Two California surgery centers are leading a class action lawsuit claiming that insurer UnitedHealth, its subsidiary Ingenix and numerous plan administrators systematically underpaid out-of-network ASCs' claims by millions of dollars.

The lawsuit, which the Downey Surgical Clinic and Tarzana Surgery Center are pursuing in federal court on behalf of ASCs nationwide, alleges that UnitedHealth calculated its usual, customary and reasonable rates for out-of-network claims through the use of in-network or Medicare rates and an arbitrary multiplier, instead of through geographical comparisons and its Ingenix database, as it had reported. This violates federal health benefits and anti-corruption laws as well as California business codes, say attorneys, and hurts surgical facilities.

"We believe that the payors' improper reimbursement calculations are the major causes of the unreasonably low amounts of reimbursement to ASCs, which improperly leaves patients on the hook for amounts that the payors themselves owe," explains Daron Tooch, a principal at the law firm of Hooper, Lundy & Bookman, which is representing the surgery centers.

The May 7 filing expands on a 2009 lawsuit, which adds as defendants a list of corporations and their in-house employee benefit plans for which United and Ingenix set prices for its enrollees' claims. According to the ASCs' attorneys, the defendants were added after United argued it could not be sued for the actions of insurance plans or plan administrators for whom it simply processed claims.

The lawsuit follows similar complaints filed by the American Medical Association and the California Medical Association last year, as well as an investigation by the New York State Attorney General, regarding insurers' alleged use of the Ingenix database to manipulate provider reimbursements and patient payments.

David Bernard

A drug formulated to alleviate constipation might also reduce the amount of bowel prep patients need to drink before colonoscopy, researchers say, which might encourage more patients to undergo screenings.

Gastroenterologist Chetan Pai, DO, and colleagues at Henry Ford Hospital in Detroit compared the colon-cleansing properties of lubiprostone, an FDA-approved treatment for chronic constipation, when prescribed in conjunction with polyethylene glycol (PEG) and electrolytes to those of PEG and electrolytes alone in 126 patients. According to their research, the lubiprostone-PEG-electrolytes combination improved the quality of the bowel prep and reduced by half the standard 1 gallon dose of solution patients must consume before the procedure.

Dr. Pai, who presented the findings at Digestive Diseases Week in New Orleans earlier this month, says an inability to tolerate large amounts of bowel prepping solution deters many patients to avoid colonoscopies, particularly those over age 50, who are at greater risk for colon cancer. "If physicians are able to offer a better way to prep, I think this will encourage more people to get the colonoscopies that may save their lives," he says.

The findings follow another study that suggests taking an entire colonoscopy prep dose on the day of the procedure is as effective as splitting the doses between the night before and the morning of the procedure.

Daniel Cook

The Da Vinci surgical robot may attract surgeons and impress the community, but in the hands of the insufficiently experienced it can be dangerous, which concerns some of its proponents.

It takes a surgeon 250 to 700 cases to master the robot for urologic procedures, says Dr. Jim Hu, MD, MPH, a genitourinary surgeon at Brigham and Women's Hospital in Boston, in a Wall Street Journal article questioning the safety of surgical robots in low-volume hospitals, where they are gaining popularity.

Of the 853 U.S. hospitals equipped with the robot, 131 have fewer than 200 beds. At the 178-bed Wentworth-Douglass Hospital in Dover, N.H., the robot has been used 300 times in 4 years, but not without complications, the article says. Two patients' bladders were lacerated; one suffered severed ureters during a routine hysterectomy; another died after his esophagus was perforated during stomach surgery in which an inexperienced surgeon was forced to convert to an open procedure. The hospital defends its complication rate as below that reported in medical literature, no lawsuits have been filed and a Joint Commission investigation did not call for improvements.

But some surgeons argue that a certain level of surgeon experience and case volume increase the safety of a robotic surgery program. And that smaller hospitals may not offer the volume necessary to hone robotic technique. For example, Dr. Hu compares his 1-year fellowship and assisting in 400 procedures before using the robot alone to the New Hampshire hospital's allowing surgeons to operate solo after 2 days on pigs and cadavers followed by 4 proctored procedures. That's not enough experience, he says.

Kent Steinriede

Do your surgeons ink an X, a checkmark, the word "yes" or their initials? Tell us how your patients' surgical sites get marked in this week's online poll. We'll report the results in this space next week.

Last week's InstaPoll asked which statement best describes your views on your anesthesia providers' patient selection judgment. The results, from 112 responses: