By Travis H. Brown

When two Anesthesiologists opened the first Ambulatory Surgery Center in Phoenix, AZ in 1970, they probably had little idea they were on the verge of introducing a facility what would become a key player in the health care industry.  On Thursday, August 12, 2010, over 5,000 Ambulatory Surgery Centers (ASC) in all fifty states had the opportunity to participate in National ASC Open House Day.  This was a chance for ASC’s to open their doors to the community, policy makers, and business leaders, and show them what is becoming a cornerstone of cost effective, convenient health care.

Poplar Bluff Medical Partners, a surgery center in Southeast Missouri composed of thirty five physicians, took advantage of ASC Open House Day to show the community why their facility can provide quality care at an affordable cost.  In addition to staff conducted tours of their endoscopy suites, operating rooms, and expansive technological capabilities, they kept everyone entertained with a bounce house for kids, snow cone stand from area cheerleaders, and BBQ for all the participants.  As a Missouri contract lobbyist for the Missouri Ambulatory Surgery Center Association (MASCA), our team was excited to see elected officials take interest in the event to better understand the surgery center operations and procedures.  In attendance were U.S. Congresswoman JoAnn Emerson (R-MO), Missouri State Senator Rob Mayer (R-Dexter), and two candidates for the Missouri House of Representatives, Steve Cookson and Todd Richardson.

With our nation’s health care climate changing rapidly, it is essential that surgery centers like Poplar Bluff Medical Partners demonstrate their capabilities and choices in providing safe, effective outpatient operations.  As health care reform under Obamacare increases the number of medically insured Americans, it will become even more important for patients to utilize surgery centers that can offer cost effective alternatives with quicker turnaround time.  A 2007 study shows that Medicare and its beneficiaries pay an average of 54% more for a procedure performed in a hospital outpatient setting.  According to the US Department of Health and Human Services, ASCs saved Medicare and its beneficiaries approximately $1.7 billion dollars.   In terms of efficiency and accuracy, nearly a third of ASC’s report that 90% of their procedures start within seven minutes of when their scheduled to begin.  All surgery centers are regulated to meet specific requirements by the Center for Medicaid and Medicare Services (CMS), and all facilities in Missouri are licensed with the Missouri Department of Health and Senior Services.

In ASC Review, physician and surgery center owner Ken Pettine, MD, says “Every time I hear Obama talk on reform, it’s about quality care at lower costs.  ASCs do that the best.  They are the right entity at the right time.”  With an influx in Medicaid expansions, there will be an expected push towards cost saving opportunities.  Moreover, as hospitals continue to lose billions of dollars in reimbursements, the idea of shifting operations to an outpatient hospital setting becomes more viable and advantageous.  Ambulatory Surgery Centers are becoming the new face of patient safety in health care, and it will be important for individuals and families across the country to tour a facility and analyze the direct savings and benefits ASCs can provide.

“Advancing Surgical Care” is the name of the campaign that kicked off earlier today, says the Ambulatory Surgery Center Advocacy Committee (ASCAC), which includes the national and state ASC associations as well as representatives of all types of ASC operators and physicians.

“At a time when healthcare costs are skyrocketing and access to quality patient care is a national priority, ASCs continue to offer high-quality, patient-centered care to communities throughout the country and create a cost savings for both the individual and the health care system as a whole,” says Andrew Hayek, chair of the Ambulatory Surgery Center Advocacy Committee and president and CEO of Surgical Care Affiliates. “As an industry, we are committed to providing patients the highest quality care in the safest environment possible and are working with physicians, hospitals and other stakeholders throughout the healthcare system to ensure that we continue to advance surgical care.”

“Patients report a 92% satisfaction rate in the healthcare services they receive at ASCs throughout the country,” says Kathy Bryant, president of the ASC Association. “We are proud to come together as an industry to lead this much-needed dialogue around the care, value and superior patient outcomes associated with ASCs.”

Outpatient Surgery Magazine Staff

FROM: http://www.outpatientsurgery.net/news/2010/03/11

State Reps. Sara Gagliardi and Debbie Benefield plan to introduce legislation that would require surgical techs to register with the state’s Department of Health and Department of Regulatory Agencies (DORA). Another measure would require healthcare facilities to report by name techs that are fired or disciplined for irresponsible behavior and check the state’s database of names to make sure potential hires haven’t been flagged because of past disciplinary actions or legal troubles.

FROM: http://www.outpatientsurgery.net/news/2010/03/6

The lawmakers were motivated to act after Kristen Diane Parker, a surgical tech who stole syringes of fentanyl while working at Rose Medical Center in Denver and Audubon Surgery Center in Colorado Springs, was sentenced on Feb. 24 to 30 years in federal prison. Ms. Parker claimed to be unaware that she was infected with hepatitis C butadmitted to replacing stolen needles with used ones she had used to get high. Her actions forced about 6,000 patients to undergo testing for the incurable disease. To date, at least 18 infections have been linked to the 27-year-old former tech.

Surgical techs are the only position on the surgical team not required by Colorado law or regulations to be competent, qualified or credentialed, says Catherine Sparkman, JD, director of government affairs for the American Association of Surgical Techs. Techs are currently required to be registered in Washington state and have title protection in Illinois, she says. In Indiana, Texas, South Carolina and Tennessee, STs must be graduates of accredited surgical technology programs and certified by a nationally accredited credentialing organization.

Tech credentialing legislation has been filed in 9 states and will be initiated in several more in 2011, according to Ms. Sparkman, who supports legislation that ensures hospitals and other healthcare facilities employ only appropriately educated and certified surgical techs.

DORA, however, released a report in January that “found no evidence of widespread competency-related harm caused by surgical technologists… the current model, where employers determine the qualifications and competencies of the surgical technologists they employ, is sufficient to protect the public health, safety and welfare.”

Rep. Gagliardi says she hopes to work with DORA and representatives from Family Voices of Colorado — the grassroots organization that requested the DORA review — to help them understand that the registry is the right thing to do. A registered nurse, she expresses outrage over Ms. Parker’s violation of the trust patients put in their caregivers and says her recklessness went against everything healthcare professionals are trained to believe in: protecting patients. “The registry,” she says, “is another safety measure to let techs know we’re watching and that stealing medication is not easy to get away with.”

Daniel Cook

“The economic downturn has continued to impact many hospitals nationwide,” said Matt Fenwick, American Hospital Assn. spokesman. “Hospitals may be particularly vulnerable now because the effect on the health care system can be lagged.”

( FROM: http://www.ama-assn.org/amednews/2010/02/08/bisa0208.htm )

A mass layoff is defined as 50 people losing their jobs from a single employer. Hospitals had 152 such incidents in 2009, leading 11,787 to claim unemployment benefits. The year 2008 was the second-highest on record, with 112 mass layoffs involving 9,268 people. But the number of people who lost their jobs in the health care sector in 2009 fell short of 2005’s record of 13,282, a number exacerbated by layoffs from facilities that were damaged by Hurricane Katrina.

The monthly totals declined near the end of 2009, with seven mass layoffs apiece in both November and December, the only months in which there were not more than 10 mass layoffs. However, the decline may be due to seasonal variation, according to the bureau.

According to an American Hospital Assn. survey released Nov. 11, 2009, 51% of the 768 CEO respondents reduced staff in response to economic pressures. In addition, 84% cut administrative expenses, and 20% reduced services. Other surveys have found hospitals’ bottom lines improving in 2009 thanks to the cutbacks, as well as improved investment markets.

The impact of the economic downturn also is being reflected in surveys at the state level. According to one by the New Jersey Hospital Assn. released Jan. 13, 43% of member institutions laid off employees and 28% eliminated vacant positions. Approximately 82% were experiencing an increase in charity care patients, and all experienced declines in donations to support this work.

“Hospitals are not recession-proof,” said NJHA President and CEO Betsy Ryan. “They face the same burdens and fiscal pressures as any other industry when the economy sours. But patients need health care services — recession or not — and they continue to turn to hospitals. This combined burden places tremendous pressures on hospitals. For many of them, cost-cutting measures such as layoffs are unavoidable.”

Ambulatory health care services, a category that includes physician offices, also were hit by the recession. A total of 85 mass layoffs occurred in 2009, the second-highest total since the numbers were first tracked in 1996. The 2009 layoffs led to 6,630 workers claiming unemployment, the most ever recorded by the BLS in the ambulatory health care services category.

The three-day conference provided a forum for a necessary discussion on the importance of screening in detecting colorectal cancer. With approximately 50,000 annual deaths related to colorectal cancer, NIH seeks to ultimately provide healthcare professionals, patients, policymakers and the general public with a comprehensive assessment of how colorectal cancer screening and surveillance are most appropriately implemented, monitored and evaluated for average-risk populations nationwide.

Laura Seeff, MD of the Centers for Disease Control and Prevention (CDC) presented the CDC’s ongoing research into the medical community’s capacity for colorectal cancer screening citing ASCs role in providing this important service. In fact, more than 40 percent of Medicare colonoscopies are provided in ASCs.

There are approximately 5,200 ASCs nationwide, offering patients seeking these services easy access and convenience within their community. Each facility is staffed with a team of specialized medical professionals providing high-quality care. Patients report a 92 percent satisfaction rate in the healthcare services they receive in the ASC setting.

“On behalf of the Ambulatory Surgery Center Advocacy Committee, I commend NIH for recognizing the high quality, safe and cost-effective colorectal cancer screening services offered by ASCs throughout the U.S.” said Arnold Levy, MD, a practicing gastroenterology physician and president and CEO of a 55 physician gastroenterology group in Washington, D.C., who attended and spoke at the conference.

ASCs are often the most cost effective solution for both patients and payers, including taxpayers, and offer an enormous savings to the entire healthcare system. Research shows that patients experience roughly a 59 percent co-pay savings on Medicare colonoscopy services, and overall, ASCs save Medicare approximately $2 billion annually.

As detailed in the recent Annual Report to the Nation on the Status of Cancer, authored by researchers from the American Cancer Society (ACS), the National Cancer Institute (NCI), the Centers for Disease Control and Prevention (CDC), and the North American Association of Central Cancer Registries (NAACCR), colorectal cancer death rates have been declining since 1984 in men and since 1975 in women, with a more marked decline in recent years. The significant decline in colorectal cancer deaths can be attributed in part to increases in colorectal cancer screening, which plays a pivotal role in early diagnosis and ultimately an overall reduction in disease mortality.

“ASCs are committed to achieving the 50 percent reduction in colorectal cancer death rates highlighted in the report and the ASC Advocacy Committee looks forward to working with key stakeholders to achieve this goal,” added Levy. “ASCs are proud to be part of the solution to improve patient access to colorectal screening services.”

About the Ambulatory Surgery Center Advocacy Committee Ambulatory Surgery Centers are healthcare facilitates that specialize in providing important surgical and preventive services in an outpatient setting. With approximately 5,200 Medicare-certified facilities throughout the country, ASCs perform more than 22 million surgeries per year.The Ambulatory Surgery Center Advocacy Committee is working on behalf of the industry to raise awareness of the important role that ASCs play in the healthcare system and the high-quality, cost-effective care that ASCs provide. The ASCAC includes the national and state ASC associations as well as representatives of all types of ASC operators and physicians. For more information about ASCs, visit www.ascassociation.org.

LINK: http://www.endonurse.com/articles/news_briefs/asc-nih-affirm-colorectal-cancer-screenings.html

(FROM: http://online.wsj.com/article/SB10001424052748703422904575039110166900210.html?mod=WSJ_hpp_MIDDLENexttoWhatsNewsForth )

It wasn’t just an educated guess: Dr. Bussell used a new risk calculator that handicaps an individual patient’s chances of surgical complications based on personal medical history and physical condition. It also helps doctors and patients make tough decisions about procedures.

For Ms. Rivard, who is 67 years old, factors including her age, blood pressure and weight lifted her risks—though the surgeon was able to reassure her that they weren’t out of line, and that any complication would be manageable.

Risk calculators, used by heart surgeons for several years, are now being developed for other surgical specialties. The American College of Surgeons recently introduced calculators for surgery of the colon and pancreas, and is designing similar tools for 18 other procedures, including gastric bypass, hernia repair and prostate surgery. The calculators use data from more than one million patient records gathered as part of the group’s National Surgical Quality Improvement Program, which works with hospitals to reduce surgical errors and complications.

More than 30 million operations are performed in the U.S. annually to remove deadly cancers, repair diseased organs and replace worn-out joints. Yet going under the knife can be risky, leading to serious infections, blood clots, heart attacks and pneumonia. Those risks increase with age and for patients who are obese, smoke, abuse alcohol or have medical conditions such as diabetes and hypertension.

The nonprofit Institute for Healthcare Improvement, which works with hospitals to improve the quality of care, estimates that 2.5 million to 3.5 million surgical patients each year experience unintended harm resulting from or contributed to by surgical care. While some complications are unavoidable, surgical teams often make mistakes, such as leaving a surgical sponge in a patient, or fail to take steps known to prevent complications, such as delivering antibiotics to a patient within one hour before beginning surgery, which can dramatically cut infection rates.

Complications are also costly. The Centers for Disease Control and Prevention estimates that there are more than 290,000 surgical-site infections each year, and the cost to treat them ranges from about $12,000 to nearly $35,000 per patient—or as much as $10 billion annually.

The American College of Surgeons’ quality-improvement program is one of several efforts to help reduce such risks. It was adapted from a program originally used by the Veterans Health Administration and shown to reduce deaths at VA hospitals from surgery by 27% and complications by 45%.

Since its launch in non-VA hospitals in 2005, 250 hospitals have signed on. The program costs hospitals about $35,000 annually to participate. But a study published last September in the Annals of Surgery found that it helped 118 hospitals prevent from 262 to 524 complications per year, saving each an average of $3 million.

Preventing Complications

“If these results were translated across all U.S. hospitals, we would have the potential to prevent millions of complications a year, save potentially billions of dollars a year and provide evidence to health-care reformers that higher-quality care can cost less,” says Clifford Ko, a colorectal surgeon at the University of California, Los Angeles, and director of research and optimal patient care for the American College of Surgeons.

The calculators allow surgeons to enter a patient’s risk variables and in a matter of minutes receive a customized report outlining the risk of death and specific complications. For example, using data from 28,863 patients who underwent colorectal surgery at 182 hospitals from 2006 to 2007, the colorectal risk calculator has 15 variables to help predict complications and death within 30 days of surgery, including age, body mass index, the extent of disease—whether it is cancer or a digestive disease—and how much of the colon must be removed.

David Bentrem, a surgeon at Northwestern University’s cancer center who has used the colorectal surgery calculator, says it not only helps assess whether a patient is a good candidate for surgery, but also helps him make sure patients understand what they are getting into—the process known as “informed consent.”

Patients often don’t read or understand the documents they sign prior to surgery, studies show, and after meeting with a surgeon they may be anxious and confused, making it hard to process and remember information key to deciding whether to go ahead with surgery or not.

“The more information we can offer surgeons to give their patients that are specific to their own individual case, the better,” says Dr. Ko. If the surgery isn’t urgently needed, Dr. Ko says he may delay it until a patient loses weight or stops smoking to lessen the risks. Patients may also decide to delay surgery after learning of the risks.

Patients considering any kind of surgery should ask if their hospital participates in surgical-quality improvement programs, and whether risk calculators are available. For example, the Society of Thoracic Surgeons offers heart surgeons a calculator to predict the risk of death and complications from heart-bypass and other cardiac surgeries.

While generally surgical risk calculators are not designed for use by consumers, patients can visit euroscore.org to calculate their risks for cardiac surgery, using a free program from the European System for Cardiac Operative Risk Evaluation, widely used in European hospitals.

Hospitals in the American College of Surgery quality-improvement program can also compare their performance against a national benchmark, and tell patients whether their complication rates are lower than the national average.

‘An Easy Recovery’

At Danbury Hospital, Dr. Bussell was also able to reassure Ms. Rivard that the facility has among the lowest infection rates among hospitals in the American College of Surgery’s quality-improvement program, and because her results were comparable to the average low-risk patient, he expected her procedure to be “uneventful and dull” with “an easy recovery.”

“Telling a patient there is a risk of dying from a cancer surgery is not an easy conversation to have,” says Pierre Saldinger, a surgeon who oversees the quality-improvement program at Danbury Hospital and was also in the room when Ms. Rivard heard about her surgical risks. “The calculator is a tool you need to use in a judicious way, so as not to scare the patients, but to make them feel more comfortable that you are being honest and open with them.”

Ms. Rivard says she had already determined that she needed the surgery before learning of the risks, but she and her two daughters, who accompanied her to the consultation, wanted to hear the doctor put the calculator data in perspective.

The last time she had surgery—on her hip, nine years ago—no one discussed risks with her. While hearing about the risks of complications and infections was “a little overwhelming,” she says, “I want to know everything that might happen.”

Write to Laura Landro at informedpatient@wsj.com

For additional information on the clinical and financial data for ASC procedures click below.

• It is our understanding that MO HealthNet will not be proactive in its enforcement of this rule, but you are advised to contract as soon as possible with a PSO if you accept Missouri Medicaid.
• MOCPS has offered a flat rate of $2500 for MASCA members as well as the opportunity to pay the fee on a bi-annual basis and commit to a one-year term. MOCPS will require only $1250 upon 30 days of invoice, which would be mid to late February, and the remaining $1250 will be due in August.

If you have executed an agreement with MOCPS and did not get this rate or payment terms, please contact MOCPS for an adjustment.  If you are not a current member of MASCA, please call 816.531.8432 for more information on membership.
For a copy of the letter sent to members, click here.

Alexandria, VA – Measuring five quality-base performance areas, an ambulatory surgical center out performed a standard hospital based surgical center in otolaryngic surgeries, according to new research in the December 2009 issue of Otolaryngology – Head and Neck Surgery.

The cross-sectional study analyzed a total 486 cases at a pediatric ambulatory surgical center (ASC) and a hospital-based facility (HBF). The cases comprised of the four most common pediatric surgical procedures at the ASC compared to the HBF: ventilation tube insertion, dental rehabilitation, adenotonsillectomy, and ventilation tube insertion/adenoidectomy. Only outpatient procedures were included.

The authors designed a series of quality performance measures based on the Institute of Medicine’s multidimensional definition of quality. The study aimed to develop a better understanding of how an ASC might be a viable high-quality, low-cost organizational structure. The quality measures included: safety, patient-centeredness, timeliness, efficiency, and equitability.

Seventy-seven percent of ASC cases finished within the scheduled time compared to 38 percent at the HBF, a difference of about 30 percent. Total charges were 12 – 23 percent less at the ASC as well. However, patient satisfaction was similar between facilities (ASC, n=64; HBF, n=35). For the studied sample size, the ASC had no unexpected safety events, compared to nine events at the HBF.

The authors point out that as the healthcare industry responds to public demand for higher quality with scarce resources, innovative delivery models that provide high-quality, low-cost care are increasingly needed. ASCs have been described as such a model by taking advantage of economies of scale and low-cost organizational structures. The authors further note that although previous studies have shown the benefits of ASCs in one quality measure or another, this study is the first to explore multiple dimensions of quality in one surgical area to give a more complete picture.

The authors write “Intense competition, increasing quality standards and scarce resources have led many institutions to shift toward ’service-line’ strategies, allowing facilities to concentrate on what they do best. It makes sense, at least, for institutions to determine what types of organizational structure provide the best patient care.” The results of this study suggest that government programs supporting ASCs may be a wise use of resources and that investment in ASCs is a way academic health centers can remain financially competitive.

FROM: http://www.eurekalert.org/pub_releases/2009-12/aaoo-asc112409.php

By Travis H. Brown, MBA

The expansion of consumer choices among healthcare facilities has brought many things to the marketplace: surgical decisions that offer convenience at lower costs, localized competition among providers, and integrated treatment options closer to the home of many patients. Missouri’s ambulatory surgery centers, lead by physicians and their staffs, however, should not rest on this notable success. A positive business climate that enables and empowers citizens to select different venues for healthcare procedures is not always a guarantee in a highly-regulated environment.

Sometimes, leaders can become an unwilling victim of their success, especially in tough budget times in the economy. It was less than five years ago that some states like New Jersey imposed additional fees, gross receipts taxes, and additional costs of licensure. Back-door levy threats via state & local authorities on the cost to deliver ambulatory care are likely to increase as state appropriators seek to balance their state deficit budgets. These periods of high awareness to health reform can remind every center of the importance of making your local business voice heard among your community.

The underlying business model of most centers represents the future of healthcare at its best: local, direct decisions convenient to citizens, appropriately-scaled to relative risks, offered in a flexible, lower-cost setting. In the field of public policy, sometimes the best defense to maintain this climate is having a strong offense.