Headlines on Deadline
Arkansas
Gynecologist: Hospital Punishing Me for Husband's Competing Interests
An Arkansas gynecologist is suing Baptist Health Medical Center, where she's practiced 19 years, after it revoked her privileges through its 2003 "economic conflict of interest policy." Janet Cathey, MD, of Little Rock, is not an investor in the new Arkansas Surgical Hospital - her specialty isn't even hosted there - but her husband, neurosurgeon Steven Cathey, MD, is. Baptist explains that the policy prevents doctors from diverting cases to a competitor. A judge has enjoined the hospital from revoking Dr. Cathey's privileges until the lawsuit is resolved.

California
Re-examine Your Surgical Waste Disposal
The California Department of Health Services has issued an advisory to hospitals and healthcare facilities recommending that they re-examine their surgical waste disposal process. Recent testing of canisters of infectious fluid waste revealed that autoclaving the containers did not adequately disinfect them for safe disposal, the department says. According to a disposal engineering firm, more than 50 million suction canisters, representing some 225 million pounds of infectious waste, are disposed of annually.

Plastic Surgery at the Dentist?
Two state lawmakers have introduced legislation that would let oral and maxillofacial surgeons perform elective facial cosmetic surgery. Senate Bill 438 would give them the option of applying for a permit through the state's dental board, which would be responsible for granting the permits based on the surgeon's education, training and experience.

Indiana
County Passes Moratorium on Medical Construction
Indiana's Morgan County has imposed a moratorium on the construction or expansion of medical facilities in the county until Dec. 31, 2005. Mooresville's St. Francis Hospital, which recently completed an expansion and is considering another, opposed the moratorium, saying it will limit healthcare choice and drive consumers, jobs and tax revenues across county lines.

Maryland
Why's It Take So Long to Obtain a CON?
Maryland officials are examining the state's process for approving new hospital construction and renovations. Healthcare leaders unhappy with delays in the construction approval process are calling into question the amount of time needed to obtain a certificate of need. Officials are also examining the minimum construction cost for requiring a CON. Projects costing less than $1.25 million don't currently need state approval in Maryland. Hospital officials want to raise the minimum amount necessitating a CON to $2.5 million.

Missouri
The Curious Fate of SB 316
A proposal to further restrict ambulatory surgical facilities in Missouri wound up as a bill that would open the door for specialty hospitals to be built in the Kansas City area. Senate Bill 316 originally included several incremental measures to tighten regulation of outpatient facilities. The bill that passed out of committee didn't include the proposed regulations - inspections, license fees and data-reporting requirements - but it did extend the moratorium on licensing specialty hospitals. During revisions, the bill was amended to exempt four Kansas City-area counties from the moratorium. Observers expect the bill to die without reaching a General Assembly vote. Even if SB 316 were to win approval, observers say, the Kansas City carve-out would be meaningless because the facilities wouldn't be able to pass the state's CON process.

Nevada
Bill Seeks to Monitor Office-based Anesthesia
Nevada's Assembly Bill 120 would require doctors to report any "unexpected occurrence involving death or injury" during the administration of sedation or general anesthesia in office-based procedures when they apply for registration or license renewal. The bill would also require the state's medical board to report this information to the governor and legislature. Introduced in February, the bill has been reviewed by the assembly's commerce and labor committee and awaits a floor vote.

New Jersey
ASC Alleges Insurers Lowballed Rates
A New Jersey surgery center has filed suit against two insurance providers for allegedly using incorrect information that kept the center's reimbursement rates inadequately low. Wayne Surgical Center of Wayne, N.J., is accusing Ingenix Inc., a division of UnitedHealth Group, of providing bad data to Horizon Blue Cross Blue Shield of New Jersey, also named in the lawsuit. The center accuses Horizon of knowingly using the flawed data to set its rates. The center is seeking to expand the lawsuit into a class action case and include other out-of-network providers in northern New Jersey. "We will be vigorously defending ourselves in this lawsuit," says Tom Rubino, a spokesman for Horizon Blue Cross Blue Shield of New Jersey. He described the surgery center's lawsuit as "curious," since state regulations require providers to use Ingenix data as a standard for determining their rates.

Oregon
Considering CON for New, Expanded Services
Oregon lawmakers are considering legislation that would require hospitals and outpatient facilities to acquire a CON before adding to or expanding services. Senate Bill 503 is currently in the hearing stage. The Oregon Medical Association argues that the requirement will stifle competition. Oregon's present CON law, which covers only the construction of new hospitals, was passed in 1989. The bill currently under discussion would amend that law to include renovations, relocations and adding or expanding services among hospitals, ASCs and freestanding diagnostic centers, none of which were covered under the original law.

Texas
Physician-owners' Referral Patterns Under Scrutiny
Texas physicians who refer patients to specialty hospitals in which they've invested would be studied under legislation recently passed by the state's senate. Senate Bill 872, which aims to determine the economic impact of doctor-owned, limited service facilities on community hospitals, would require the state to review referral patterns of physicians with and without ownership interests in the facilities and would require physicians to disclose their ownership interests. The Senate's passing of the bill is good news to the Texas Hospital Association, which hopes to create a moratorium on physician self-referrals to properly study the financial effects of niche providers on the state's conventional hospitals.

- Compiled by David Bernard

Two Ways to Washington
FASA, AAASC Take Different Tacks On Reforming Medicare ASC Program
As they lobby CMS to reform the Medicare ASC program, FASA and AAASC are taking slightly different paths in the hopes of arriving at the same place: the elimination of Medicare's ASC procedures list, the rebasing of ASC facility fees, the matching of ASC reimbursement rates to those paid to hospital outpatient departments (HOPD) and the annual updating of those rates. FASA's message is that ASCs are cheaper than HOPDs. AAASC's message is that ASCs should be treated like HOPDs.

FASA, which represents 1,560 ASCs, has heavily promoted its paid-for study that found that Medicare would save more than $1 billion a year if certain surgical procedures were performed in ASCs rather than HOPDs. The study, conducted for FASA by the Moran Company, analyzed 2003 Medicare claims that included at least one surgical procedure payable by Medicare in both ambulatory and hospital outpatient settings. The study re-priced the claims according to 2005 Medicare rules and rates for ASCs and HOPDs and found the following:

• Claims on average cost $320 less in an ASC compared to an HOPD.
• Procedures performed in an ASC in 2005 will cost the Medicare program $1.1 billion less than if the same procedures were performed in an HOPD.
• If procedures performed in an HOPD - that Medicare also reimburses ASCs for providing - were instead performed in an ASC, Medicare would save nearly $1.6 billion in 2005.

"This study makes it clear that Medicare should be encouraging patient access to ASCs, not limiting it," says Kathy Bryant, executive vice president of FASA, in a statement issued with the study. "These findings should be very useful to Congress and the administration as they consider Medicare policies affecting patient access to ASCs."

Ellen Pryga, director of policy for the American Hospital Association, says FASA's study didn't provide a balanced comparison. A study conducted for the Medicare Payment Advisory Commission, she says, shows that "patients treated by hospital outpatient departments are sicker than those treated by ambulatory surgery centers."

"In addition," she says, "hospitals have costs associated with the care they provide that ASCs do not, like providing 24/7 emergency departments and added regulatory costs."

While FASA talks patient access, the physician-led AAASC, which represents 361 ASCs, is talking procedures and payment. AAASC is hoping to mandate the following:

• CMS should eliminate the ASC procedures list and rebase ASC facility fees within the next two years.
• The new ASC payment system should link ASC facility fees to the payments made to HOPDs for the same surgical procedures.
• ASCs should receive the same annual updates paid to hospitals, as well as enjoy other additional payments made to hospitals, including outliers, implants and medical devices.

Both groups say they're working in tandem.

"In terms of legislative agendas, we do tend to work together," says Ms. Bryant. "I don't think there's a great difference between the two groups in terms of what we want to accomplish."

AAASC Executive Director Craig Jeffries agrees. "We're all in the same songbook, singing from the same score," he says.

- David Bernard

Keeping Those Keyboards Clean
Study: Hospital Keyboards Can Spread Germs
You might want to place waterless hand sanitizers next to every keyboard in your facility. Harmful bacteria can survive as long as 24 hours on computer keyboards, a new study shows.

The study, carried out at Northwestern Memorial Hospital in Chicago, found that keyboards could contaminate the fingers, bare or gloved, of a nurse or doctor, who could then transfer bacteria to patients.

Researchers contaminated keyboards with three types of bacteria commonly found in hospitals: vancomycin-resistant Enterococcus faecium, methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa.

Vancomycin and methicillin are common antibiotics, but the drugs no longer affect some bacteria. Both of the drug-resistant bacteria strains were capable of surviving on a keyboard 24 hours after contamination, while the Pseudomonas aeruginosa lasted up to an hour, according to the study.

The study, presented at a meeting of the Society for Healthcare Epidemiology of America, also found that touching a keyboard was enough to transmit the bacteria.

While it's important to disinfect computer equipment on a regular basis, the best defense is frequent hand washing, says Gary Noskin, MD, medical director of healthcare epidemiology and quality at Northwestern Memorial.

"Not only should we continue to enforce handwashing before and after any patient care, but we should also place a container of waterless hand sanitizers next to every keyboard in patient care areas. Why not take one more step toward patient safety?" says Diana Procuniar, RN, BA, CNOR, administrator of the HealthSouth St. Petersburg Surgery Center in St. Petersburg, Fla.

- Dan O'Connor

Hand Hygiene
CMS Gives Final OK to Hand Gels in Hallways
The final piece of the alcohol-based hand-gel placement puzzle has fallen into place. Nearly one year after the National Fire Protection Association approved gel dispensers in hallways retroactive to the 2000 NFPA 101 Life Safety Code, CMS has issued an interim final rule endorsing and adopting the amendment to the LSC, as long as the prescribed safety conditions are met. There are six:

• The corridor must be a minimum of 6 feet wide if you mount a dispenser in a hallway.
• Dispensers in rooms and corridors can hold, at most, 1.2 liters; they can hold up to 2 liters if they are mounted in suites of rooms (such as a pre-/post-op areas).
• The dispensers must be at least 4 feet apart.
• They can project as much as 6 inches from the wall and may be installed above handrail height.
• Alcohol-based hand rub dispensers may not be mounted over or next to an ignition source.
• Dispensers may be over carpets only if the room is also a sprinklered smoke compartment.

"This long-awaited step comes at a time when every opportunity to make hand hygiene easier matters," says Judene Bartley, MS, MPH, CIC, a clinical consultant for the Premier Safety Institute. "There's now no question that the benefits of alcohol-based hand gels outweigh the risks."

This interim final rule will go into effect May 24, after a 60-day comment period (go to www.fasa.org) to comment).

- Stephanie Wasek