This Just In

National ASC Open House Day
Informing the Public the First Step
The Surgery Center of Arlington is no longer the best-kept secret in the Dallas-Fort Worth area, not after nearly 600 people toured the freestanding facility on National ASC Open House Day on July 29, the launch of the Federated Ambulatory Surgery Association's (FASA) ongoing awareness program designed to create better-informed healthcare consumers and fight Medicare cuts.

"We wanted to reintroduce our surgery center to the community," says Trudy Wiig, MBA, BSN, RN, the administrator of the Surgery Center of Arlington. "Many of our visitors said 'Oh, we didn't know you were here' and weren't aware that they have less costly and more efficient options when planning a surgery."

The multispecialty clinic with six ORs, two GI rooms and two 23-hour observation rooms opened its doors to the public from 1 to 7 p.m. To promote the open house, the facility ran a public service announcement in the local newspaper and offered free sports physicals - urinalysis, vision exam and physical - to school-aged children (nearly 300 from two neighboring school districts participated).

"Most patients don't know that surgery centers are an option for them when they make choices about having surgery," says Ms. Wiig. "The open house let us show off our center to the community. We couldn't have imagined a better turnout."

Download an open house toolkit at www.fasa.org/ASCOpenHouse.htm.

Hospital Medicare Reimbursement
CMS Proposes 2004 HOPD Revisions
Hospital outpatient department payments would increase by 3.8 percent in 2004 under CMS's proposed changes to the HOPD reimbursement system. The changes would take effect Jan. 1, 2004. Among the key provisions published in the Aug. 12 Federal Register:

• The potential 3.8 percent increase in HOPD rates equals 3.5 percent inflation adjustment, plus 0.3 percent to account for changes in the new technology reimbursement pool.
• CMS would shield hospitals from losses represented by ambulatory payment classifications calculated to decrease more than 15 percent from the 2003 rate.
• The proposal would create two Medicare outlier thresholds (one for hospitals and one for community mental health centers), representing 2 percent of the government's outpatient spending.

The public may comment on the proposed 2004 HOPD rule until Oct. 6. CMS should publish the final rule around Nov. 1.

Inside The Numbers
79.7% Percentage of all surgical procedures that were hospital inpatient procedures in 1981.
20.7% Percentage of all surgical procedures that were hospital inpatient procedures in 2002.

66% Percentage of payments in 2001 to hospital outpatient departments that were higher for the same procedures performed in ASCs, with a median payment difference of $282.33.
1.9% Percentage the average ASC payment update has increased per year between 1991 and 2002.

3,644 Number of operational outpatient surgery centers as of February 2003, an increase of 50 percent since 1996.
37% Percentage of surgery centers in the U.S. concentrated in California (505 total), Florida (295), Texas (229), Maryland (163) and Georgia (161).

72% Percentage of surgery centers affiliated with group purchasing organizations.
38 Years Medicare turned July 30, while both the House and Senate deliberated the final form of legislation designed to modernize the program.

103,000 Number of bariatric surgeries estimated to be done this year, four times as many as just five years ago.

SOURCES: SMG Marketing, Verispan, TripleTree, American Society of Bariatric Surgery, JWT Specialized Communications

Office-based Surgery
Survey: Office Surgery Visits Grow by 81% in Last Decade
The percentage of surgery-related physician office visits increased 81 percent over the last decade, according to the latest National Ambulatory Medical Care Survey conducted by the CDC's National Center for Healthcare Statistics. The survey looks exclusively at medical care provided in physicians' offices. Other key findings:

• While general and family practice (23.9 percent) remains the top reason patients visit to physicians' offices, 6.1 percent of office visits pertained to ophthalmic procedures and 5.3 percent to orthopedic surgery.
• Compared with 1992, office-based physicians were more likely to have managed care contracts and less likely to be in solo practice; office-based physicians also have fewer of their weekly patient encounters during hospital rounds or hospital OR block times.

Restructuring
HealthSouth Sells Florida Acute-Care Hospital
HealthSouth is selling one of its two acute-care hospitals to a Florida nonprofit health giant for an estimated $125 million, a move that infuses HealthSouth with capital and lets it concentrate on its core business of rehabilitation institutions and outpatient surgery centers as it attempts to recover from a massive accounting fraud.

HealthSouth says the sale of 281-bed Doctors' Hospital of Coral Gables to Baptist Health South Florida won't launch a massive sell off. "This is a disposition of a non-core asset," says HealthSouth spokesman Andy Brimmer, adding that the company does not plan to sell its acute-care facility near corporate headquarters in Birmingham, Ala. However, Mr. Brimmer would not comment on whether HealthSouth has plans to sell any of its 200-plus outpatient surgery centers.

How You Reprocess
More Than Half Prefer Steam Sterilization
Fifty-two percent of a survey's respondents named steam sterilization as their primary way to reprocess medical instruments, and another 16 percent placed it second, according to a survey of 181 OR nurses and 179 infection control staffers conducted by the Wirthlin Worldwide research and consulting firm. All survey participants work in the hospital setting. Other findings:

• Peracetic acid sterilization finished second overall (13 percent first preference, 19 percent second mention), but first in terms of use for heat-sensitive devices such as flexible endoscopes and easily damaged instruments.
• Ethylene oxide (ETO) gas sterilization (9 percent first, 12 percent second) and gluteraldehyde (8 percent first, 13 percent second) tied for third.
• Hydrogen peroxide gas plasma finished fifth with 7 percent first and 6 percent second mentions.

Physician Salary Survey
GIs, ENTs and Orthopods Earning
While physician compensation declined for several specialties in 2002, physicians specializing in gastroenterology (10.07 percent) otolaryngology (11.54 percent) and orthopedic surgery (7.82 percent) experienced significant compensation increases from 2001 to 2002, according to a survey by the American Medical Group Association. Internal medicine (-1.81 percent), pediatrics (-3.79 percent), pulmonary disease (-1.24 percent), emergency care (-1.42 percent), ophthalmology (-2.31 percent) and pathology (-3.24 percent) saw decreases.

Transfusion Alternatives
Facilities Offering Bloodless Surgery
About 100 facilities nationwide offer bloodless surgery, which is performed with aids such as blood-volume-expanding fluids, erythropoietin, hypotensive anesthesia and cell-saver machines that re-circulate blood through the body.

Roper Hospital in Charleston, S.C., instituted its program in 1995; St. Francis Hospital in Poughkeepsie, N.Y., performed its first bloodless surgery in May. Both facilities started exploring bloodless options at the behest of groups of Jehovah's Witnesses, who do not believe in blood transfusions. St. Francis has enrolled about a dozen patients thus far. Roper saw 50 to 60 patients in its first year and will see about 300 patients this year, according to Loretta Humes, RN, Roper's bloodless surgery program coordinator.

"[St. Francis] was interested in blood conservation in general, because blood is so difficult and expensive to get," says Gina Mandel, RN, MSHA, the coordinator of the hospital's transfusion alternatives center. She estimates the cost of a pint of blood, including auxiliary and administrative costs, to be $400.

Ms. Mandel says a key to success is having a pre-screening process that finds patients who want bloodless surgery and that allows the facility sufficient preparation time.

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• Hospital CEOs expect a two- to three-fold increase in competition over the next three years from freestanding facilities such as ambulatory surgery centers, surgery hospitals and imaging centers, according to a white paper released by the Governance Institute...
• The FDA cleared Vision-Sciences to market its Trans-Nasal Esophagoscope (TNE). The product's narrow diameter allows for transnasal introduction during an office-based procedure instead of transoral, which often requires sedation. The company plans to launch the TNE at the American Academy of Otolaryngology in Orlando this month...
• Wellness industry darling AmeriScan is franchising its direct-to-consumer diagnostic/ screening imaging centers, which offer full body scans, virtual colonoscopy and breast screening...
• Karl Storz Endoscopy-America, Inc., will broadcast a live telesurgery demonstration of the company's new Tricam 3D Video Imaging System to attendees at the Society of Laparoendoscopic Surgeons 12th International Congress and Endo Expo 2003, Sept. 22 to 25 in Las Vegas, Nev. The company claims the system's single camera provides a three-dimensional sense of depth which makes it easier to maneuver instruments during minimally invasive surgical procedures that requiring more detailed, precise reconstruction and suturing techniques...
• Temporary CRNAs' pay rose 70 percent in the past four years (from $55 per hour in 1998 to $95 per hour in 2002), but now appears to be leveling off, according to StaffCare.