Reimbursement Changes
FASA Hoping ASC Rates Will Be Linked to Hospital Rates
Hospital outpatient department payments will increase 3.5 percent next year under the proposed rate schedule for 2003. The question on everyone's mind, though, is how the Medicare rates for procedures performed in ambulatory surgery centers will compare with those for the same procedures when performed in hospital outpatient departments.

ASC rates have not yet been re-based, although Kathy Bryant, executive director of the Federated Ambulatory Surgery Association (FASA), reports that progress is being made in developing a new methodology for ASC reimbursements, with direct linkage to the generally higher hospital rate remaining one of the main alternatives to the present system that is under consideration. Here are some of the key features of the proposed hospital payment schedule:

• Colonoscopy gets the biggest reimbursement increase, climbing 18 percent.
• There will also be a meaningful jump in certain ophthalmic procedures, such as cataract extraction/IOL insertion (CPT 66984), which will increase 16 percent (from $1,055 to $1,226.89).
• For the first time, Medicare will pay for hospital outpatient services on a rate-per-service basis that varies according to the APC group to which the service is assigned. Theoretically, at least, this should result in reimbursements being more reflective of real-life cost data, the addition of new services and changes in technology.
• The new rule also includes a proposed method for incorporating the costs of certain drugs and devices that currently are being paid under a cost-based, transitional pass-through payment methodology.

- Bill Meltzer

ISO Anesthesiologists?
Here's a Web Site Worth Bookmarking
Is the anesthesiologist provider shortage as dire as some have said? Depending on whom you ask, the glass is either half empty or half full.

"There are many medical specialties facing shortages, including an imminent shortage of anesthesiologists," says Ed Salsberg, director of Center for Health Workforce Studies at the New York State University in Albany.

On the other hand, "the profession has been notorious in its ineptitude in predicting work needs," says Jeffrey Katz, MD, Associate Professor of Anesthesiology at Northwestern University. "I still remember predictions that there would be a huge need for anesthesiologists in the late 90s. They were dead wrong. I think they'll be wrong about this shortage as well."

Regardless, we thought you'd be interested in bookmarking www.gasjobs.com, which bills itself as "the Web's free anesthesia employment resource." The site lists job opportunities for both anesthesiologists and CRNAs. Providers can search the job listings by the state(s) of their choosing and facilities have the ability to review resumes posted by job seekers.

- Bill Meltzer

Allograft Infection Alert
Controversy Grows Over Regulation of Donated Tissue
In light of the news that the FDA shut down a large portion of the CryoLife Corporation, the nation's largest processor of donated human tissue, the spotlight on the regulation of tissue banks has become more intense. But Bob Rigney, CEO of the American Association of Tissue Banks, notes that the FDA has been regulating tissue banks since 1993. Last year, FDA conducted 132 inspections of tissue facilities.

Surgeons implant more than 750,000 allografts each year and reports of infections resulting from contaminated donor ACLs, bone grafts and meniscal tissues continue to grow. Many point to lax oversight of tissue procurement and processing practices. To learn how your facility can safeguard against allograft infections, see "How to Guard Against Allograft Infections" on page 60.

- Bill Meltzer

What's in a Name?
What Makes It a 'Surgery Center?'
An Illinois law prohibits physician's offices from calling themselves "surgery centers" or "centers for surgery" to prevent any confusion between licensed ambulatory surgery centers and office-based facilities.

"Not all office-based centers bother to get accredited or meet the same licensing requirements as an ambulatory surgery center," says Mark Mayo, executive director of the Illinois Freestanding Surgery Center Association.

So far, the law has forced a group of podiatrists to change its name.

- Kristin McKee

Regulatory Update
HHS Publishes Final HIPAA Rule
Highlights of the final modifications to the Health Insurance Portability and Accountability Act (HIPAA):

• Marketing. Communicating with patients about treatment options or treatment-related products does not constitute using the patient's health information for marketing purposes. For example, informing patients about discounted prescription drugs for post-op pain will not require the patient's prior written consent.
• Simplification of authorization forms. Patients must grant advance permission for each type of "non-routine" disclosure of their health information, but providers will no longer have to use different types of forms.
• Good faith consent efforts. The "minimum necessary" consent rule removes mandatory consent requirements that could block access to care. As long as a good faith effort has been made to obtain written acknowledgement, treatment can proceed without a signature.

- Bill Meltzer


Hold off on performing arthroscopic surgery to relieve pain of osteoarthritis until further review, the Department of Veterans Affairs has advised its doctors after a study by V.A. researchers concluded that the operation was no more effective than placebo arthroscopy

...We've been told that the 1,673 pieces of scrubs that have "walked" out of a Pennsylvania surgery center in the last three years have cost the facility $14,000

...Reprocessing Class II devices without a cleared 510(k) is prohibited. To verify if a third-party reprocessor has received clearance for a particular medical device, go to www.accessdata.fda.gov.

...Around the country this summer, at least six hospitals have closed obstetric wards, others have curtailed trauma services and a string of rural clinics have been temporarily shuttered as a result of soaring costs for medical malpractice insurance..The medical board of Massachusetts has indefinitely suspended the license of David C. Arndt, MD, for leaving an anesthetized patient on the OR table with an open incision in his back while he ran a personal errand. The patient was left under the care of another surgeon who was not credentialed for the back procedure and had not scrubbed in

...A growing number of medical facilities are using palmtops for writing prescriptions, consulting reference manuals, keeping patient records and transmitting the records to a network server elsewhere in the facility...Two rural Vermont hospitals have elected not to seek JCAHO re-accreditation but rather to opt for a free accreditation process offered by CMS through Vermont's state health department, which will charge an assessment fee if more hospitals follow suit.

...Rubbing the hands with an aqueous alcohol product was as good as the standard scrubbing protocol with respect to rates of surgical site infections, a study found. Added benefits: less skin irritation and better compliance.