in a statement confirming the decision it first announced in February. The agency says its analysis has not shown the test to be a cost-effective alternative to colonoscopy. "While it is a promising technology," CMS writes in the final decision, "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."

The CTC Working Group, a coalition of healthcare providers, patient advocates and imaging equipment manufacturers who sought Medicare coverage of CT colonography, issued a statement asking CMS to "immediately re-open the rule making process to consider new clinical data" showing the efficacy of the screening test in Medicare recipients. "If CMS will not reconsider this coverage decision, Congress should vote to mandate Medicare coverage of CT colonography," says James H. Thrall, MD, FACR, chair of the American College of Radiology's Board of Chancellors.

However, some physicians are backing CMS' decision, noting that if a polyp is found via CT colonography, patients still have to undergo colonoscopy to have the polyp removed. They also say CT colonography can pick up cysts and other growths in the abdomen that would lead to more costly and potentially dangerous tests for patients.

Irene Tsikitas

The surgery center business is not an easy one to master. Last week's online poll found that 62% of the 42 respondents have a corporate partner or work with a management consultant.

This week's poll wants to know if you take all the vacation time you earn in a year. Go to our front page to participate in the poll and view real-time results.

Dan O'Connor