This Just In

Patient Safety
JCAHO Warns About Surgical Fires
JCAHO's latest Sentinel Event Alert report calls on hospitals and ASCs to reduce the risk of fires in operating rooms. The bulletin says surgical fires are greatly underreported and preventable, urges better reporting of such fires and offers risk-reduction strategies.

The FDA estimates that about 100 surgical fires happen each year, causing up to 20 serious injuries and one to two patient deaths. While JCAHO's patient-safety reporting database includes only two OR fires since 1996, the alert comes on the heels of these published reports of OR fires:

• Last June, Joan Faulkner of Raleigh, N.C., entered Franklin Regional Medical Center in Louisburg, N.C., for a biopsy and came out with second- and third-degree burns, which covered her face, neck and chest, and nearly killed her. She still faces several more reconstructive surgeries.
• On April 18, 8-year-old Andrew Garcia sustained burns to more than 40 percent of his upper airway after his endotracheal tube caught fire early during a tonsillectomy at San Jose Medical Center.
• On June 2, a newborn suffered first-, second- and third-degree burns on 5 percent of its body when a fire erupted during surgery at Duke Hospital's Pediatric Intensive Care Unit.
• On June 10, Melanie Allen of Sylacauga, Ala. was shocked into consciousness when she caught fire during a procedure at Montclair Baptist Medical Center in Birmingham, Ala. Ms. Allen, who had been undergoing the removal of a fatty tumor and a cyst, was burned on her face and into her nose and sinuses.

"The basic elements of a fire are always present during surgery, and a misstep in procedure or a momentary lapse of caution can quickly result in a catastrophe," says ECRI VP Mark Bruley.

Medicare Update
Specialty Hospital Provision Sparks Medicare Controversy
An amendment to the Senate version of the Prescription Drug and Medicare Improvements Act of 2003, sponsored by Sen. John Breaux (D-La.), would bar physician ownership in specialty hospitals (surgical, orthopedic, cardiac, and women's). The amendment would grandfather in surgical hospitals operating by June 12, 2003, or "under development as of such date." The House version of the bill includes a provision that calls for a MedPAC study of specialty hospitals. These provisions might change when the two chambers hold a conference committee to finalize the act.

Meanwhile, the Centers for Medicare and Medicaid Services (CMS) rescinded its proposal to ban physician self-referral to specialty hospitals in which doctors have a financial interest. The proposal was published in the May 27 Federal Register. CMS did not explain the withdrawal, but it appears to be related to Sen. Breaux's amendment.

Physician Reimbursements
House Considers Plan to Raise Medicare Payments by 1.5 Percent
After narrowly averting a budgetary plan that would have cut Medicare physician fees once again in 2003, the House of Representatives will now consider a bill to raise physician Medicare payments by 1.5 percent for the next two years. The bill passed the House's Energy and Commerce Committee 29-20.

HR 2473 would replace a CMS-predicted cut of 4.2 percent in 2004 with a minimum 1.5 percent increase in 2004 and 2005. It also would change part of the sustainable growth rate formula that is used to calculate the annual physician fee update by using a 10-year rolling, or average, gross domestic product.

Risk Management
Can NAPS Programs Jeopardize Your Facility Insurance?
One problem with Nurse Administered Propofol Sedation (NAPS) (see "RNs Pushing Propofol," page 24) is that many insurers do not want to risk defending potential claims arising from a sentinel anesthesia event related to a NAPS case, according to risk management expert Caryl Serbin, RN, BSN, LHRM. Ms. Serbin, the president of Fort Myers, Fla.-based Surgery Consultants of America, Inc., says the standards of care for the practice are not sufficiently established to convince many insurers to cover facilities that do NAPS, even if the state's Nurse Practice Act permits it and the facility has a competency protocol.

A Lloyd's of London medical underwriter echoes this view. He says that if the center had an accident involving the administration of propofol and the patient has a valid claim for damages, the RN, an employee of the center, would create direct liability for the center. More importantly, the insurer has no defense for a claim. "We'd have to write a blank check on the spot," he says. "I will not insure this risk."

ASC Procedure List
CMS Corrects 5 Errors
On May 30, CMS published in the Federal Register corrections to five errors in the updated ASC procedure list:

• CPT 21365 (Treat cheekbone fracture) should be listed as a deleted, not added, code.
• CPT 36819 (Atervenous anastomosis, open; by upper arm basilic vein transposition) should be listed as a Group III payment ($510).
• CPT 42415 (Excise parotid gland/lesion) should be listed as a Group VII payment ($995).
• CPT 52355 (Cystouretero w/excise tumor) should be listed as an added code available for public comment.
• CPT 54512 (Excision of extra parenchymal lesion of testis) should be listed as a Group II payment ($446).

Michael Romansky, Esq., calls the ASC Medicare procedure list a mixed bag.

• The good. MedPAC's recommendation to cap ASC facility fees at hospital outpatient department rates for any procedure has been delayed.
• The bad. The House Medicare reform bill calls for no ASC cost-of-living adjustment for five years.
• The status quo. There has still been no progress on rate rebasing for ASCs.

For The Record

• The focusability feature of Skytron surgical lights has nothing to do with "preventing tissue damage," as we reported in "Update on Surgical Lighting" (June, page 46). Skytron lighting provides only cool, soft white illumination to the surgical field, for every procedure, according to the company. We should have stated that the focusability feature "is key for cardiovascular, neuro, orthopedic and GYN surgery, where the lights need to be moved to greater distances to allow the surgeon and surgical team optimal patient access while still providing excellent illumination and intensity over these greater working distances."
• Sporicidin, which received 510(k) clearance from the FDA on June 29, 2001, is registered with the EPA for hospital disinfection and compliant with OSHA's bloodborne pathogen standards. Our "2nd Annual Manager's Guide to Infection Prevention" incorrectly stated that Sporicidin is ineffective for chemical high-level disinfection and sterilization.
• "Your Viscoelastic Choices" (June, page 60), should have credited the 2002 American Society of Cataract and Refractive Surgeons survey for the statement concerning Alcon's market share. In addition, the phrase "owns about 56 percent of the total market" refers to the entire Alcon viscoelastic product line.
• The CPT code for Injection for sacroiliac is G0260, not 60260 as appeared in the chart on page 33 of May's cover story, "New CPT Codes." Also, 5775 should be 15775 on the table that appears on "New Questionable Covered Services" (June, page 26).