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| CMS: Same-day Scheduling Allowed |
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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:
the procedure is scheduled the day it is to be performed (in other words, if the referral to the ASC for surgery is made on that same date); and
the referring physician indicates in writing that it is medically necessary for the patient to have the surgery on the same day, and that surgery in an ASC setting is suitable for that patient.
CMS notes that cases of ambulatory surgery occurring on the same day they are scheduled are expected to be rare, since ASCs typically perform elective procedures. A frequent occurrence of such cases, it adds, may represent non-compliance with the advance notice requirement.
Dan O'Connor |
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| Wrong-site Surgery Prompts Safety Review at R.I. Hospital |
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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:
suspend surgical operations for 2 or 3 hours within the next two weeks, during which time staff will review safety policies;
hire a patient safety organization to create a near-miss reporting system to add to the safety policies;
establish a system to ensure that surgical staff consistently understand and are up to date on the safety policies; and
revamp the "time out" process to improve surgical site identification and visualization.
On 3 occasions in 2007, surgeons at Rhode Island Hospital drilled into the wrong sides of patients' skulls. Additionally, in September 2008, a surgeon at Miriam Hospital in Providence performed an arthroscopic surgery on the wrong knee. Miriam, like Rhode Island Hospital and Hasbro Children's Hospital, is a member of the Lifespan group of hospitals.
In a published report, Dr. Gifford says the recent error could have been caused by a combination of factors, ranging from "it couldn't happen to me" to "how do you mark inside the mouth?" He also says the state's hospitals and health department have been actively publicizing their "never events" in order to bring attention to the importance of surgical safety.
According to the Joint Commission, there were 93 wrong-site surgeries reported nationwide in 2007 and 116 reported in 2008.
David Bernard |
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| Medicare Won't Cover Virtual Colonoscopy |
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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 |
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| News & Notes |
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Tip of the week Cellular phones may or may not interfere with the operation of medical devices, but the noise their use generates and the cameras they contain can interfere with patient privacy, staff at work and simple decorum. "Patients don't need the extra disruption, and the nurses need to be able to communicate discharge instructions to patients and their caregivers without being interrupted by cell phone usage," says Susan Russell, RN, JD, CPAN, CAPA, of
Seton Northwest Hospital in Austin, Texas. For that reason, she recommends that patient escorts be notified that phone use is prohibited in patient care areas and that those who want to use them be directed to the waiting room.
Back pain guidelines The American Pain Society has revised its clinical guidelines for the treatment of lower back pain to emphasize non-invasive methods over the use of invasive diagnostic procedures and treatments such as provocative discography, prolotherapy, facet joint injection of corticosterids and intradiscal corticosteroid injects for patients with nonradicular low-back pain. The guidelines, published in the May 1 issue of the journal Spine, also recommend more communication between the surgeon and patient in deciding on treatment options, especially given the benefit-harm tradeoffs of some interventional procedures. "In general, non-invasive therapies supported by evidence showing benefits should be tried before considering interventional therapies or surgery," says lead author Roger Chou, MD, director of the APS Clinical Practice Guideline Program, in a press release.
EHRs for free? The U.S. Department of Veterans Affairs VistA software is an open-source electronic health records system that's available to the public for free and continually improved by its users. But hospitals have been slow to take advantage of the technology, reports the Boston Globe. More affluent hospitals tend to purchase customized solutions from private vendors, while facilities in poor, rural areas lack the resources to install and maintain the software. More information on VistA is available at the VA's Web site. |
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