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Publish Date: October 10, 2007   |  Tags:   News

Working on the Weekends
Who's Opening Their ORs on Saturdays?
How much longer will Saturday be a day of rest in outpatient surgery? More than one-fifth (21 percent) of hospitals perform non-emergency outpatient cases on Saturdays, according to our reader survey. And while only 2.4 percent of ambulatory surgery centers we surveyed are doing so now, another 4 percent are thinking about adding weekend surgeries.

"It's a nightmare to get people to come in on the weekends," says Venetia Sharpe, MHA, of Midlands Endoscopy Center in Irmo, S.C. "Physicians love it for a while and then they figure out they're giving up their golf day and it just becomes another work day."

When the GI doc asked if he could bring his cases to the Clifton Surgery Center in Clifton, N.J., on Saturdays, the administrator and physician-owners had two questions: How many cases will you bring and what's our break-even point? When the answers came up six and four, they figured that was better than the 12-year-old multi-specialty facility sitting vacant two days a week.

"If we could accommodate him and not lose money, we'd do it," says administrator Alan M. Leventhal, MBA, who offered staff time-and-a-half to work 7 a.m. to 11 a.m. Saturdays.

North Miami Beach Surgical Center's trial run at weekend surgery lasted six weeks and 12 urology cases. "It was costing us more to staff the OR than we were reimbursed," says business office manager Lucy Jeanlouis.

Saddleback Memorial Hospital in Laguna Hills, Calif., also pulled the plug on Saturday surgery. After running two of its seven ORs until 11 p.m., Saddleback decided to give Saturdays a try. The problem: Surgeons were doing more semi-urgent than elective surgery, says Marie Paulson, RN, BSN, MS, executive director of surgical services. Plus, she says, everything from getting transportation to getting supplies seemed to take more time and effort. "In the docs' minds, it took longer to do things on Saturday," says Ms. Paulson.

Do You Perform Surgery on Saturdays?

Most centers schedule outpatient surgery only Monday to Friday during the morning and afternoon, which staff members love because they don't have to work nights or weekends. Our online survey found that more than a few facilities are doing or thinking about doing elective cases on Saturdays.

ASCs (n=130)

HOPDs (n=68)

Yes 2.4%

Yes 21%

No 91%

No 68%

No, but we plan to 4%

No, but we plan to 1.4%

SOURCE: Outpatient Surgery Reader Survey, December 2004

Another consideration: Surgery on Saturdays doesn't give patients enough time to recuperate by Monday. "That's why patients like to have cases on Thursday or Friday - so they have the weekend to recuperate," says Ms. Paulson.

Bothwell Regional Health in Sedalia, Mo., does outpatient cases on Saturdays, but patients must wade through the inpatient admissions, says Sue Brauer, RN, the clinical director.

Michelle Ziegler, RN, the director of surgical services at Bay Park Community Hospital in Oregon, Ohio, anticipates running one OR for a half day on Saturdays as a release valve for a heavy weekday caseload. Her six ORs typically run past dinnertime. "Some of our surgeons would actually like [it] now, but we're not yet completely filled during the week," says Ms. Ziegler. "Staff will grumble. It's a sensitive issue. Is it worth doing?"

- Dan O'Connor

Hospital and ASC Dig in for Courtroom Battle
Hospital's Economic Credentialing Could Violate Antitrust Laws, Says Judge
Economic credentialing by a hospital could be considered anticompetitive behavior in violation of antitrust laws, according to a federal judge's decision in an ambulatory surgery center's claim against a community hospital.

The lawsuit that will proceed, brought by Rome Ambulatory Surgery Center against Rome (N.Y.) Memorial Hospital, stems from a claim by the ASC's physician-owners that the hospital's actions forced their facility to close in January 2001.

The battle between the hospital and ASC began when Rome Memorial unsuccessfully opposed the surgery center's application for a CON, according to court documents.

Once the center opened in 1999, Rome Memorial amended its bylaws to terminate hospital privileges for physicians affiliated with Rome ASC and signed damaging exclusive contracts for ambulatory services with the area's two largest third-party payers: MVP Health Plan and Blue Cross Blue Shield.

Court documents show Rome Memorial obtained an exclusive deal with MVP for three years, and agreed to offer reduced rates for ambulatory surgery from the hospital.

In 2000, Rome ASC wanted a 25-percent rate increase from BCBS in its next contract, and BCBS received what it considered to be an unfavorable report concerning Rome ASC's financial status and plans, say the court papers. In November 2000, BCBS entered into a two-year contract with Rome Memorial, which gave the hospital exclusivity in ambulatory surgery. Whether Rome ASC's request for a rate increase or the actions of Rome Memorial were a factor in the hospital's deal are in dispute. The physician-owners claim the hospital's exclusive contract with BCBS was the final dagger, and less than a month later, the surgery center closed.

No date has been set for the case that could have a widespread effect on the nationwide battle between community hospitals and ASCs.

"This is the first case that will bring the behavior of hospitals to the forefront," says William Kopit, Esq., the lawyer for the Rome ASC.

Mr. Kopit says the jury's decision will determine the type and extent of anticompetitive behaviors hospitals may conduct. "This decision will have a temporizing impact on hospital conduct," he says. "It might make them a little more leery about what they can do to protect their own interests."

Thomas Buckel, Esq., the lead council for Rome Memorial, says the jury's verdict will be telling. "This case will help define what is a legitimate response by hospitals to competing facilities," he says.

- Daniel Cook

10 Cosmetic Plastic Surgery Predictions for 2005
The American Society for Aesthetic Plastic Surgery's predictions for cosmetic surgery in 2005.

1. National attention to patient safety issues will result, in some states, in more stringent requirements for physician credentials to perform cosmetic surgery.

2. Endoscopic facial rejuvenation procedures and suture suspension techniques may become more popular.

3. Experimental techniques for non-invasive fat removal, as a future alternative to liposuction (lipoplasty) surgery, will be tested in clinical trials.

4. The number of patients seeking plastic surgery for body contouring after dramatic weight loss will rise by 20 percent.

5. Cosmetic surgery for racial and ethnic minorities in the United States will continue to rise, exceeding 20 percent of the total procedures performed.

6. Hyaluronic acid (Restylane, Hylaform) will surpass collagen as the most popular soft-tissue filler for lines and wrinkles.

7. In cosmetic surgery, more patients will express a preference for classical facial features, and more women will opt for smaller-sized breast implants.

8. More plastic surgeons will offer lifestyle assessment and counseling to their cosmetic surgery patients.

9. Developments creating the biggest buzz: a new generation of breast implant fillers and coatings; advanced lasers that rejuvenate the skin from the inside out; new products for scar management and prevention of keloids; and permanent injectable treatments for facial lines and wrinkles.

10. Reality TV programs featuring plastic surgery might lose their appeal. The long-term psychological effect of undergoing a dramatic change in appearance from simultaneous multiple-procedures may surface.

FDA Urges Caution When Using COX-2 Inhibitors
The FDA has issued an advisory because recently released data from controlled clinical trials shows the COX-2 selective agents (Vioxx, Celebrex and Bextra) may be associated with an increased risk of serious cardiovascular events (heart attack and stroke), especially when they are used for long periods of time or in very high-risk settings (immediately after heart surgery).

Also, preliminary results from a clinical trial suggest that long-term use of a non-selective NSAID, naproxen (sold as Aleve, Naprosyn and other trade names and generic products), might be associated with an increased cardiovascular risk as compared to a placebo.

Although the results of these studies are preliminary and conflict with other data from studies of the same drugs, FDA is making the following interim recommendations:

  • Physicians prescribing Celebrex (celecoxib) or Bextra (valdecoxib) should consider this emerging information when weighing the benefits against risks for individual patients. Patients who are at a high risk of gastrointestinal (GI) bleeding, have a history of intolerance to non-selective NSAIDs, or are not doing well on non-selective NSAIDs may be appropriate candidates for Cox-2 selective agents.
  • Individual patient risk for cardiovascular events and other risks commonly associated with NSAIDs should be taken into account for each prescribing situation.

- Yasmine Iqbal

Fast Tracks\

JCAHO Warns on Patient-controlled Analgesia
The JCAHO has issued a Sentinel Event Alert on patient-controlled anesthesia (PCA) errors by proxy - those that occur when unauthorized family members, caregivers or clinicians administered the analgesia for the patient. To prevent such errors, the organization recommends developing criteria for selecting appropriate patients to receive PCA; carefully monitoring patients who do receive it; teaching patients and family members about the proper use and dangers of PCA; warning staff of the dangers of PCA by proxy administered outside protocol; and placing warnings on PCA-delivery devices that only patients should administer the dose.

Migraine? Pop a Botox Injection
A combination of Botox and surgery can help treat migraines in chronic sufferers, according to a study published in the January Plastic and Reconstructive Surgery. Researchers treated 100 chronic-migraine patients with botox injections to identify migraine trigger sites; 25 served as controls. Eighty-nine patients in the treatment group noted improvement in their symptoms for four weeks and subsequently underwent surgery to deactivate migraine trigger sites. The results: 82 (92 percent) had at least 50 percent reduction in migraine frequency, duration or intensity; and 31 (35 percent) reported migraine elimination. In addition, the mean annualized cost of migraine care for the treatment group was just $925, compared with the baseline expense ($7612) and the control group ($5530).

Fast-tracking Fast for Whom?
Bypassing Phase I recovery after outpatient procedures may not affect nurses' workload and associated costs, according to a study of Canadian doctors published in the December issue of the British Journal of Anesthesia. The study found that fast-tracking reduced time from awakening to discharge by an average of 17 minutes, but the findings also suggest two possible reasons why bypassing the PACU could not lead to decreased total nursing workload. First, the extra post-op monitoring received by PACU patients in the early phase of recovery represents only a tiny proportion of the overall nursing workload. Another possible explanation could be that patients undergoing the routine recovery process in this study also had decreased postoperative nursing interventions as a result of receiving an effective fast-track anesthetic technique.

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