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Click Here to Schedule Your Surgery

It's commonplace these days to order merchandise, book hotels and arrange transportation online, and in each case the provider of goods or services tells you what it'll cost right up front. A new website offers a similar transaction for patients seeking to undergo elective surgery.

Launched earlier this month, I Need a Surgery connects both insured and uninsured patients with participating surgery centers nationwide, which agree to provide the patients' surgeries at pre-arranged, all-inclusive prices.

The web service's efforts toward patient education and price transparency also include easy-to-understand explanations of common surgeries, a calculator that allows patients to see how much their procedure has typically cost, and a "No Surprises Guarantee." Once patients schedule their procedures, the price is settled, with no unexpected costs arriving afterward.

I Need a Surgery (INS) is the brainchild of Jeff Blankinship, president and CEO of Surgical Notes, the Dallas-based medical business software and IT services firm. Until now, he says, healthcare consumers, unlike nearly every other consumer, have had little input and little information going into their life-changing purchases. "Patients would go wherever their physicians told them, and only after receiving the surgery would they learn the cost of that care," he says. "Through INS, consumers can finally gain control of their health care."

As ASCs' clinical and operational efficiencies gain attention in a cost-crazed healthcare environment, this kind of transparency is the way to go, Mr. Blankinship argues. "Many consumers are unaware that ambulatory surgery centers offer more affordable, safer and better quality care than other settings, making it imperative that surgery centers become more involved in direct marketing to consumers," he says.

This isn't the first attempt to bring purchasing power to the patient, though. In addition to individual centers' move to transparency, last year saw the introduction of a website through which self-paying patients could choose from physicians and hospitals bidding for their elective surgery business.

David Bernard

Nerve Damage After Hip Surgery May Not Be Providers' Fault

Nerve damage after hip surgery, traditionally blamed on anesthesia providers' or surgeons' actions, may in some cases be related to inflammatory neuropathy instead, a recent Mayo Clinics Proceedings article suggests.

In a retrospective study of patients who developed pain and weakness in limbs after hip surgery despite no documented or direct traction injury during surgery, researchers demonstrated inflammatory neuropathies in all patients, via nerve biopsy. Historically, such injuries have been attributed to mechanical factors, such as patient positioning or direct surgical damage to nerves.

Physicians should be aware of certain signs that suggest that damage in such patients may be related to an inflammatory issue, says Nathan Staff, M.D., Ph.D., a Mayo Clinic neurologist, including neuropathy that develops over time; severe pain; neuropathy that progresses; and anatomical distribution that's differs from what's expected.

The ability to identify patients with inflammatory neuropathy, as opposed to those with mechanically caused damage, may allow for better and faster treatment, for example via immunotherapy, to ease pain and improve outcomes, says Dr. Staff.

Jim Burger

Medicaid Expansion Could Jeopardize Hospital Finances

A new study in JAMA Surgery suggests that it will cost hospitals more to care for sicker Medicaid patients at a time when the federal program is set to expand in more than half of the nation's states.

In a comparison of nearly 12,000 privately insured patients aged 18 to 64 and more than 2,000 Medicaid insured non-elderly patients who underwent inpatient general surgery at 52 Michigan hospitals over the course of a year, the Medicaid beneficiaries were twice as likely to have such health issues as hypertension, diabetes and COPD before surgery; suffered two-thirds more post-op complications and used 50% more hospital resources.

Hospitals who care for a large volume of Medicaid patients should pay particular attention to the findings, say the researchers, who were surprised that less than half of the hospitals included in the study cared for more than 61% of the low-income patients. They point out that 26 states have used the Affordable Care Act to expand Medicaid programs, which increases the possibility that the growing number of beneficiaries will decide to undergo surgery just as federal subsidy payments to cover the cost of caring for these patients are set to decline in the coming years.

"If we make the presumption that the new Medicaid-covered patients will fit the mold of what we see now, surgical and inpatient teams must be prepared to provide the care and support they need," says Seth Waits, MD, a surgical resident at the University of Michigan Medical School, who led the analysis. "Financially, it may be a double whammy for hospitals, especially those that have the highest percentage of their surgical population covered by Medicaid."

Daniel Cook

InstaPoll: Is Your Career Sabotaging Your Relationships?

Does your job stress — the long hours and the demanding, pressure-filled environment — adversely impact your relationship with your significant other? Tell us in this week's InstaPoll, then check back next week for the results.

We've seen a thumbs-down on patients staying over in ambulatory surgery centers. Only 38% of the 234 respondents to last week's poll think ASCs should be allowed to admit patients overnight. The results:

Are overnight stays a good idea for ASCs?

  • Yes: 38%
  • No: 62%

Dan O'Connor

News & Notes
  • Ready, set, wrap! How fast can your sterile processing staffers wrap instrument trays? In the first-ever Smart-Fold Wrap Races, sponsored by Kimberly-Clark Health Care at the IAHCSMM's annual conference earlier this month, Naomi Campbell of Brandywine Hospital in Coatesville, Pa., was crowned national champion after wrapping 3 trays in 34 seconds.
  • Camera-in-capsule hits the market The Endocapsule 10 system, designed to deliver non-surgical imaging of the small intestine, is now commercially available, says manufacturer Olympus. The capsule provides a 160-degree field of view and a 12-hour battery life, and its recording unit is lighter and more compact, able to be worn over clothing as opposed to applied directly to the skin.
  • Predicting elderly outcomes Assigning frailty scores based on mental cognition, nutrition and daily activity to elderly patients undergoing moderate- to high-risk elective surgeries predicts length of post-op hospital stays, mortality risk and need for discharge to a nursing care facility, according to a study in JAMA Surgery. The researchers say their risk scores identify older patients who are suitable candidates for surgery and could lead to improved care for patients who are at increased risk of adverse post-op outcomes.