Special Report: Be On the Lookout for Uninvited Invoices

When an invoice for $89 from a company called ASC-Exchange arrived at Sagamore Surgical Services in Lafayette, Ind., last week, it looked like any other invoice in the day's mail, except for one thing: It was demanding payment for services that no one at the center had requested.

On closer inspection, the invoice was also unusual in that it did not include a telephone number for ASC-Exchange, just a Houston, Texas, mailing address, an e-mail address and a website address. The company's website, an online subscription-based listing service that facilitates ASC-to-ASC buying, selling and trading of used and surplus equipment and supplies, didn't include a telephone number either. It was littered with misspellings and other errors. The invoice's mailing address could not be verified.

Sagamore's administrator and director of nursing, Carol Blanar, RN, BS, CNOR, is also executive director of the Indiana Federation of Ambulatory Surgical Centers. She'd heard that the Marion Eye Specialists Surgery Center in Marion, Ind., had received a similarly unsolicited "payment due" notice from the company. "I believe this is a hoax and a way to get money from the ASCs," she wrote in an e-mail to Outpatient Surgery Magazine.

According to representatives of ASC-Exchange, the invoices were not a ploy. "Over 1,100 centers received free trial subscriptions. To renew their subscriptions there is an $89 annual fee. If this was not clear we sincerely apologize," wrote an unnamed company rep in an e-mail. "Should someone choose not to renew their membership there is no consequence other than the trial subscription expires. We have been contacted by many centers that have chosen not to renew, and we immediately issue credits."

Following our request for comment, the front page of the company's website had, as of Monday, been updated to explain the invoices. It still didn't list a phone number, and when a company rep identifying himself as Fred Silver called us later that day to describe the invoices as a marketing strategy, he refused to give his number.

To ASC administrators, the company's "opt-out" subscription model seems somewhat deceptive, especially because they were never notified of the "free trial." And it demonstrated the importance of monitoring your business office's activities.

You've got to remain on guard, says Ms. Blanar. "In a small business, a lot of times all the magazine subscriptions and other invoices go straight to accounts payable. They'll just pay it, thinking it's a legitimate thing," she says. "If you send out a subscription offer as an invoice, that's just nasty."

David Bernard

Report Cards Lead to Better Colonoscopies

Giving endoscopists report cards led to better colonoscopy results in a retrospective study involving 928 patients at a veterans hospital.

The study, which appears in the June issue of the journal Gastrointestinal Endoscopy, found that when endoscopists were given quarterly report cards, their overall adjusted adenoma detection rates increased from 44.7% to 53.9%, largely as a result of better detection of proximal adenomas -- polyps on the right side of the colon that are often harder to detect. Additionally, cecal intubation rate improved from 95.6% to 98.1%.

The study, which was carried out at the Roudebush Veterans Affairs Medical Center in Indianapolis, Ind., compared the results of 336 patients who had colonoscopies before the report cards were implemented and 592 patients who had them after implementation.

Jim Burger

Joint Replacement Helps Rheumatoid Arthritis Sufferers

Individuals suffering from rheumatoid arthritis do in fact benefit from knee and hip replacements, say researchers at the Hospital for Special Surgery in New York City.

A pair of studies performed at the Manhattan facility contradicts the long-held belief that patients with rheumatoid arthritis who undergo joint replacements don't fare as well as patients who have the procedures because of osteoarthritis.

In the first study, researchers analyzed the outcomes of 178 rheumatoid arthritis patients and 5,206 osteoarthritis patients who underwent total knee replacement. Rheumatoid arthritis patients had worse pain and function before surgery, but their post-op improvements matched those of the osteoarthritis patients. Post-op satisfaction scores were similar in both groups, according to the findings. In addition, a comparison of individuals who underwent total knee revision showed rheumatoid arthritis sufferers had significantly less pain, better function and much higher satisfaction at 2 years post-op than osteoarthritis patients.

According to the second study, rheumatoid arthritis patients who had their hips replaced were as likely as osteoarthritis patients to show improvements in joint function and decreased pain, but at 2 years post-op the improvements were significantly less than those realized by the osteoarthritis group.

The HSS researchers couldn't pinpoint an exact reason for the difference in outcomes between knee and hip replacement patients with rheumatoid arthritis. Susan Goodman, MD, a rheumatologist at HSS and lead author of both studies, hypothesizes rheumatoid arthritis patients delay their hip replacement procedures, and that earlier intervention would improve post-op functionality. She plans further research to identify possible differences between the groups.

Daniel Cook

InstaPoll: Do You Use Anti-Fatigue Mats?

Anti-fatigue mats help reduce the leg and foot pain associated with standing during long cases for extended lengths of time, giving your surgeons and staff a more comfortable work environment. Tell us in this week's InstaPoll whether you use them at your facility.

Last week we asked if medication shortages are still a nuisance for you. For 95% of our 373 respondents, they are.

Managing medication shortages has become a regular priority in my facility.

  • Strongly agree: 70%
  • Agree: 25%
  • Neither agree nor disagree: 3%
  • Disagree: 1%
  • Strongly disagree: 1%

Dan O'Connor

News & Notes
  • Workers' comp cases costly Hospitals receive $2,000 more for outpatient shoulder surgeries performed on injured workers than they do for cases reimbursed by private payors, according to a 16-state study conducted by the Workers' Compensation Research Institute. Workers' comp payments significantly exceed private payor reimbursements in states where hospital price regulations are non-existent or are based on a percentage of hospital charges, notes the study. The study's authors wonder if the price differential is necessary to induce HOPDs to treat injured workers, and suggest addressing the discrepancy could help reduce healthcare costs.

  • Illinois ASCs fight proposed limits Surgical facilities in Illinois are pushing back against a proposal that would require multi-specialty centers to obtain approval before they can add new specialties. The proposed rule would force all ASCs to apply to the Illinois Health Facilities and Services Review Board for certificates of need when they want to add new procedures, a requirement hospitals do not face. Critics say the proposal would counter Medicare's recent efforts to cut costs by expanding the number of procedures that can be performed in outpatient facilities.

  • Senate hears RAC complaints Two healthcare reimbursement experts urged the U.S. Senate's finance committee to exercise greater oversight on insurers' recovery audit contractors last week, arguing that appealing the audits is cost- and staff-intensive and taxes patient care and quality improvement. The hearing was called to consider the Medicare Audit Improvement Act (S.1012 and H.R.1250, which would limit records requests and penalize non-compliant contractors, among other actions.