This Just In

Alternative Medicine
Study: Electro-acupuncture Reduces Post-op Pain and PONV
A high-tech, acupuncture-like therapy not only reduces nausea and vomiting after major breast surgery, it also has previously unknown pain-relieving properties. That finding, by researchers at Duke University Medical Center, appears in the Sept. 22 issue of Anesthesia & Analgesia.

In the trial, Tong Joo (T.J.) Gan, MD, an anesthesiologist and director of clinical research at Duke University Medical Center, used an electro-acupuncture device with an electrode - like that used in standard EKG tests - at the appropriate point. Instead of breaking the skin with the traditional long slender needles, the electro-acupuncture device delivers a small electrical pulse through the skin.

In this case, the point is known as P6, which is located along the pericardial meridian, 2 inches below the bottom of the palm of the hand and between the two tendons connecting the lower arm and wrist. According to Chinese healing practices, there are about 360 specific points along 14 different meridians, that course through the body just under the skin. This is the first study to show that P6 also has analgesic effects to go along with its known antiemetic properties.

About 70 percent of women who undergo major breast surgery requiring general anesthesia suffer from PONV, says Dr. Gan. In his study, Dr. Gan tracked 75 cancer patients recovering from major breast surgery. One group of women received electrostimulation after surgery, another received ondansetron (Zofran) and a third group received neither type of treatment. Two hours after surgery, 77 percent of the women receiving electrostimulation experienced no PONV and required no antiemetics. That compared with only 64 percent getting ondansetron and 42 percent of those who received neither treatment.

"Patients who received acupuncture enjoyed a more comfortable recovery: In the areas of PONV control, pain relief and general overall satisfaction, acupuncture appears to be more effective than the most commonly used medication, with few to no side effects," says Dr. Gan. "Electro-acupuncture enhances or heightens the effects of traditional acupuncture. Also, in the busy and complicated setting of the operating room, the electro-acupuncture device is much more convenient to use."

- Dan O'Connor

Medicare Payments
GAO Wants New Rate-setting For Hospital Outpatient Services
It's time to reconsider the hospital outpatient prospective payment system (HOPPS), says the Government Accountability Office (GAO). According to a GAO study released this month, CMS currently uses hospital claims to calculate costs and set payment rates, and has excluded more than 40 percent of multiple-service claims when calculating the cost of all HOPPS services, leading to potentially unfair reimbursement levels for drugs, devices and services.

The study was prompted by concerns of hospital officials and healthcare manufacturers that certain drugs and devices are not being reimbursed at levels that cover their costs, according to a GAO spokeswoman.

Multiple-service claims are excluded by CMS because they are difficult to associate with corresponding primary services, the study says. But the GAO says that excluding this data results in payment rates that might not accurately reflect hospitals' actual costs.

The report also claims that CMS assumes hospitals mark up the costs of services by the same percentage when setting charges within specific departments. Based on data collected from 113 hospitals, however, the GAO discovered charges varied significantly across hospitals and within departments.

- Daniel Cook

Court Upholds CONs in Georgia
' The Georgia Supreme Court has ruled that the state's CON regulations are constitutionally valid, denying an Albany, Ga., surgeon his bid to overturn the laws. John Bagnato, MD, and his five partners had challenged the CON statute on the basis it violates the state's separation-of-powers doctrine. The court disagreed, calling the CON regulations reasonable and saying the proposed surgery center requires a CON and doesn't qualify for the state's single-specialty exemption. Georgia has about 160 ASCs.

' The Florida Board of Medicine exceeded its authority when it started requiring an MD anesthesiologist to personally administer or supervise the administration of anesthesia for Level III surgery performed in doctors' offices, says Florida's Fourth District Court of Appeals. The ruling lets CRNAs in Florida administer all types of anesthesia in a doctor's office under the supervision of a physician, who can be the operating surgeon and not necessarily an anesthesiologist.

' A one-year moratorium on new ASCs in South Carolina hinges on a state Department of Health and Environmental Control board vote scheduled for Oct. 14, when approval of the state Health Plan to which it's attached will be decided. Hospitals have lobbied for the moratorium, but ASCs do have one voice on their side: Albert Whiteside, the DHEC director, in August recommended new standards instead of a ban to slow the pace of ASC construction.

Bariatric Surgery
Seven Patient Deaths Spur Gastric Bypass Ban in Iowa Hospital
Iowa Methodist Medical Center has suspended its gastric-bypass surgery program following the deaths of seven patients, hospital officials say. The seven deaths occurred in 348 bariatric cases, they say.

"That sounds like it's over the top," says Nancy Ridley, the director of the Betsy Lehman Center for Patient Safety in Boston, which along with the Massachusetts Department of Public Health recently issued comprehensive guidelines for bariatric surgery. "But the hospital did the right thing. Even really good programs will suspend procedures if outcomes are not good."

Both the hospital and Iowa Clinic cite dramatic increases in malpractice insurance rates as a major reason for the program's suspension. Iowa Methodist's decision may signal a nationwide trend - a reverse of the recent bariatric boom.

"I think there will be a slow down in the number of facilities offering the surgery," says Harvey Sugerman, MD, the president of the American Society for Bariatric Surgery. "Insurance companies will ratchet the numbers down; concerns over risks will make programs a little more cautious, as will potential problems with malpractice insurance."

Aetna and Cigna, for instance, are starting to exclude weight-loss surgeries from or make them optional parts of their plans, according to published reports. Individuals or companies who opt for such bariatric coverage will find themselves paying higher premiums. Coverage by Medicare and other insurers may increase. At a meeting next month, Medicare's advisers will assess the safety, efficacy and cost of increasingly popular weight-loss surgery as a first step in a new policy that could lead to the use of federal money to cover a range of other obesity treatments.

Denville Myrie, MD, will continue to perform the bariatric procedures at Iowa Methodist until Dec. 31, when the surgeries will be halted. A disappointed Dr. Myrie still believes in the procedure. "I encourage people considering weight-reduction surgery to explore other local or regional programs - with qualified bariatric surgeons and complete support systems," he says in a statement.

- Daniel Cook

Inside The Numbers
Cataract Surgery

• 3.4 million Number of cataract procedures (CPT 66984) billed to Medicare in 2003 by hospitals and ASCs
• 21% Percentage growth that represents over 2001 numbers
• $1.7 billion Amount paid to ophthalmologists for cataract surgery in 2003
• 1 Cataract surgery's (CPT 66984) rank among the most expensive surgical procedures paid for by Part B Medicare
• $973 Medicare ASC facility fee for cataract surgery with IOL
• $1,253 Medicare's allowed hospital facility fee for cataract surgery with IOL
• 68% Share of the cataract market commanded by freestanding ASCs in 2003
• 2 Number of percentage points ASCs have gained annually in market share since 2001
• 1,838 Number of Medicare-certified ASCs performing ophthalmic procedures
• 45.8% Percentage of Medicare-certified ASCs that represents