ASCA News Digest (July 22, 2014)

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July 22, 2014





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ASCA Highlights


Pay-Per-Day Registration for 2014 Fall Seminar

ASCA’s 2014 Fall Seminar, October 9–11, in Scottsdale, is an outstanding opportunity to tap into the expertise of some of the top experts in ASC management today, and to focus intensely on improving the operational areas in your ASC where your biggest challenges lie. Because you register only for those days that best meet your needs, you can design an itinerary built to fit your budget and your travel schedule. MORE
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If you haven’t purchased your 2014 subscription yet, there is still time to sign up. The collection period will close next Thursday, July 31. ASCA Benchmarking features some significant improvements for the 2014 program, including an Executive Summary section, new survey questions and enhanced help capabilities. Subscribe today and start submitting your data before July 31. MORE
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Help us plan next year’s annual meeting. Submit your ideas for session topics and speakers so that we can provide you with the exceptional educational content that matters to you most. Submissions are due next Thursday, July 31. ASCA 2015 will take place in Orlando, May 13–16, 2015. MORE
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ASCA is conducting a brief survey to determine which procedures should be added to the list of ASC payable procedures for 2015. This information will help ASCA advocate for the expansion of the list of procedures that CMS considers clinically appropriate for ASCs to provide to Medicare beneficiaries. Participants must complete one survey for each procedure they would like added. MORE
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Learn about proposed changes to the Centers for Medicare & Medicaid Services’ (CMS) ASC payment system for 2015 during ASCA's next webinar on Tuesday, August 5, at 1:00 pm ET. Find out if Medicare plans to add any new procedures to the ASC-eligible list and gain important insights into proposed changes to the Medicare quality reporting program. MORE
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Simplify your business office operations. Surgical Notes is a nationwide provider of transcription, coding, and document management applications. The ASC industry’s largest management companies and roughly 20,000 healthcare providers trust Surgical Notes to provide customer-focused solutions that eliminate manual processes, streamline workflow, and accelerate the revenue cycle. Visit us at www.surgicalnotes.com or call 800-459-5616 today!



Ensuring Patient Safety with Capnography
The RespSense™ and LifeSense® capnography monitors are simple-to-use, cost-effective tools that help you ensure your patients are adequately ventilated during sedated dental procedures. The monitors provide continuous and reliable monitoring to help identify potentially life-threatening ventilation status changes such as respiratory depression during dental procedures on sedated patients.



We're here for you. It's a simple concept, but how many partners answer your questions and help guide you in your quest to manage your revenue cycle? LaClaro is always here to answer questions, offer guidance, and make sure your team has the data it needs to make better decisions for your facility.

New and updated payer rules and regulations, a growing reliance on high-deductible plans and increasing levels of bad debt change the landscape of revenue cycle management every day. To make certain that your ASC's business office is functioning at its best, you have to have the right people in the right role as well as benchmarking, ASC standards, policies and procedures. MORE
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ASCA staff joined the American Cancer Society Cancer Action Network (ACSCAN) on Capitol Hill last week to promote the Removing Barriers to Colorectal Cancer Screening Act (H.R. 1070/S. 2348). During the day, ASCA participated in a stakeholder meeting and met with members of Congress asking them to cosponsor H.R. 1070 and S. 2348. MORE
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Industry News


Deaths by Medical Mistakes Hit Records
Healthcare IT News (07/18/14) McCann, Erin

Preventable medical errors represent the third leading cause of death in the United States, behind heart disease and cancer, claiming the lives of approximately 400,000 people annually. At a July 17 Senate hearing, patient safety officials presented ideas on how to resolve the crisis, such as increasing the number of registered nurses and establishing incentives. Tejal Gandhi of the National Patient Safety Foundation said, "We need better systems to minimize cognitive errors…such as computerized algorithms. Another important issue is missed and delayed diagnoses, she said, so IT systems need to be designed to better manage test results.
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Ambulatory Surgery Centers and Outpatient Urologic Surgery Among Medicare Beneficiaries
Urology (07/14) Vol. 84, No. 1, P. 57 Suskind, A.M.; Dunn, R.L.; Zhang, Y.; et al.

Researchers sought to determine the effect of an ambulatory surgery center (ASC) opening in a health care market on utilization and quality of outpatient urologic surgery. They conducted a retrospective cohort study of Medicare beneficiaries undergoing outpatient urologic surgery from 2001 to 2010, focusing on markets with ASCs, those without ASCs, and those where ASCs were introduced. During the study period, 195 ASCs opened in markets previously without one. Rates of hospital-based urologic surgery in markets where ASCs were introduced declined from 221 to 214 procedures per 10,000 beneficiaries in the four years after baseline. In contrast, rates in the other two market types increased over the same period. The researchers concluded that the introduction of an ASC into a health care market lowered rates of outpatient urologic surgery performed in the more expensive hospital setting. This redistribution was not associated with declines in quality or with greater growth in overall outpatient surgery use.
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Health Care Provider’s Apology to Injured Patient Now Inadmissible as Evidence
State Bar of Wisconsin (07/16/14) Wilkinson, Tyler K.

Under a new Wisconsin law, apologies from health care providers to patients are not admissible as evidence in a medical malpractice lawsuit. The aim is to allow doctors to more freely apologize to reduce the number of medical malpractice suits against doctors. Psychological benefits of an apology exist for both the injured and injuring parties, so some lawyers believe health care providers should apologize to injured patients irrespective of whether an apology can later be used in court. The majority of states have adopted a law that precludes an injured patient from using a health care provider's apology against them in court. Wisconsin's rule of evidence broadly covers apologies made by a wide range of health care providers, including physicians, nurses, ambulatory surgery centers, hospitals, clinics, adult family homes, and residential care apartment complexes.
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Two Oregon Vets Get Free Surgery in Tigard in Wake of VA Scandal
Portland Business Journal (OR) (07/16/14) Thompson, Dennis

Two veterans in Oregon have received surgery at no cost from the Oregon Outpatient Surgery Center (OOSC) in Tigard, Ore., through a program designed to help vets waiting for surgery because of backlogs at Veterans Affairs hospitals. The two men underwent successful surgery on July 7, one for a shoulder rotator cuff tear and the other for an anterior cruciate ligament repair on his knee. The men are now undergoing rehabilitation and physical therapy, says Jesseye Arrambide, executive director of the Oregon Outpatient Surgery Center. Under the center's new Save Our Veterans program, OOSC has pledged to donate at least one day per quarter to local veterans who have urgent medical problems that can be treated through outpatient surgical care. Veterans receive pre- and post-treatment free of charge, including medical services, physical therapy, and supplies, with the bulk of surgical supplies and implants donated by corporate sponsors, says Arrambide. She says other surgery centers have expressed interest in offering similar programs. [Note: The patient's last name is spelled incorrectly in the original article's photo caption and should be "Robert Gustafson"]
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CBO: Slowed Federal Health Spending Yields Savings
Kaiser Health News (07/16/14)

The Congressional Budget Office (CBO) reports that federal spending on health care has slowed sharply, partly due to the federal health-care law, but this is not enough to resolve long-term U.S. debt. Cost controls implemented in the health-care law will further reduce the growth of federal spending. The budget office estimated that federal spending on major health-care programs would amount to 8 percent of gross domestic product (GDP) by 2039, one-tenth of a percentage point lower than its previous projection. For the 10-year period beginning in 2010, the estimated cost of Medicare and Medicaid has dropped by $1.23 trillion, according to CBO projections. The office warned in a Tuesday report that the nation’s debt would jump to 106 percent of GDP in 2039, driven by the rising costs of entitlement programs like Medicare and Social Security.
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First Observations Around the Affordable Care Act
Athenahealth (07/14/2014) Sung, Iyue; Gray, Josh

Although there were concerns that the Affordable Care Act (ACA) would release a flood of pent-up medical demand, a new Athenahealth report suggests that this is not the case. New-patient visits appear to have declined slightly over 2013, before 9 million people were newly covered under the ACA. This year marks the implementation of the coverage expansion requirements of the ACA, and before the end of 2016, millions of individuals are expected to sign up for insurance through new health-care exchanges. A research team from Athenahealth looked to see if the trend varied by state, but overall there was no great surge in demand for care. Some states have embraced the ACA and built their own health insurance exchanges and expanded Medicaid, while others have pushed against the ACA and done as little as possible. “One important concern about the transition to coverage expansion was that some newly insured patients might seek care for illnesses that had previously been untreated,” the Athenahealth team wrote. "Physicians and other providers would then struggle to provide care to these sicker-than-average patients while continuing to meet the needs of their established patients.” However, test results, diagnoses, and other data from the doctor visits provide little evidence that patients were coming with, for example, untreated diabetes. New patients, in fact, seemed healthier than expected.
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'Black Box' Tracks Errors in Toronto Operating Room
Toronto Star (Canada) (07/09/14) Karstens-Smith, Gemma

In April, a "black box" was installed in an operating room at St. Michael's Hospital in Toronto to monitor potential errors. The black box consists of three microphones and three cameras, two of which film the operating room, while a third internal camera records what is happening inside the patient’s body while the surgeon and his team perform minimally invasive surgeries. An initial pilot involving the black box recorded approximately 80 gastric bypass surgeries performed by Dr. Teodor Grantcharov, who developed the technology. The pilot found that 86 percent of the errors were made after surgery, during suturing and grafting of the bowel. A team is now working on creating educational tools based on the data.
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Quantification of the Hawthorne Effect in Hand Hygiene Compliance Monitoring Using an Electronic Monitoring System: A Retrospective Cohort Study
BMJ Quality and Safety (07/07/2014) Srigley, Jocelyn A.; Furness, Colin D.; Baker, Ross; et al.

Rates of hand-hygiene compliance among health care workers tend to be higher when there is an auditor in sight, which suggests that the compliance rates reported by many hospitals may not be accurate. Researchers studied an academic acute care hospital to determine whether the presence of auditors was associated with an increase in hand-hygiene events as measured by a real-time location system (RTLS). The system recorded all uses of alcohol-based hand rub and soap for eight months in two hospital units, and also tracked the movement of hospital hand-hygiene auditors. The researchers compared the rates of hand-hygiene events per dispenser per hour as measured by the RTLS between dispensers within sight of auditors and those not exposed to auditors. Results showed that there were an average of 3.75 hand-hygiene events per hour for dispensers that were visible to auditors, but 1.48 events per hour for dispensers that were not visible to the auditors at the same time.
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Rural Disparities in Receipt of Colorectal Cancer Screening Among Adults Ages 50-64 With Disabilities
Disability and Health Journal (06/17/2014) Horner-Johnson, Willi; Dobbertin, Konrad; Lee, Jae Chul; et al.

Although early detection can reduce mortality associated with colorectal cancer, U.S. adults over age 50 who live in rural areas are significantly less likely to receive any colorectal cancer screening. Overall, only 59 percent of U.S. adults over age 50 meet recommended colorectal cancer screening guidelines. The findings came from data from the Medical Expenditure Panel Survey from 2002-2008. Among U.S. adults ages 50-64 with disabilities, those living in rural areas were less likely to have ever received any type of screening for colorectal cancer, regardless of demographics, socioeconomics, health, and health care access.
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The Effect of Pre-Affordable Care Act (ACA) Medicaid Eligibility Expansion in New York State on Access to Specialty Surgical Care
Medical Care (06/30/14) Aliu, Oluseyi; Auger, Katherine A.; Sun, Gordon H.; et al.

Medicaid expansion in New York state has significantly improved beneficiaries' access to common musculoskeletal procedures, including lower extremity large joint replacement, spine procedures, and repair for extremity fractures and dislocations. Researchers used New York state's Medicaid expansion in October 2001 to examine whether Medicaid expansion increased access to such procedures for beneficiaries. Study authors looked at data from patients aged 19-64 who underwent one of these procedures from January 1998 to December 2006. They found that, before Medicaid expansion, there was a slight but steady temporal decline in the proportion of musculoskeletal surgical patients who were Medicaid beneficiaries. The trend reversed after expansion, until the proportion of musculoskeletal surgical patients who were Medicaid beneficiaries was 4.7 percentage points higher than expected five years after the expansion.
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Polypectomy Rate: A Surrogate for Adenoma Detection Rate Varies by Colon Segment, Gender, and Endoscopist
Clinical Gastroenterology and Hepatology (07/14) Vol. 12, No. 7, P. 1137 Gohel, Tushar D.; Burke, Carol A.; Lankaala, Pavan; et al.

The adenoma detection rate (ADR) is a key measure of the quality of colonoscopy, and recommended indicators of competence for colonoscopy include minimal ADRs greater than 25 percent for average-risk men and greater than 15 percent for women. Researchers sought to compare ADRs with polypectomy detection rates (PRs) in different segments of colon and between sexes, using a cross-sectional review of findings from 2,167 screening colonoscopies performed by 65 endoscopists on average-risk outpatients at the Cleveland Clinic from 2008 to 2009. The findings from screening colonoscopies suggest that overall PR correlates with ADR for the entire colon, but PR and ADR correlate most strongly for the proximal colon, where many adenomas can be missed and interval cancers develop. The correlation between PR and ADR is weaker for women than men and for the distal colon. "If PR is used as a surrogate for ADR, colon location and patient sex should be considered," the researchers said.
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Medicare's Colonoscopy Loophole Could Cost Your Patients
Outpatient Surgery (07/17/14) Bernard, David

Proposed ways to overhaul how Medicare collects colonoscopy co-pays from its beneficiaries are currently being considered by both houses of Congress. Supporters of House Bill 1070 and Senate Bill 2348 say the measures would enhance patients' access to colonoscopies and as a result would help curb the incidence of colon cancer. The legislation is necessary because the Affordable Care Act waived Medicare's co-insurance payments for colorectal cancer screenings, but if an endoscopist removes a polyp, the procedure is classified as therapeutic and the patient is responsible for the co-pay. Colorectal cancer prevention and treatment advocates are urging surgical facilities to support the proposed co-pay fix by contacting their federal lawmakers. The Ambulatory Surgery Center Association makes it easy for consumers to identify and email U.S. senators and representatives on the issue.
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