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Archive December 2002 III, No. 12

This Just In...

New CASC Credential to Recognize and Reward Outpatient Surgery Administrators

Bill Meltzer

BIO

Your Name Here, RN, MBA, CASC
New 'CASC' Credential to Recognize and Reward Outpatient Surgery Administrators

Many other healthcare professions have credentials to lend legitimacy to their field, so why not outpatient surgery? That's the thinking behind the Federated Ambulatory Surgery Association's "CASC" (Certified Administrator Surgery Center) credential, the first credential that designates expertise in ambulatory surgery administration. "This certification will bring a new level of respect to ASC administrators," says one of the 91 administrators who paid $750 to sit for the first 200-question CASC exam in St. Louis in September. FASA plans two CASC exams for 2003: May 8 in Boston and Sept. 13 in Las Vegas. You can download an application at www.aboutcasc.org.

"ASC administrators have to assume so many roles," says FASA executive director Kathy Bryant. "This exam assesses whether they meet the industry standard."

"As more administrators take the exam, the ?CASC' credential will become a valuable asset in the ambulatory surgery field," says Jerry Henderson, RN, CNOR, CASC, executive director at the Surgicenter of Baltimore.

You may also like to consider the Association of periOperative Registered Nurses (AORN)'s Ambulatory Surgery Administrator Certificate Program, a continuing education program for new or future ASC administrators. The program includes a two-day seminar and 11 online courses, covering topics from daily operations to regulatory requirements. For more information about the AORN's Ambulatory Surgery Administrator Certificate Program, visit www.aorn.org/education/amb.htm.

- Kristin McKee

ASC Reimbursement
CMS to Add 400-plus CPT Codes for ASC Procedures

The long wait for Medicare to update the list of reimbursable surgeries at ambulatory surgery centers is almost over. CMS is expected to publish a notice in the Federal Register that will add more than 400 CPT codes for ASC procedures. All specialties will be affected, especially ophthalmology, ophthalmic dermatology and ENT surgery, says American Association of Ambulatory Surgery Centers (AAASC) legal counsel Eric Zimmerman.

"The larger issue of completing a cost analysis and re-basing ASC payment rates still remains to be accomplished," says Craig Jefferies, executive director of the AAASC. "But this is a very important step for both ASCs and Medicare patients. Now these patients can receive services they previously could not in a preferred surgical setting."

Meanwhile, physician reimbursement rates will continue to drop in all healthcare settings. CMS reimbursements to surgeons operating on Medicare patients will drop by an estimated 4 percent in 2003 after a 5.4 percent decrease in 2002.

Patient Risk Assessment
Study: Ambulatory Surgery Patients Who Smoke at Higher Risk of Surgical Complications and Infection

Patients who smoke have markedly higher risks for developing respiratory complications and wound infections than non-smokers, according to a study of 484 patients undergoing ambulatory surgery at a hospital in Victoria, Australia.

The rate of such respiratory complications as apnea, bronchospasm, laryngospasm and coughing, for smokers was 32.8 percent compared to 25.9 percent for non-smokers. Smokers sustained surgical wound infections that required antibiotic therapy at a rate of 3.6 percent as opposed to 0.6 percent of non-smokers.

"It is legitimate to consider smoking status as one of the risk factors involved in assessing a patient for ambulatory surgery, although it is not a counter-indication of the same magnitude as morbid obesity," says researcher P.S. Myles, MD.

Single-use Devices
The Not-so Hidden Dangers of Reusing Needles and Syringes

About one healthcare provider in 100 reuses the same needle and/or syringe on multiple patients, according to findings released by the American Association of Nurse Anesthetists (AANA). This finding is based on random nationwide telephone surveys of anesthesiologists, CRNAs and other physicians and nurses. Although this percentage seems low, two recent episodes highlight the risk of exposing patients to bloodborne pathogens:
  • A nurse anesthetist who reused a needle and syringe to inject pain medication through IV tubing on multiple patients at two surgicenters and a pain management clinic in Oklahoma is to blame for infecting more than 50 patients with hepatitis C.
  • Last year, 12 patients in a Brooklyn endoscopy clinic developed hepatitis C reportedly after an anesthesiologist reinserted used needles into sterile, multi-dose medication vials.


"There is no excuse for ever reusing a syringe or needle on different patients. Whether it's a needle or a needleless device, reuse is a practice expressly forbidden by our organization, the ASA (American Society of Anesthesiologists) and virtually every organization concerned with infection control from bloodborne pathogens," says AANA president Rodney Lester, CRNA, PhD.

Fast Tracking
Are You Equipped to Fast Track Your Knee Surgery Patients?

A University of Pittsburgh study of 894 patients undergoing outpatient sports medicine knee surgery revealed that, under prescribed conditions, the vast majority of these patients can be fast-tracked successfully. Many of the patients in the study had invasive knee surgery. When invasive surgery was planned, the patient was given femoral, with or without sciatic nerve blocks (based on the surgical invasiveness).

The study measured different anesthesia techniques (general versus regional) and quantified the subsequent post-op care necessary. Some key findings:
  • 87 percent of patients were able to bypass PACU and go to phase II (step down) recovery
  • 91.5 percent bypassed PACU when general anesthesia (secured airway, volatile anesthetic agent) was not used
  • 75.8 percent bypassed under volatile general anesthesia
  • Of the patients requiring PACU care, only 19 (or 16 percent) required additional nursing interventions in step down.
  • However, 31 percent of the PACU bypass patients required at least one nursing intervention in the step down phase.
  • There were fewer unplanned hospital admissions (0.007 percent) among the fast-tracked patients with no reportable adverse events.


A crucial pre-requisite for fast-tracking these cases is having top-notch pain management techniques in place at your facility, says Brian Williams, MD, an assistant professor of anesthesiology at University of Pittsburgh. Otherwise, says Dr. Williams, "it's ill-advised to bypass PACU with these patients." He also recommends routine antiemetic prophylaxis before or during surgery.




A Roanoke, Va., church is slated for demolition so that The Carilion Health System, which owns the church, can convert the site into an outpatient surgery center

...CMS will pay $625 for Given Imaging, Inc.'s ingestible camera-in-a-pill device and related hospital costs. A payment for physician fees is expected in January

...You can read back issues of Outpatient Surgery's E-Weekly Newsletter at www.outpatientsurgery.net/newsletter

...The Department of Health in DC proposed eliminating physician supervision of CRNAs and giving nurse anesthetists the ability to determine the technique and administer general, regional, inhalational and intravenous agents as well as independently diagnosis and treat adverse reactions. Similar debates are ongoing in Alaska, Kansas, Kentucky, New Mexico, North Dakota, Oregon, Washington State and Wisconsin. Texas and Missouri recently indicated that mandatory physician supervision would not be removed

...AORN helped launch a "Patient Safety First" initiative (www.patientsafetyfirst.org) to help surgical nurses make their environments safer for patients and nurses

...Efforts to expand access to expensive, yet often cost-effective cochlear implants may be impeded by insurance reimbursement levels, a study has found. Medicare sometimes and Medicaid often fails to cover surgeon costs of aural rehabilitation, according to surveys of physicians and audiologists. Under Medicare, in 1999 hospitals lost more than $5,000 per device for each outpatient surgery. Medicaid device payment policies vary greatly and fail to cover costs in at least 18 states

...Medical devise reprocessing company Surgical Instrument Services and Savings Inc., has changed its name to MediSISS.
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