Beginning Jan. 1, most hospital outpatient departments will receive an inflation update of 2.1% in their Medicare payment rates and ASCs will receive a 1.2% inflation update in theirs - double the 0.6% raise proposed earlier this year.

As required by Medicare law, hospitals that didn't participate in quality data reporting for outpatient services or didn't report the quality data successfully will receive a 2010 update equal to the annual inflation update factor minus 2.0 percentage points for a net update of 0.1%.

Medicare has once again delayed requiring ASCs to report quality data. As in 2009, ASCs will continue to be paid using the same payment methodology. CMS continues to apply the Consumer Price Index rather than the market basket. However, CMS has re-estimated the CPI, resulting in the 1.2% update.

CMS projects that aggregate Medicare payments to more than 4,000 hospitals and community mental health centers will be $32.2 billion in 2010, while payments to the approximately 5,000 Medicare-certified ASCs will be $3.4 billion.

CMS's Web site includes more information on the final rules for Medicare's 2010 payments for the hospital OPPS and ASC payment systems.

Dan O'Connor

A recently published study has spurred debate on whether a commonly used anesthesia technique prevents aspiration during the administration of general anesthesia.

Researchers at the University of Florida, Gainesville, report in the November issue of Anesthesia & Analgesia that Sellick's maneuver - in which anesthesia providers press their fingers to the cricoid cartilage, just below the Adam's apple - works, but by closing the lower throat (hypopharynx) rather than the esophagus, as originally described by British physician Brian Sellick in 1961.

For the study, 24 volunteer patients underwent the technique during an MRI scan. Researchers found that pressing on the cricoid cartilage caused the lower throat to move sideways along with the cartilage, closing the lower throat enough to block regurgitated gastric contents from entering the pharynx and lungs. "Sellick's original proposal that [cricoid pressure] compresses the conduit between the stomach and the pharynx as intended has been confirmed," write the researchers.

An accompanying editorial, however, argues that instead of documenting how Sellick's maneuver affects the anatomy, researchers should focus on determining the technique's effectiveness.

"Currently, there is insufficient evidence to advocate or abandon the use of cricoid pressure to prevent passive regurgitation in at-risk anesthetized patients," writes the editorial's author. "We need to prove that properly applied cricoid pressure is effective at preventing regurgitation or discard it."

Kent Steinriede

Unsedated colonoscopy is accepted by a majority of patients, according to researchers in Taiwan, who say performing the primary cancer screening without sedation eliminates risk for patients with co-morbidities, reduces recovery times and, ultimately, results in significant cost savings.

In a study published in the October issue of Gastrointestinal Endoscopy, researchers compared the experiences of 176 patients who underwent unsedated colonoscopy to those of 85 patients who underwent unsedated sigmoidoscopy, which is typically well-tolerated. They discovered no significant differences in pain, acceptance and need for sedation between the 2 groups.

About 90% of patients who underwent either exam felt sedation was unnecessary, and no complications were reported in either group. The patient's sex (women requested sedation more often than men did) and the endoscopist's skill - but not the screening performed - correlated with severity of pain and need for sedation, according to the researchers.

While acknowledging that only 14% of patients who were given the choice between the 2 procedures opted for unsedated colonoscopy, which could have limited that study group to patients with a higher pain threshold, the researchers believe that, despite physicians' and patients' assumptions to the contrary, primary colorectal cancer screening with unsedated colonoscopy is feasible, may be more effective and may save costs and time compared with sigmoidoscopy.

Daniel Cook

We want to know what types of restrictions you're placing on visitors to your facility this flu season and whether you're requiring staff to get flu shots. Tell us in this week's InstaPoll and we'll report the results in this space next week.

Last week we asked you whether you belonged to any social networking sites online. Nearly three-fourths (72%) of the 105 respondents said they'd signed up with Facebook. Another 3% are on LinkedIn, and 25% don't participate in any.

Dan O'Connor