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What If Amazon Sold Surgical Gloves and Sutures?
Amazon Logo ADD TO CART Amazon wants to give ASCs fast shipping on latex gloves, bandages and sutures.

Amazon will enter the health care system by learning how to supply latex gloves, bandages and sutures quicker and cheaper to ambulatory surgical centers, Bloomberg reports.

A pilot program in the Midwest is testing whether Amazon Business can successfully supply 150 outpatient facilities that belong to a large, single hospital system. Amazon customized its shopping interface to show the specific supply catalog for the unnamed hospital system. The interface also lets purchasers compare Amazon's prices with the prices negotiated by the hospital.

Amazon Business already sells some medical supplies to hospitals but a lack of options, changes in supply continuity and lack of control over shipping makes many administrators hesitant to solely use its service, says Bloomberg. Breaking into the ASC supply market will let Amazon learn the ropes and provide a service that could be expanded to include high-tech medical devices.

Currently, patients and smaller physician's offices use Amazon's services to purchase medical supplies. But Amazon's success with ASCs could mean stiff competition for companies that distribute basic medical and surgical supplies to ASCs and hospitals.

"They are a force to be reckoned with," said Paul Cody Phipps, chief executive officer of Owens & Minor, to Bloomberg last week.

JoEllen McBride

Aetna Medical Director's Stunning Admission on Denying Care
Nurse Approval CLINICAL REVIEW? A former Aetna medical director says nurses decided whether to deny coverage after they, and not him, reviewed patients' records.

A former medical director for Aetna says he never reviewed patients' medical records before approving or denying coverage, a shocking admission that has sparked an investigation into the insurance giant's clinical review process.

Rather than review the records himself, nurses reviewed the records and made recommendations to him, per company policy, says Jay Ken Iinuma, MD, a medical director for Aetna from 2012 to 2015.

A CNN investigation uncovered the practice.

The California's insurance commissioner will examine how frequently Aetna's medical directors examine patient records before making a decision on care.

Dr. Iinuma's admission came out in a deposition, during which the doctor said the practice was merely part of Aetna's training, in which he got medical record information secondhand from nurses.

"Claims and preauthorization requests are held hostage while payers make repeated requests for hundreds and hundreds of pages of records," says Tammy Tipton, president of Appeal Solutions. "What is the effect? A demoralized healthcare team, which can’t deliver timely care because it is buried in paperwork."

Anna Merriman

Computer Model Shows Forced-Air Warming Can Cause SSIs
Bair Hugger FEELING THE HEAT 3M refutes claims that the Bair Hugger is to blame for post-op infections.

It's possible for forced-air warmers to cause surgical site infections by disrupting laminar air flow and blowing bacteria back into the sterile field, according to new research published in the International Journal for Numerical Methods in Biomedical Engineering.

An OR's Laminar air flow is designed to send highly filtered air down from the ceiling to push airborne contaminants away from the sterile field. The study's authors used high-fidelity simulations of how warming blanket blowers impact laminar air flow to show the blowers push and drag potentially colonized skin squames shed from surgical team members above the sterile field and over the side of surgical tables, where laminar air flow pushes them down toward the surgical site.

"Medical equipment in the OR, and the surgical staff, can disrupt the air flow in ways that increase the amount of bacterial colony-forming units, and so do the rising plumes of hot air from forced-air warming devices that prevent patient hypothermia," says study lead author Sourabh Apte, PhD, ME, BE, a professor of mechanical engineering at Oregon State University.

3M faces more than 4,000 lawsuits from patients who claim the company knew about the potential increased risk of joint infections linked with the use of the popular Bair Hugger forced-air warming devices during hip and knee replacement surgeries. The first trial is scheduled to begin this spring.

3M continues to deny its product causes surgical site infections. "There is no generally accepted science that the Bair Hugger warming system causes infections," says the company.

The FDA "has been unable to identify a consistently reported association between the use of forced-air thermal regulating systems and surgical site infection," after reviewing available data.

Daniel Cook

InstaPoll: How Do You Define an On-time Start?

How do you measure a late start — wheels in the room, incision time or induction time? Tell us in this week's InstaPoll.

Patients in 30% of the 291 respondents to last week's poll leave the surgical facility without a painkiller prescription. The results:

Typically, a patient leaves your facility with a prescription for ___ painkillers.

  • 0 30%
  • 3-10 18%
  • 10-20 18%
  • 20-30 23%%
  • more than 30 11%

Dan O'Connor

News & Notes
  • Insurer says sedation not needed in cataracts Monitored anesthesia care (MAC) is not medically necessary during routine cataract surgery, says Anthem in a new clinical guideline that the California Society of Anesthesiologists strongly opposes. The group wrote a letter urging Aetna to "urgently rescind" the guideline, arguing that MAC provides a still surgical field and allows doctors to safely inject nerve blocks or antibiotics.
  • Could surgical instruments spread Alzheimer's? Eight people diagnosed with a rare brain-bleeding disorder, triggered by one of the same proteins that triggers Alzheimer's, all had brain surgery as children, says research from the University College of London. Surgical tools that aren't properly sterilized could transfer the amyloid proteins that build up in Alzheimer's patients the research suggests. The 8 patients all had brain surgery before current sterilization procedures, but researchers say the rare chance of transfer should factor into review of sterilization practices for surgery.
  • Suit: Ankle surgery led to brain damage A woman who had her broken ankle repaired at the Texas Institute for Surgery at Texas Health Presbyterian Dallas reportedly suffered brain damage when vomit blocked her airway and prevented oxygen from reaching her brain. The patient's insurer says it has paid more than $1 million in continuing medical expenses and is seeking compensation from the facility and the anesthesiologist who worked the case.