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Credentialing Tops List of Joint Commission Dings

Which Joint Commission requirements were most likely to trip up surgery centers in 2015? Those related to credentialing, infection control, fire safety, and medication storage and management, says the accreditation agency.

Nearly half (48%) of the ASCs surveyed by the Joint Commission were cited for compliance issues related to granting "initial, renewed or revised clinical privileges to individuals who are permitted by law and the organization to practice independently."

Almost as many (46%) were cited for failing to "reduce the risk of infections associated with medical equipment, devices and supplies. Meanwhile, more than a third (36%) had issues with maintaining fire safety equipment and building features.

Rounding out the top 5 areas of non-compliance were failures to safely store medications (31%) and to safely manage high-alert and hazardous medications (28%). The Joint Commission's numbers did not include data from for-cause surveys.

Jim Burger

Medicare Launches New Total Joint Payment Plan

The Centers for Medicare & Medicaid Services last week officially launched its Comprehensive Care for Joint Replacement Model , a new bundled payment plan designed to eliminate the significant variation in Medicare reimbursements for inpatient total joint procedures performed in different parts of the country.

The bundled payment plan, which has been implemented at approximately 800 hospitals located in 67 diverse markets across the U.S., will pay hospitals a single fee for an episode of care — beginning at hospital admission and extending to 90 days post-op. The fee includes reimbursement for the facility, physician and anesthesia provider, and 90 days of recovery treatment. Hospitals that spend less than the targeted amount will earn additional payment, while those that spend more will pay a portion of the difference to CMS.

More than 400,00 hip and knee replacements were performed in 2014 and totaled more than $7 billion in hospitalization costs, according to CMS. The cost of care for surgeries performed on Medicare beneficiaries varies widely among hospitals, ranging from $16,500 to $33,000 in different parts of the country.

The CJR is designed to hold hospitals accountable for an episode of care and to promote coordination of services among surgeons, hospitals and providers of recovery care, says CMS.

It "offers a chance for hospitals, doctors and other providers to partner with CMS in furthering our shared goal of improving the quality of care for beneficiaries undergoing the most common inpatient surgery, lower extremity joint replacements," says Patrick Conway, MD, principal deputy administrator and chief medical officer for CMS. "The model is part of the Administration's broader strategy to improve the healthcare system by paying providers for what works, unlocking healthcare data, and finding new ways to coordinate and integrate care to improve quality."

Daniel Cook

Ibuprofen Doesn't Increase Bleeding Risk After Plastic Surgery

Do your plastic surgeons avoid prescribing certain NSAIDs to post-op patients for fear of increased bleeding? Their concerns may be overblown, according to a recent study.

In a systematic review published in Plastic and Reconstructive Surgery, researchers report that ibuprofen may be a safe and effective treatment for pain following plastic surgery.

Researchers analyzed 4 randomized, controlled trials that looked at 443 patients undergoing several different plastic surgery procedures. In the studies, patients were given ibuprofen, acetaminophen, acetaminophen plus codeine or ketorolac to control pain after surgery. When looking at post-op bleeding rates among patients who received ibuprofen, the researchers did not find higher rates of bleeding compared with those taking other painkillers.

The results show that the NSAID could help boost a multimodal regimen and avoid adverse effects associated with the use of opioids. The researchers write, "Over-the-counter analgesics like ibuprofen are more cost effective given their effectiveness in pain control, well-established public tolerance and low-risk qualities for abuse."

Kendal Gapinski

InstaPoll: When Did Your Last Sharps or Needlestick Injury Occur?

Needlesticks and other sharps-related injuries that expose workers to bloodborne pathogens continue to be a significant occupational hazard for those who work in surgery. Tell us when a surgeon or staff member last suffered a sharps injury in this week's InstaPoll, and check back here next week for the results.

The overwhelming majority (81%) of the 250 respondents to last week's poll gave itself high grades for patient safety, even though some observers contend that patients are no safer today than they were years ago. The results:

Patient safety is ______ than it was 10 years ago.

  • much improved 47%
  • somewhat improved 34%
  • about the same 11%
  • somewhat worse 8%
  • much worse 0%

Dan O'Connor

News & Notes
  • Clear the air with AORN "Go Clear," AORN's new surgical smoke safety program, is designed to renew facilities' focus on recommended practices for reducing the occupational hazard. Facilities that achieve a smoke-free environment can earn a designation from the organization that certifies their commitment to employee and patient safety. The Go Clear campaign, sponsored by Medtronic through the AORN Foundation, is scheduled to launch late this summer and run for 3 years.
  • Blocks boost joint replacement outcomes Peripheral nerve blocks bring both clinical and economic benefits to hip and knee arthoplasty, say researchers who calculated post-op complications and resource utilization in more than 1 million patient cases taking place over 7 years for a study presented Saturday at the American Society of Regional Anesthesia and Pain Medicine's annual meeting.
  • FDA investigating counterfeit mesh Urogynecologic surgical mesh from Boston Scientific may have been manufactured from counterfeit material, says the FDA, which is investigating the issue to determine its potential effects and a possible response. While the FDA has not as yet received reports of adverse events from the product, the company is testing its safety and effectiveness. The company reported its concerns after obtaining the raw material for the mesh from a new supplier, a switch that does not require FDA pre-approval.