A small victory for a handful of facilities, but a giant setback for many others: That's how physician-owned hospital ventures see the healthcare reform bill that narrowly passed the Senate last week.

About 75 physician-owned hospitals currently under development would not be able to meet the Aug. 1, 2010, deadline for exemption from new restrictions included in both the House and Senate versions of the healthcare reform legislation, says Molly Sandvig, executive director of Physician Hospitals of America.

If the same language is included in a final bill and ultimately signed into law, it would effectively ban the development of new physician-owned hospitals by prohibiting physicians from referring Medicare patients to hospitals in which the docs have a financial interest. The bill grandfathers in existing hospitals and facilities under development that are able to secure Medicare certification by Aug. 1, 2010.

Advocates succeeded in moving the deadline 6 months from the originally proposed date of Feb. 1, thereby sparing a few physician-owned hospitals that otherwise wouldn't have made it. But that's of little comfort to the approximately 75 other ventures that won't meet the deadline, says Ms. Sandvig.

When lawmakers reconvene to hammer out a compromise bill in mid-January, PHA wants them to move the deadline back further to grandfather in more facilities under development. Ms. Sandvig says the organization is also pushing for changes to language in both bills that would prohibit the growth of close to 300 existing physician-owned hospitals. "We have to allow for existing hospitals to grow in one way, shape or form. We can't be forced to be a stagnant industry," she says.

Irene Tsikitas

Canadian researchers report that fasting may not be necessary for cataract surgery patients, based on their observations of 5,125 procedures.

Physicians at the Mount St. Joseph Hospital in Vancouver have reported seeing no cases of aspiration or pneumonia as a result of aspiration between April 2007 and April 2008, according to an article published in the December issue of the Canadian Journal of Ophthalmology.

This has led them to the conclusion that "it is safe to perform cataract surgery under topical or infiltration anesthesia with intravenous sedation without fasting prior to surgery," they write.

The Vancouver hospital has no fasting requirement for cataract patients and allows patients to eat and drink freely until 1 hour before surgery. About 50% of the patients receive IV sedation, according to the article.

The risk of aspiration pneumonia following cataract surgery is extremely low, not just in their hospital but industry-wide, they write. "A Medline search over the past 10 years yielded only 1 case report of aspiration pneumonia after cataract surgery."

Kent Steinriede

Robot-assisted radical prostatectomy is feasible on an outpatient basis, offers the promise of decreased healthcare costs and provides patients with a convenient treatment option, according to researchers at the Mayo Clinic in Phoenix, Ariz.

Erik P. Castle, MD, of the clinic's department of urology, performed the surgery on 11 patients who consented to same-day discharge provided the procedure and recovery were free of complications. The patients showed few co-morbidities, had no history of bleeding diathesis and were not taking blood thinners. All 11 were discharged the evening of the procedure.

Within 2 weeks of their surgeries, 8 of the 11 patients completed a satisfaction survey. It revealed that each respondent felt satisfied with post-op pain control and was comfortable at discharge, with none feeling rushed out of recovery.

Most patients who undergo robot-assisted radical prostatectomy stay overnight and are discharged on the first post-op day, according to the Mayo Clinic study, which appears online in the December issue of the journal Urology. The researchers say that further research building on their findings could shorten the current recovery pathway for prostatectomy patients and decrease overall healthcare costs.

However, payment for radical prostatectomies varies across insurance plans and hospital contracts, and hospitals cannot receive full Medicare reimbursement unless it's performed as an inpatient procedure, says Aaron D. Martin, MD, MPH, clinic urologist and study co-author. "If diagnosis-related groups were changed to allow full reimbursement for an outpatient prostatectomy, then surgeons would be more likely to try it with healthy, well-selected candidates," says Dr. Martin

Daniel Cook

You might be surprised how much money your anesthesia providers can save your facility, if only you'd ask for their input and include them in budgeting discussions. Do you agree that your anesthesia providers can help reduce supply costs and waste at your facility? Tell us in this week's InstaPoll. We'll report the results in this space next week.

Two-thirds (66%) of the 100 readers who answered our online poll last week said they were caught off guard by the FDA's Steris System 1 safety alert and are not sure which sterilizer they're going to purchase to replace their SS1. The FDA suggests that SS1 users purchase another sterilizer in the next 3 to 6 months. About 1 in 5 (22%) say they know which sterilizer they'll buy next. Another 12 percent don't use the SS1.

Dan O'Connor