Re: "Managers Get Tough on Implants" (July, page 62). We recently began using a third-party implant billing service and have found that some insurance companies won't pay for the implant through the billing service. The billing service then bills the patient. These patients are very angry when they get a bill for the implant from a company they've never heard of. We've had to deal with this twice now. A word of warning: Find out which insurance companies will pay for implants through billing services.

Steven H. Smith, RN
Director, Surgery Center of Wisconsin Rapids
Wisconsin Rapids, Wisc.
writeMail("[email protected]")

Issues in Reprocessing
Re: "Pitfalls to Avoid in Instrument Reprocessing" (August, page 58). I know you cannot name brands, but there are a number of popular instrument cleaners that are too caustic for surgical instruments. You should be looking at the pH and trying to get a near-neutral pH cleaner.

Rita Clissold
Materials Manager
Doctors Surgical Center
Houston, Texas
writeMail("[email protected]")

I would have liked more information on fine ophthalmic instruments as well as the marking and taping of instruments for sets.

Barbara Abbott, RN
Surgical Services
Clinical Coordinator
Huntington Beach Hospital
Huntington Beach, Calif.
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This will provide good information to the instrument technician. I would have liked to have read more on the care and processing of delicate instruments.

Mary Blackwell, BS, RN
Clinical Administrator
Medicus Surgery Center
Anderson, S.C.
writeMail("[email protected]")

Thanks for ASC Payment Update
Re: "Dissecting the Revised ASC Payment System" (August, page 30). It's great to have a resource that can provide fast-track updates to help me stay current with the changes. Thank you again for your magazine and the informational resource. They're both greatly appreciated.

Carol Gawrys
Billing and Collection Manager
Center for Ambulatory Surgery
West Seneca, N.Y.
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Setting the Record Straight on Patient Safety
Re: "The Spotlight Grows on Outpatient Surgery" (USA Today, July 30). The article profiles a patient who had an allergic reaction to anesthesia and began having muscle convulsions shortly before a sinus procedure at an outpatient facility. Now, according to the article, the patient isn't sure he'd go back.

But the patient's reaction to the anesthesia could have been the same in a hospital setting. Connecticut is fortunate to have a high standard of regulation in place to ensure the safety and well-being of its patients regardless of whether a patient chooses to go to the hospital or to an outpatient setting. A balanced article would have addressed these issues.

Connecticut surgery centers must have an agreement with a hospital to transfer patients and emergency procedures. When using anesthesia, Connecticut physicians can't provide care without a special licensure from the Connecticut Department of Public Health. The facility must also be licensed and accredited. And every surgery center must belong to a patient safety organization that reviews quality and safety. These are important points to consider that were surprisingly absent from this article.

Ken Rosenquest
Administrator
Constitution Surgery Centers
Newington, Conn.
writeMail("[email protected]")

Pre-op Cardiac Work-up
Re: "How Much of a Cardiac Work-up Is Too Much?" (July, page 22). It seems ironically timely with the death of a local TV and radio personality on KGO in San Francisco, Pete Wilson, who died from undiagnosed coronary artery disease during a seemingly routine hip replacement at Stanford Hospital. It is obviously an issue of growing importance with the aging of the baby boomers.

Ted Kucklick
CTO & VP, Research and Development
Cannuflow
San Jose, Calif.
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Nurse Ida Know
w Re: "It's Not My Fault" (July, page 96). I laughed and laughed at your list. I have been an RN in the OR for 39 years and I have heard every one of these. Thanks for the fun.

Nina Merklin, RN
South Sound Surgery Center
Olympia, Wash.
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Still Smoking in the OR
Re: "Making the Case for Smoke Evacuation" (August, page 53). With everything we've known about the hazards of surgical smoke for more than 15 years, it's hard to believe that staff and patients continue to be exposed to it every day.

Name withheld upon request