Celebrating Nurses’ Monumental Impact
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By: Zzz Zzz
Published: 10/10/2007
From Outpatient to Overnight
Ohio ASC Expanding Into Physician-owned Hospital
Newark Surgery Center in Newark, Ohio, isn't the only surgical option available to Licking County residents and the physicians who'll operate on them. The facility faces competition from the 161-bed Licking Memorial Hospital, also in Newark, and even from the Ohio State University Medical Center, 40 miles west in Columbus. Yet market research surveys have shown that 50 percent of Licking County's residents who've sought surgical care have done so outside the county.
That's why the 9-year-old, three-OR, physician-owned, multi-specialty outpatient surgery center is undergoing an expansion that will later this year convert it into the Medical Center of Newark, a 22-bed inpatient hospital, says Laurie Eberly, the surgery center's chief operating officer.
The $15 million expansion - to be completed early this year - will add 45,000 square feet, including a fourth OR, an emergency room, a laboratory and a pharmacy, to the 15,000-square foot ASC and connect it to a 7,500-square foot imaging center on the physician-owned medical campus. Currently licensed by the state to perform only procedures requiring a 23-hour or less recovery stay, the facility is slated to go 24/7 by October.
Because the facility will be opening as a general acute care hospital, it sidesteps any complications that the state's 90-day moratorium on the building of specialty hospitals - scheduled to take effect in the spring - may have caused. Its plans were criticized, however, by Licking Memorial Hospital administrators for oversaturating the market.
While Ms. Eberly says the ASC's founders see the transition from outpatient surgery to overnight services as "a natural progression," she also acknowledges the conventional wisdom that warns small, efficient ASCs to avoid the size, expense and bureaucracy that can encumber hospitals.
"We have the advantage of coming from an [ASC] environment," says Ms. Eberly, explaining that a focus on customer service for patients - including a direct telephone number to the pre-op triage nurse on its Web site instead of an e-mail address and complimentary valet parking for surgery patients and family members - "will keep all eyes on the facility's primary purpose."
- David Bernard
A Threat to Liposuction?
Lipid-dissolving Treatment Claims to Melt Fat Away
It doesn't suck. It dissolves fat away." With these seven words, Advanced Lipo Dissolve Center in St. Louis is promoting an injectable called Lipodissolve (www.lipodissolve.com) as an alternative to liposuction in several markets.
According to David Caplin, MD, medical director at Advanced Lipo Dissolve Center, the treatment is a compound of phosphatidylcholine, a polar lipid molecule, and deoxycholate, a bile salt. The compound is said to break down the fat cell wall, which the body then metabolizes along with the cell's contents - or, in layman's terms, it literally melts fat away.
Dr. Caplin says the price varies by the number of body parts being treated. On average, he says, most patients require about six treatments spaced about two weeks apart at $400 per injection. The length of treatment can be as short as three months or as long as 12 months, depending on how long it takes the skin to contract after a treatment. Each injection only takes minutes to perform and generally no bed rest or reduced activity is necessary afterwards.
"Lipodissolve is a non-surgical technique designed to eliminate fat in areas that don't respond to diet and exercise," says Dr. Caplin. "Liposuction is a surgical technique with the same goals although it is capable of removing significantly larger quantities of fat than the quantities targeted by Lipodissolve."
Arnold M. Rotunda, MD, of the department of dermatology at the University of Southern California School of Medicine, who has published a few studies on this therapy, says it seems to be effective, particularly due to the way deoxycholate can remove small deposits of adipose tissue. "It does work, there's not doubt about that," he says. In his practice, he says he sometimes uses just deoxycholate for small injections. "I feel more comfortable using deoxycholate alone. It's safe and stable at a molecular level."
Allen Matarasso, MD, a Manhattan plastic surgeon and president of the New York Regional Society of Plastic and Reconstructive Surgeons, is concerned that Lipodissolve and other mesotherapies where numerous concoctions can be injected into the skin's mesoderm layer could have a varying range of ingredients. "There is no standard formulation of these products, and that is a concern," he says. Dr. Caplin says all the ALDC centers use the same combination of phosphatidylcholine and deoxycholate.
Dr. Matarasso doesn't see Lipodissolve as a threat to liposuction but rather as an adjunct therapy for body contouring procedures or for patients who aren't good candidates for liposuction.
- Nathan Hall
Medicare's Proposed ASC Payment System
GAO Report Good News?
A new government study expected to influence CMS's final rule on the restructuring of the outpatient payment system shows that ASCs' costs, while significantly lower than hospitals', far exceed proposed payments. The long-awaited GAO report backs linking ASC and hospital rates, as proposed by CMS in August. It also reveals that ASCs' costs are 84 percent of current hospital payments - a far cry from the 62 percent of payments the government has proposed.
"The GAO report clearly shows that for the services currently performed in ASCs, 62 percent of the hospital rates falls woefully short of the cost of providing ASC services to Medicare beneficiaries," says Craig Jeffries, executive director of AAASC.
Overall, the GAO found that ASCs operate at just 39 percent of hospitals' costs. However, notes AAASC, many of those procedures are rarely or never performed, and it is the "analysis that account[s] for the procedures actually performed in an ASC" that is most important. That weighted figure is 84 percent of payments.
Further, notes Kathy Bryant, the president of FASA, the report shows that both ASCs and hospitals bill for diagnostic, laboratory and imaging services added to the top 20 ASC procedures at very similar rates. Despite the similarity of these figures, hospital costs were 104 percent of payments, meaning ASCs perform at 81 percent of hospital costs for the same procedures.
"If the government gives us the 75 percent of hospitals' rates that we've been asking for, it'll still be getting a bargain," says Ms. Bryant.
- Stephanie Wasek
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