Medicare to New Facilities: Good Luck Getting Surveyed
Pay for Accreditation Rather Than Wait for a Free State Survey?
Expect a much longer than usual wait for a state Medicare surveyor to visit your new surgical facility. Citing an increase in the number of new providers applying to participate in Medicare and limited resources, CMS has directed state surveyors to give new Medicare applicants the lowest priority, according to a memorandum to state survey agency directors. CMS says it hopes that new providers won't wait for state survey visits and instead will decide to pay private accreditation organizations such as the Joint Commission, AAAHC or AAAASF to provide Medicare-deemed status through accreditation surveys.

"While the applicant will pay a fee to the [accrediting organization] for the initial survey, applicants may conclude that the benefits outweigh the expense, particularly the expense of time waiting for a no-cost survey," reads the memo.

Since 2002, the number of Medicare-participating ASCs has increased by 38.4 percent, says CMS.

"Many providers have preferred to have state agencies conduct the initial Medicare certification survey because the state surveyors do not charge for the surveys," says healthcare lawyer Nate Gilmer of Waller Lansden Dortch & Davis. "CMS's new survey directive will undoubtedly change this practice, as few new providers will be willing to wait for the state surveyor to make it to the end of their priority lists."

Mr. Gilmer adds that CMS is shifting the financial burden of the Medicare initial survey to providers by forcing them to use third-party accreditation. He says some providers have complained that accreditation standards are needlessly technical, subject to frequent change and are not well suited to their organizations.

— Dan O'Connor

Beyond Red Light, Green Light: Ohio Wristbands Standardizing for Safety
Colored wristbands can alert providers to patients requiring special care, but only if the providers know what the colors mean. A recent study of the wristbands used in Ohio healthcare facilities found 19 colors used to signal 28 different conditions. That's why the Ohio Patient Safety Institute is promoting the statewide adoption of standardized colors for healthcare wristbands: white (or clear with a white insert) for patient identification, red for patients with allergies, yellow for those at risk of falling and green for those using blood products requiring special attention.

The Columbus-based group, a project of the Ohio Hospital Association, Ohio State Medical Association and Ohio Osteopathic Association, began promoting its color standards in September to reduce providers' confusion as well as their reliance on wristband signals. Their eventual aim? Statewide use of just a patient ID bracelet, bar-coded for electronic tracking.

"Reducing the number of colors used does improve safety," says Tiffany Himmelreich, a spokeswoman for the OPSI. "But also, as it is with anything in healthcare, any time you rely on humans, there is a potential for error."

The group's efforts were sparked by a December 2005 incident in which a Pennsylvania nurse accidentally placed a yellow "do not resuscitate" wristband on a patient because the yellow bands meant "restricted extremity" at another hospital she'd worked at.

The results of a survey measuring implementation and compliance are expected in January, says Ms. Himmelreich, but early responses have already been forthcoming. "Quite a few hospitals have reported back and told us that they have adopted the standardized system or are considering it," she says.

— David Bernard

In the Know

• Outpatient Surgery Magazine Announces Winner of Apple iPhone. Greg Easom, RN, BSN, was pleasantly surprised when we called to let him know he'd won an Apple iPhone. The clinical director of the Idaho Urologic Institute participated in our "Council on Advertising Effectiveness" and was randomly selected from a pool of 246 participants for the grand prize. To see a list of current reader surveys and contests, visit www.outpatientsurgery.net/surveys.
• 4,000 Facilities for ASCA? About half of the nation's surgery centers belong to either FASA (2,600 members) or the soon-to-be defunct American Association of Ambulatory Surgery Centers (675). Craig Jeffries, executive director of the AAASC, was recently quoted as saying that the long-term goal of the merged trade group, the Ambulatory Surgery Center Association, is to grow to 4,000 facilities, or 80 percent of the industry.
• Profiting from Pathology in Peril. Surgical centers that set up off-site laboratories to provide pathology services will have a harder time profiting from such arrangements under new anti-markup rules announced last month. CMS's expansion of the Medicare anti-markup rule could end many of these arrangements by eliminating the profit margin for the billing group, says Nora Liggett, a healthcare lawyer with Waller Lansden Dortch & Davis. The anti-markup rule prohibits a physician from marking up the technical component of certain diagnostic tests purchased from or reassigned by outside suppliers. The expanded anti-markup rule will also apply to the professional component of diagnostic tests and technical services that are not performed in the office of the billing physician.

Medical Tourism With a Twist
U.S. Institutions and Physicians Get Their Feet Wet
The more than 500,0000 Americans who go abroad for $850 rhinoplasty procedures and cardiac surgery for less than $5,000 have caught the attention of U.S. healthcare providers, who are jumping into the medical tourism market.

World-famous American medical schools are teaming up with offshore healthcare providers to create hospitals and clinics, some with Joint Commission accreditation, to cater to Americans, Canadians, Britons and wealthy locals. Harvard has a relationship with Wockhardt Hospitals, a for-profit chain in India; Johns Hopkins sponsors Hospital Punta Pacifica in Panama; and Duke University is partnering in a $300 million project to create a medical school in Singapore.

Even regional health networks are getting into the act. In 2001, Dallas-based Christus Health bought 51 percent of Muguerza hospital network and began an expansion. Now Christus Muguerza owns five hospitals and several clinics in Mexico. In September, the Christus Muguerza Alta Especialidad Hospital in Monterrey, Nuevo Le??n, became the first Joint Commission-accredited hospital in Mexico.

In Reynosa, Tamaulipas, across the Rio Grande from McAllen, Texas, Christus Muguerza is building a prototype small hospital with outpatient surgery facilities. The model could be reproduced in 44 communities throughout Mexico, says Peter Maddox, senior vice president for business, strategy and corporate development at Christus Health.

U.S.-based surgeons are also going international. Last year, Planet Hospital, a medical tourism planning agency based in Calabasas, Calif., launched a program that matches patients with U.S.-based physicians who consult with the patient first in the US, perform the procedure in a foreign hospital and then continue caring for the patient when he returns to the United States.

— Kent Steinriede