CMS Considering Office-Based Cataract Surgery for 2016

Should cataract surgery be performed in office-based settings? CMS is seeking public comment before potentially adding the highest-volume procedure performed on Medicare beneficiaries to its 2016 fee schedule.

In the call for comment (details of the proposed change appear on p. 53; instructions for commenting are on p. 1), CMS says advancements in technology have significantly reduced operating times and improved patient safety and case outcomes, which create the possibility of performing the surgery in office-based settings. CMS says shifting some procedures to the office might add to the convenience of scheduling for patients and give surgeons the flexibility of performing routine cases on patients with no comorbidities in appropriate clinical sites. However, CMS also notes that more complicated cases should be performed in an ambulatory surgical center or hospital outpatient department.

Paying for cataract surgery in the office setting would lower Medicare spending if the payment rate was set lower than the combined total of the physician fee and ASC or HOPD fee, according to CMS.

Experts with interest in keeping procedures in the ASC setting have expressed concern about the proposed payment change. "Our priority is the health and safety of the patient having surgery in an office," says Michael A. Romansky, JD, vice president of corporate development and Washington counsel for the Outpatient Ophthalmic Surgery Society.

Mr. Romansky points out that Medicare certification involves rigorous requirements for facility setup, equipment, qualifications of nursing personnel, governance and supervision, infection control, and policies and procedures.

"If office surgery is to be approved — and we are skeptical — facilities should be subject to the same requirements," he adds. "We owe that to our patients."

Daniel Cook

Repair the ACL, But Leave the Meniscus Alone

When an athlete damages her anterior cruciate ligament, she often tears the meniscus, too. Both problems are usually treated during ACL reconstruction surgery, but recent research suggests that leaving some meniscus tears alone can still result in positive outcomes.

In a study presented at the annual meeting of the American Orthopaedic Society for Sports Medicine, researchers found that when surgeons did not treat stable meniscus tears during ACL reconstruction surgery, an overwhelming majority of patients still exhibited successful post-op results.

Of the 194 patients examined in the study, the researchers found that nearly 98% of patients whose lateral meniscus tears went untreated and 94% with untreated medial tears did not need additional surgery 6 years following their ACL repairs.

Overall, they said, only 16 of the tears required reoperation, mainly those found in younger patients and those greater than 10 mm.

"As surgeons, we want to avoid too much intervention on a patient's knee when good outcomes can be expected," says lead author Kyle R Duchman, MD. "While large, unstable meniscus tears may need treatment at time of ACL surgery, this study confirms the smaller, stable tears can be left alone."

Kendal Gapinski

Depression, Anxiety Reduce Opioids' Benefits for Pain Patients

Opioids may be both less effective and more dangerous when prescribed to patients whose chronic lower back pain is accompanied by depression or anxiety, suggests a recent study.

Compared with patients who have low levels of depression or anxiety, patients who were highly depressed or anxious experienced significantly less pain relief (21% vs. 39%), and were nearly 5 times as likely to abuse opioids (39% vs. 8%), in addition to experiencing a greater incidence of other side effects, according to researchers at the University of Pittsburgh School of Medicine.

The prospective cohort study included 55 patients with various levels of depression and anxiety. They were given either morphine, oxycodone or placebo for 6 months and recorded both their pain levels and doses daily.

"It's important for physicians to identify psychiatric disorders prior to deciding whether to prescribe opioids for chronic back pain," says study author Ajay Wasan, MD, MSc. "We suggest that these conditions be treated early, and preferably before lower back pain becomes chronic. Successful treatment of underlying psychiatric disorders may improve pain relief and reduce the chance of opioid abuse."

Jim Burger

InstaPoll: Who's the Weakest Link on Your Staff?

Your facility's operations are probably strong in some areas, but weak in others. Tell us in this week's InstaPoll which department represents the weakest link in the process.

Most of the 255 respondents to last week's poll admit that the thought of the accreditation surveyor makes them "slightly nervous" or "lose a little sleep," but about one-fourth have a "quiet confidence" and "actually look forward to" a survey. The results to last week's poll:

Do you fret over a visit from the accreditation surveyor?

  • Full panic mode 11%
  • I lose a little sleep 21%
  • Slightly nervous 43%
  • Quiet confidence 19%
  • Actually look forward to it 6%

Dan O'Connor

News & Notes
  • Hep C outbreak doc sentenced for insurance fraud Dipak Desai, MD, the former co-owner of the Las Vegas endo center that sparked a 2007 hepatitis C outbreak, has been sentenced to 71 months in federal prison, 3 years of supervised release and $2.2 million in restitution payments for defrauding Medicare, Medicaid and private insurers. Desai, 65, pleaded guilty to the charges in April. He was sentenced to life in prison in October 2013 for causing the outbreak, with an opportunity for parole after 18 years.
  • Med safety demands standardization In the wake of a fatal medication error caused by a nurse's confusion of multiple scales on an oral liquid dosing cup, the American Society of Health-System Pharmacists and the Institute for Safe Medication Practices are calling for the adoption of cups and oral syringes that measure in metric milliliters (mL) only.
  • Ink that can think An ink derived from silk proteins, which contains enzymes, antibiotics and other bacteria-sensing agents, can be inkjet-printed onto surgical gloves to create a color-changing signal that alerts the wearer to contamination by E. coli or other pathogens, say biomedical engineers at Tufts University in Massachusetts. This is just one of the selectively reactive ink's potential clinical uses, they note in a recent issue of the journal Advanced Materials.