The forced federal spending cuts that took effect on March 1 are expected to have a wide-ranging, if not yet entirely known, impact on government operations and anyone who does business with the government. Industry observers say that hospitals and ASCs may feel the ripples through curbed Medicare payments.

Specifically, the $85 billion cut from the federal government's 2013 fiscal year, which ends in October, includes a 2% reduction in Medicare payments to healthcare providers, about $10 billion in total. Medicare's cuts are expected to take effect on April 1, though observers are awaiting clarification as to whether that indicates date of service or date of claim.

Surgical providers "are also likely to see other reimbursement cuts down the line, as payors who model their systems on Medicare begin to adopt some of these changes," says Nap Gary, president of the Ambulatory Surgery Center Association's board of directors. "ASCs that provide services to the largest numbers of Medicare beneficiaries will, of course, experience the greatest impact on their bottom line."

There is, perhaps, a silver lining. "Many Medicare providers may have breathed a sigh of relief," says Michael A. Romansky, JD, the Washington counsel and vice president of corporate development for the Outpatient Ophthalmic Surgery Society, because the sequester's cuts might have been less severe than other, more deliberate, steps that may have been taken to reduce spending.

Where the federal budget and legislative negotiations are concerned, though, nothing is certain. And down the line may be cause for more concern, especially because cost-efficient ASCs are already squeaking by on 42% less from Medicare than hospitals get for the same procedures.

"I don't want to minimize the impact of 2%, but what might happen on the horizon might be more problematic," says Mr. Romansky. "This 'inaction' might be the first in a series of 'actions' that Congress will consider to rein in costs and meet various budget targets."

David Bernard

One of the risk factors for surgical site infections has nothing to do with your facility's hand hygiene efforts, antibiotic prophylaxis or disinfection and sterilization. It may lie in patients' genetic makeups, according to research conducted at the University of Utah School of Medicine and recently published in the journal Wound Repair and Regeneration.

The researchers combed the records of 651 patients in a state population database who'd suffered SSIs, comparing them to randomly selected control individuals who shared birth years, birthplaces and genders. Only people who had both parents, all 4 grandparents and at least 6 great-grandparents in the database were analyzed in either group.

By testing the relatedness of patients who'd suffered SSIs, the researchers found that the infections appear to be genetically linked, even in extended relatives. If further investigation bears out these findings, people who are genetically at risk for SSIs might be identified through personal genome analysis before surgery, says Harriet W. Hopf, MD, professor of anesthesiology at the University of Utah and one of the study's authors.

"Individual genome analysis might benefit many people if SSIs appear to run in their families," said Dr. Hopf in a statement. "This type of personalized health care could be available in a few years," particularly in conjunction with resources like the state database.

Stephanie Wasek

Including mental health experts in pre-op patient assessments can improve surgical outcomes, according to psychologist David Sarwer, PhD.

The professor of psychology in psychiatry at the University of Pennsylvania's Perelman School of Medicine in Philadelphia says pre-procedure psychological screenings help ensure patients are mentally prepared for surgery, have realistic expectations about the surgery's benefits and follow post-op directives that lead to improved recoveries.

In the book Presurgical Psychological Screening: Understanding Patients, Improving Outcomes, Dr. Sarwer and co-author Andrew Block, PhD, a board-certified clinical health psychologist with the Texas Back Institute in Plano, say it's easy to think of surgery as a technical process as techniques and equipment continue to evolve rapidly. But it's essential for surgeons to consider the psychological issues - emotional distress, substance abuse, personality disorders, and willingness to comply with medical regimens - that can strongly influence outcomes.

The authors say psychological screenings have long been in place for patients undergoing bariatric and cosmetic procedures, but more surgeons are realizing the importance of considering all factors that might keep patients focused on their recoveries, especially in light of increasing healthcare costs and potentially lower reimbursements for undesirable results.

While conceding pre-op psychological screenings can't fully predict post-op outcomes, the authors say mental health professionals can be valuable members of the surgical team in evaluating the likelihood that patients will use appropriate medications, exercise, change their diets and schedule follow-up care appointments.

Daniel Cook

Do your staff members feel comfortable speaking up when they have safety concerns, or do they feel too intimidated to voice their feelings? Tell us in this week's InstaPoll.

Last week's poll, which asked about surgical volume in the first 2 months of 2013, revealed a bit of a sluggish start to the year. Volume's up for only about one-third (30%), and down for more than one-half (54%) of the 587 facility managers who responded. The results: