ASCA News Digest (October 15, 2014)

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October 15, 2014





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ASCA Highlights


Save the Date for ASCA’s Medical Director Leadership Seminar

ASCA's Medical Director Leadership Seminar, May 16–17, 2015, in Orlando, is a new meeting targeted exclusively to the unique interests and needs of medical directors and other physician leaders in the ASC setting. CME credits will be awarded for this meeting. They will not be awarded at ASCA's annual meeting, ASCA 2015. MORE
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ASCA members who purchase the 2015 survey before January 1, 2015, can save 10% off the total price ($269 for the year). If you are a current subscriber, make sure to submit your data for Q3 of the 2014 survey before October 31. If you haven’t subscribed yet for 2014, sign up today to submit data for Q3 and Q4 and receive the national/specialty report for Q1 and Q2. MORE
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Does your ASC deliver free and reduced-price surgical care or other health services to patients in need? Please complete a brief survey to help ASCA staff counter arguments that ASCs do not provide any charity care when advocating for your ASC to legislators and regulators. As always, survey information is kept confidential. MORE
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Flu season officially started October 1, 2014. ASCs will be required to collect data on ASC-8: Influenza Vaccination Coverage among Healthcare Personnel now through March 31, 2015, as part of Medicare’s ASC Quality Reporting Program. To report ASC-8, someone from your ASC must register with NHSN. This registration process can take several weeks, so ASCs are advised to register immediately. MORE
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Medicare-certified ASCs will be required to report 10 quality measures in 2015 for Medicare's ASC Quality Reporting Program. To help ASCs comply and avoid payment penalties down the line, ASCA has developed a free quality reporting resource that identifies the deadlines and reporting mechanisms associated with all 10 quality measures that ASCs will need to report next year. MORE
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Oregon Compounding Centers, Inc. (also called Creative Compounds) is voluntarily recalling certain unexpired human and veterinary sterile products due to a lack of sterility assurance. Users or recipients of these products should immediately discontinue use and return the recalled unexpired products. MORE
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Salaries, wages and benefits (SWB) represent the single largest expense category for most ASCs. ASC administrators attempting to restrain these costs must keep in mind that any attempt to manage expenses cannot compromise safe patient care. Find out how volatile changes in the surgical schedule can make covering all contingencies difficult without over-staffing. MORE
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Unable to join yesterday's call with the Centers for Disease Control and Prevention (CDC) about Ebola preparedness? The audio recording and slides will be available within a week on the CDC web site. The call focused on preventing the spread of Ebola within the United States and the lessons learned from how Emory Healthcare and Nebraska Medical Center prepared for patients with Ebola. MORE
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CMS has reopened the submission period for hardship exception applications for eligible providers to avoid the 2015 Medicare payment adjustments for not demonstrating meaningful use of Certified Electronic Health Record Technology (CEHRT). The new deadline will be November 30, 2014. Previously, the hardship exception application deadline was July 1, 2014, for eligible professionals. MORE
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Industry News


Getting Beyond Joan Rivers: Bethesda Center Pushes for More Outpatient Surgery
Washington Business Journal (10/10/14) Reed, Tina

Officials at Massachusetts Avenue Surgery Center, located in Bethesda, Md., are asking regulators and insurers to boost the number of surgical procedures performed outside of the traditional hospital setting. The center is working to get insurers to cover an increasing number of outpatient joint surgeries, such as knee and hip replacements, and they plan to lobby the state's general assembly next session to change a law that would enable them to perform surgeries that require overnight stays allowed under Medicare regulations. "Our doctors have the same training, the same certification, the same equipment, the same protocols as any other facility," said Randall Gross, Massachusetts Avenue Surgery Center's executive director. In addition to the center's very low infection rate and its low rate of cases that were transferred to area hospitals, mainly due to pain control, Gross said the cost can be up to 40 percent lower for procedures performed outside the hospital. The center only works with lower-risk patients, said Dr. Louis Levitt, surgical center chairman at Massachusetts Avenue, adding that patients over 55 must receive clearance from specialists, while those with higher body-mass indexes must meet with the anesthesiologist in person.
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Quality in an Ambulatory Surgical Setting
Health Leaders Media (10/13/2014) Clark, Cheryl

Seven years ago, OSF Saint Francis Medical Center in Peoria, Ill., allowed four independent groups of 43 doctors to take a good part of its surgical business to a freestanding ambulatory surgery center 11 miles away. The Center for Health Ambulatory Surgery Center, LLC, now conducts procedures on about 7,000 patients a year in the outpatient setting, for about half the price of the hospital. Dr. Michael Cruz, OSF Saint Francis' vice president of quality and safety, says the ambulatory environment "is more expeditious and efficient," and that patients with more routine issues have a better experience than in "a complicated medical center." He also points out that the ambulatory center frees up the 616-bed hospital to address more complex cases.
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Surgery Centers Say Safety a Priority
Press of Atlantic City (New Jersey) (10/11/14) Lala, Elisa

Officials with AtlantiCare Surgery Centers in New Jersey say that procedures performed on an outpatient basis are just as safe as those performed in a hospital and follow the same state regulations. Melissa Bushnell, R.N., executive director of AtlantiCare's three surgery centers, notes that the AtlantiCare Surgery Centers' transfer rate is 0.05 percent, below the national average of 0.12 percent, and those rates include patients who are transferred before surgery began because they were deemed too high a risk on arrival day. AtlantiCare also reports that overall patient satisfaction is high as its surgery centers, with overall patient confidence in care 96.7 percent at the Egg Harbor Township facility and 97.8 percent at the Cape May Court House site in the second quarter of 2014. At one local senior center, one older adult indicated that she had been very pleased with the care she received in an AtlantiCare ASC. Another older adult indicated that she would not hesitate to undergo surgery in an ASC, despite what she called "hysteria" following the death of John Rivers in a New York ASC.
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AAAASF Provides Outpatient Facilities With Ebola Checklist
American Association for Accreditation of Ambulatory Surgery Facilities (10/06/2014)

The American Association for Accreditation of Ambulatory Surgery Facilities, Inc. is providing an Ebola checklist and facts about the virus to U.S. outpatient facilities. The checklist advises facilities to ensure the availability of appropriate infection-control supplies, review their infection-control policies, begin education training for health care providers on Ebola virus signs and symptoms, and have the capability to request diagnostic tests. While Ebola is severe and often fatal in humans, it cannot be contracted through the air, water, or food, but can be spread by touching the bodily fluids of a person who is sick with Ebola, or by touching contaminated objects. Those infected with the virus should be isolated, given intravenous fluids and balancing electrolytes, and have their oxygen status and blood pressure maintained. The Centers for Disease Control and Prevention reports that a person infected with Ebola is not contagious until they show symptoms: fever of more than 101.5, severe headaches, muscle pain, vomiting, diarrhea, stomach pain, and unexplained bleeding or bruising.
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Anesthesia for Elderly Not Necessarily Risky
San Francisco Chronicle (10/07/14)

Some people are concerned about the risk of anesthesia in older people in the wake of the death of 81-year-old comedienne Joan Rivers, who experienced complications after a routine endoscopy to find nodules or polyps on her vocal cords. "Age in and of itself is not a large risk factor for anesthesia," says Greg Perkins, a member of Allied Anesthesia Medical Group. "What happened to Joan Rivers was a very rare occurrence." He advises anyone planning to undergo an endoscopy to carefully follow their doctor's instructions regarding fasting and which medications can be safely taken. Paul Yost, president of the California Society of Anesthesiologists, says the risk from anesthesia has more to do with a patient's condition rather than age.
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UCLA Receives $11 Million Grant to Lead NIH Center of Excellence for Big Data Computing
UCLA Newsroom (CA) (10/09/14) Schmidt, Elaine

The National Institutes of Health has awarded $11 million to UCLA to create a Center of Excellence for Big Data Computing that will develop new strategies for mining and understanding complex biomedical data sets. UCLA will be one of 11 centers nationwide to create analytic tools to address the challenges for researchers in accessing, standardizing, and sharing scientific data that could lead to new medical discoveries. UCLA will focus on creating and testing cloud-based tools to analyze data about protein markers that have been linked to cardiovascular disease. According to Peipei Ping, the UCLA center's principal investigator, a long-term goal for the center is to standardize patient data to allow a health care provider to retrieve all of a person's medical records at once, instead of trying to gather fragmented data from multiple sources.
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Mass. Becomes First State to Require Price Tags for Health Care
WBUR.org (10/08/14) Bebinger, Martha

As of Oct. 1, consumers in Massachusetts with private health insurance can go to their health insurer's Web site to check the price of various health care costs, including office visits, MRIs, and Cesarean sections. Massachusetts passed a law two years ago instructing health insurers and hospitals to make real-time costs more public. Consumers should note that insurers negotiate their own rates with physicians and hospitals, and some of these prices include all charges related to a particular test or procedure, while others do not. Barbara Anthony, Massachusetts Undersecretary of the Office of Consumer Affairs and Business Regulation, hopes the new tool will lead to more competition among providers and help reduce prices.
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More Than $1B in Payments to Doctors Is Excluded From Sunshine Database
Wall Street Journal (10/07/14) Silverman, Ed

The federal government's new Open Payments database excludes more than $1.1 billion in transactions, according to a new Centers for Medicare & Medicaid Services (CMS) fact sheet. A CMS spokesman says the omission was noted at a recent conference call, and the bulk of the missing payments data is related to research funding or disputed ownership and investments. Additional updates are expected in the future. Doctors and hospitals have the right to examine and dispute payment data submitted by drug and device makers. The agency had previously noted that data on 190,000 research payments would be withheld because these relate to drugs and devices that are not yet being marketed. The CMS said the names of doctors and hospitals that have been withheld due to the need to verify data are expected to be disclosed in 2015.
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Prescription for Job Growth: Medical Coders in Demand
CNBC News (10/03/14) Thompson, Mary

Experts predict that a shortage of skilled medical coders could potentially disrupt insurance payments for health providers. Torrey Barnhouse, president of TrustHCS, says there is a consistent 20 percent to 30 percent shortage of medical coders, which could increase to 50 percent in the coming year as a result of the migration to the ICD-10 coding system. The new coding system uses more than 140,000 codes, compared with just over 17,000 codes used by ICD-9. The higher level of detail could mean that a coder's productivity could decline by 50 percent after using ICD-10.
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Outpatient Surgery as a Means of Cost Reduction in Total Hip Arthroplasty: A Case-Control Study
HSS Journal (10/14) Vol. 10, No. 3, P. 252 Aynardi, Michael; Post, Zachary; Ong, Alvin; et al.

Performing total hip arthroplasty (THA) as an outpatient procedure is possible for certain patients as a result of the health care market and improvements in analgesia. Researchers sought to compare outcomes and cost-effectiveness of conventional inpatient THA with outpatient hip replacement at the same facility. An observational, case-control study conducted from 2008 to 2011 included 119 patients who all underwent outpatient THA via a direct anterior approach. The researchers observed no difference in complications or estimated blood loss between groups, and the $24,529 average overall cost in the outpatient setting was significantly lower than $31,327 average inpatient total. "Appropriately selected patients can undergo THA in an outpatient setting with no increase in complications and at a substantial savings to the health care system," the researcher said.
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ICD-10 Implementation Delay Gives Clinicians Time to Reduce Potential Headaches
Pain Medicine News (10/08/2014) Bosworth, Ted

The deadline for implementation of the ICD-10 coding system has been pushed back by one year to Oct. 1, 2015, which can relieve those clinicians who have not yet begun the change. Those who continue to delay may experience chaos and even lost income from the transition. ICD-10 is expected to be better at capturing data on value-based health care. One example is the effort to amend electronic medical records for colonoscopy to capture performance benchmarks, regardless of steps relevant to billing. Preparing for the change may be expensive, particularly the training for physicians and staff, and every individual practice should conduct extensive testing before launching the full transition.
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