ASCs would see a 0.6% increase and hospital outpatient departments a 2.1% increase in Medicare payment rates under the Center for Medicare and Medicaid Services' proposed rule for calendar year 2010 policy updates, issued on July 1.

According to the proposal, which plans out the third year of the revised ASC payment system's four-year phase-in, 2010 is the first year in which surgery centers' conversion factors are eligible for inflation adjustments.

For ASCs, the proposed rule adds 28 procedures to Medicare's payment list, including kidney stone removal and repair of venous or arterial blockages. The ASC Association is posting a list of 2010's payable procedures on its Web site. CMS's proposal does not require ASCs to conduct quality reporting in the coming year.

For hospitals, the proposal includes the caveat that facilities which didn't participate in or didn't successfully comply with the Hospital Outpatient Department Quality Reporting Program will see their annual conversion factor update docked by 2 percentage points, resulting in an increase of only 0.1%.

It also suggests improvements to the reporting program, including verification requirements to ensure that data is reported accurately, the public availability of the data that hospitals collect and possible future areas of quality measurement.

CMS is accepting comments on the proposed rule until Aug. 31 and anticipates issuing its final rule on the issue by Nov. 1.

David Bernard

Rhode Island's 12 hospitals and 21 surgery centers have all agreed to abide by a standard protocol in order to prevent the occurrence of wrong-site surgeries and other medical errors.

With an emphasis on clear communication among surgeons, staff and patients, the protocol is also intended to reduce the confusion that sometimes arises when practitioners split their time between facilities. It is important, says William Cioffi, MD, surgeon-in-chief at Rhode Island Hospital, "especially in a small state where many physicians work in several hospitals, to have a policy which is consistent across hospitals."

The Hospital Association of Rhode Island notes that it is the first state to have all its surgical facilities voluntarily accept a standardized safety protocol. The new rules, developed over the past 18 months by state hospital and healthcare leaders in cooperation with the Joint Commission, include the following features:

A surgical tech working at 2 Colorado facilities possibly exposed thousands of patients to hepatitis C while feeding her addiction to pain medications.

Kristen Diane Parker allegedly stole syringes of fentanyl from the operating rooms of Rose Medical Center in Denver and Audubon Surgical Center in Colorado Springs, injected herself and refilled the syringes with saline solution. The syringes were then administered to surgery patients, according to the Colorado Department of Public Health and Environment, which notified both facilities of 9 patients with hepatitis C who were treated at Rose Medical.

The Audubon Surgery Center terminated Ms. Parker when alerted of her possible connection to the outbreak. She is currently under federal investigation and faces several criminal charges.

Rose Medical Center has sent 4,700 letters to patients that underwent surgery between Oct. 21, 2008 and April 13, 2009. The Audubon Surgery Center is in the process of notifying 1,200 patients who may have been exposed between May 4 and July 1, 2009. Both facilities have established patient care information hotlines and are offering free hepatitis C testing for at-risk patients.

"We are shocked and deeply distressed by the events that have been revealed to us over the past 48 hours regarding potential exposure our patients may have had to hepatitis C," says J. Michael Hall, MD, medical director of the Audubon Surgery Center. "We recognize the stress this situation will create for patients and their families so our first and top priority right now is to notify those patients to offer support and care to those who may be impacted."

Daniel Cook

All 12 hospitals and 21 surgery centers in Rhode Island have agreed to adopt uniform procedures to prevent wrong-site surgeries and other errors. Would a standard safety protocol work for your state's surgical facilities? Go to our Web site to register your opinion and see real-time results.

A record 123 of you answered last week's InstaPoll on how long it takes for surgical facility managers to experience career burnout. The results: 15% said it takes 1 or 2 years, 59% said it takes 2 to 4 years and 26% laughed at the idea.

Dan O'Connor