Patients should no longer be slapped with surprise co-pays when polyps are discovered during supposedly free screening colonoscopies, according to administrative guidance issued last week by the U.S. Department of Health and Human Services.

The 2010 Affordable Care Act, which waived annual deductibles and co-pays for Medicare beneficiaries undergoing colonoscopies, required most private insurers to cover preventive care at no additional cost to patients. However, an unintended loophole emerged that let insurers charge patients with significant co-pays when physicians discovered polyps during exams, which essentially reclassified supposedly covered preventive screenings into uncovered therapeutic procedures.

"Polyp removal is an integral part of a colonoscopy," notes the HHS, which now says insurance plans or insurers "may not impose cost-sharing with respect to a polyp removal during a colonoscopy performed as a screening procedure."

Evidence shows that even limited cost-sharing can deter patients from getting the test, says Christopher Hansen, president of the American Cancer Society Action Network. He points out that polyps left untreated can result in advanced stage colorectal cancer that is much more expensive to treat and difficult to survive.

The loophole won't be completely closed until legislation is enacted that ensures screenings are free to all patients - even if polyps are discovered. U.S. Rep. Charles W. Dent (R-Pennsylvania) introduced the Removing Barriers to Colorectal Cancer Screening Act of 2012 last March. The legislation died during a subcommittee's review, but he plans on reintroducing the act this year, according to Mr. Hansen.

As previously reported, Medicare's screening oversight doesn't affect surgical facilities from a revenue standpoint, but it's in a facility's best interest to stand up for its patients, says Andrew S. Weiss, CASC, administrator of the Endo Center at Voorhees in New Jersey. He says the cost-sharing loophole is still an issue for patients, and urges support of Rep. Dent's legislation.

Daniel Cook

Continuous wound infiltration with a local anesthetic is an inexpensive and simple option for post-op pain management, but after colorectal surgery epidural analgesia may work better, say French researchers.

"We knew [continuous wound infiltration] was seen as an attractive solution for pain care in abdominal surgery recovery, but it hadn't been directly compared to the tried-and-true epidural method for colorectal surgery patients," says anesthesiologist Emmanuel Futier, MD, of the University Hospital of Clermont-Ferrand. "Unlike after abdominal surgery, our study found [epidural analgesia] was the superior choice after colorectal surgery."

For the study, published in the March issue of the journal Anesthesiology, Dr. Futier and his colleagues observed the methods' results among 50 patients who underwent elective open colorectal surgeries.

While epidural analgesia was a costlier and more complex process than continuous wound infiltration, they found that it offered better pain relief, enabled speedier recoveries and shortened hospital stays, which would certainly be of benefit to fast-track surgical facilities, they note.

David Bernard

A unanimous ruling by the U.S. Supreme Court upholding a Federal Trade Commission challenge to a public hospital merger will strengthen the agency's ability to stop other healthcare consolidations on antitrust grounds.

The SCOTUS decision reverses a lower court's ruling that would have let the Hospital Authority of Albany-Dougherty County in Georgia, which owns Phoebe Putney Memorial Hospital in Albany, acquire the competing Palmyra Medical Center. This merger would have been conducted under the state action doctrine, which provides an exemption from federal antitrust laws.

The FTC had challenged the acquisition in 2011, alleging the deal would "reduce competition significantly and allow the combined Phoebe/Palmyra to raise prices for general acute-care hospital services charged to commercial health plans, substantially harming patients and local employers and employees." It further alleged that the deal had been purposely structured to misuse the state action doctrine as a shield from federal scrutiny.

"We have no doubt that Georgia's hospital authorities differ materially from private corporations that offer hospital services," wrote Justice Sonia Sotamayor in the SCOTUS opinion. "But nothing in the Law or any other provision of Georgia law clearly articulates a state policy to allow authorities to exercise their general corporate powers, including their acquisition power, without regard to negative effects on competition."

According to coverage in the New York Times, the decision should give pause to hospitals "when they join forces with other health care providers to form so-called accountable care organizations, as called for in the new health care law." The $195 million Palmyra acquisition had been completed in 2011, after a circuit court had ruled Georgia's "hospital authorities law" extended antitrust immunities to such mergers, "trumping the FTC's argument that the acquisition would cause higher health costs in the Albany area," says Georgia Health News.

Stephanie Wasek

Is surgical volume off to a good start after the first 2 months of 2013? Tell us in this week's InstaPoll how your case volume rates.

About 1 in 5 (19%) of the 275 respondents to last week's poll uses OR turnover kits. Another 1 in 3 (33%) might soon be in the market for them. The results when we asked, "Do you use turnover kits?":