New York’s Vassar Brothers Medical Center Plans Expansion

Vassar Brothers Medical Center in Poughkeepsie, N.Y., has proposed a $66 million expansion project that includes the construction of an ambulatory surgery center, according to the Poughkeepsie Journal.

Officials from the hospital announced the plans last year as part of an effort to reduce crowding and improve parking at the hospital, according to the report.

VBMC has proposed a 78,000 square-foot medical complex that would include an ASC as part of the project, according to the report. Other additions include an 850-space parking garage and a cafeteria.

If approved by the board, construction could begin this summer and completed by the end of 2011.

Read the Journal’s report about Vassar Brothers Medical Center.

Growing Your ASC: Q&A With Robert Zasa of ASD Management

Q: Solid business fundamentals are essential to the success of ASCs. What can centers do to ensure their processes are running as effectively and efficiently as possible?

Robert Zasa: Case costing remains as important as ever. At our centers, we are currently running some spring housekeeping to see where we can reduce items we buy. For example, we may see a reduction in reimbursement from HMOs when it comes to surgical implants. In this case, we go back to the payor and try to renegotiate rates. We will be honest with the payors and explain that we can’t afford to do the cases at the current rates, which will, in turn, force them to go back to the hospitals and pay a higher rate. Often, we will be able to negotiate a new rate.

Aside from reviewing case costs and reimbursement rates, we look at all areas of the practice, including staffing costs, suppliers, etc., to see what we can do to get better pricing. Recently, we’ve been able to work with our GPO to contract for more items on more of discount. We’ve also shopped distributors to see if we can get better pricing. Overall, though, staffing and supplies account for the biggest variable costs in an ASC, and we make sure we are reviewing these areas.

Q: ASCs continue to have concerns over falling reimbursements, as they have in the past. How can ASCs make sure that they are receiving adequate reimbursement on their cases and what should be done to improve these rates?

RZ: As with case costing, ASCs should review their reimbursements per case. At our centers, we review one specialty every month so that it becomes a routine practice. We also perform a retroactive contract analysis of the top 20 or so procedures at our ASCs by CPT code. The top 20 codes will typically represent 80 percent of your business at your ASC.

Using these codes, we perform a payor breakdown, including case volume per payor, so we can track any disparities among the rates. You want to make sure you have a good sense of what you are doing per payor.

For example, you might discover you are doing 200 cases for Cigna at $100 and 300 for Blue Cross at $50. This way you can see what insurers are more profitable for your center and which ones it may be necessary to renegotiate with.

ASCs should also receive annual notification of changes in reimbursement from payors, so that they can prepare for significant changes.

Q: What opportunities for growth exist for ASCs currently? Are there any new developments or procedures beneficial to service lines in ASCs?

RZ: One opportunity we’ve taken is to go back to our existing physicians to make sure that they are maximizing the use of the center. We have also examined CMS’s list of newly approved procedures for ASCs and ask our physicians what they are willing to or want to learn. For example, we had a general surgeon say he was interested in learning new endoscopic procedures. We already had the equipment for other specialties, so it was worthwhile to have the surgeon train on the new techniques and add them to the ASC. Keeping constant communication open with your investors will help you to gauge the interest of your surgeons.

Spine and retina also remain popular new areas for growth, and, again, we add these specialties according to physician interest. Retina is now paid by Medicare, so it can be a profitable addition for ASCs. We’ve had outside surgeons from other ASCs come in and demo these areas for our surgeons, and if there is interest we look into adding the procedure.

Q: Reports have shown that more new physicians are choosing the hospital setting over private practice. How can this effect the ability of ASCs to recruit new physicians?

RZ: Hospital employment can be good for ASCs that are in joint ventures with hospitals as it means new physicians will continuously be added on to the center. ASCs can also benefit in entering into joint ventures with hospitals, as the recruiting office will see the surgery center as key to attracting new surgeons. For instance, a hospital may be attracted to a new orthopedic surgeon, and the ASC can help bring the surgeon in because it can offer a place where he or she can work and have ownership.

Mr. Zasa is a managing and founding partner of ASD Management, which specializes in development and management of new and existing ASCs. Learn more about ASD Management.

CMA Says California HMOs Will Need More Doctors to Meet New Time Limits

New state regulations setting time limits for HMO patients to see doctors may force HMOs to add more physicians to keep appointments on time, according to a release from the California Medical Association.

Under the regulations, HMOs must make sure members have urgent care within 48 hours, see a primary care physician within 10 business days of requesting an appointment and a specialist within 15 days.

“As doctors, our No. 1 priority is our patients,” said CMA President Brennan Cassidy, MD. “We want to be sure that HMOs meet these requirements without forcing doctors to shorten patient visits or meet unrealistic quotas that would comprise the quality of care.”

Read the California Medical Association’s release on patient waiting times.

Wake Forest Medical Center in North Carolina Proposes 8-OR ASC

Wake Forest University Baptist Medical Center in Winston-Salem, N.C., is asking for state permission to build a $38.7 million ASC next to its main campus, according to a report by the Business Journal Serving the Greater Triad Area.

Wake Forest University, which runs a medical school, wants to build an eight-OR facility, adding seven rooms to its total inventory and relocating one existing room to the new center.

The facility would also include two teaching rooms to simulate operating and robotic surgery techniques for medical students.

Read the Business Journal Serving the Greater Triad Area’s report on Wake Forest University Baptist Medical Center.

Massachusetts Report Finds Hospitals’ Negotiating Clout With Insurers Drives Up Costs

Massachusetts hospitals and physician groups with market clout negotiate rates that are twice as high as for other hospitals, and such clout is the main cause of healthcare inflation in the state, according to a release by State Attorney General Martha Coakley.

Ms. Coakley’s office based the findings on a year-long study of the Massachusetts market, finding that about 10 hospitals enjoy reimbursements 10-100 percent higher, for similar work, than reimbursements for the other 55 hospitals in the state.

The office’s report says the 10 favored hospitals had brand-name recognition or few competitors in their markets, but it did not name any provider or insurer, saying its aim was to identify systemic problems and not blame individual organizations.

Based on its findings, the report recommended against establishing global payments covering a patient’s entire medical care for an illness, an approach recommended by a state commission.

The study concluded that higher healthcare costs are basically caused by rising prices, not increased demand for new services. One major insurer reported provider price increases accounted for 80 percent of the growth of medical expenses from 2006-2009.

The report called on the state to:

• Discourage or prohibit contract provisions that perpetuate market disparities;
• Increase transparency and standardization in payment and quality;
• Reform payments to account for market distortions; and
• Encourage development of a “value-based” healthcare market.

Read the Massachusetts Attorney General’s release on health insurance reimbursements.

Former Hospital Executive Charged With Stealing From Donations

The former director of the cardiovascular center at South Shore Hospital in Weymouth, Mass., has been charged with embezzling donations to the hospital’s fundraising program and from other hospital sources, according to a report by the Enterprise News.

Federal prosecutors allege that William S. Burke diverted to a personal bank account charitable contributions from the hospital’s “Dare to Care” fundraising program and medical-supply rebates to the cardiovascular center from 2007-2009.

Hospital employees reported the alleged theft to federal law enforcement officials and Burke left South Shore in Oct. 2009, after more than four years of service.

Read the Enterprise News’ report on South Shore Hospital.

FDA issues warning letter to researcher about promoting Ipsens Dysport

The U.S. Food and Drug Administration (FDA) has issued a warning to Miami Beach-based researcher Leslie Baumann, M.D., regarding promotional statements she made about Ipsen Biopharm’s (Paris) injectable frown line treatment Dysport (abobotulinumtoxinA), the FDA said in a letter.

Dr. Baumann’s promotional statements about Dysport, which were made to two magazines and NBC’s “Today Show,” were reportedly made in 2006, prior to the drug’s FDA approval. The statements were therefore in violation of the FDA’s regulations on pre-approval promotion, the agency said in its letter.

Dr. Baumann was involved as a researcher in Phase III trials of Dysport, also known as Reloxin, at the time she made the promotional statements, the FDA stated.

Dr. Baumann’s statements about Dysport included claims that its effects “last a month longer than Botox (onabotulinumtoxinA, Allergan, Irvine, Calif.),” the FDA letter cited. The FDA approved Dysport for treating forehead wrinkles and frown lines last spring. Ipsen granted distribution rights for the drug’s cosmetic use to Medicis (Scottsdale, Ariz).

Gov. Paterson proposes bill to require disclosure from PBM

New York Governor David A. Paterson has proposed legislation that would increase transparency and promote competition among pharmacy benefit managers (PBMs) by requiring them to disclose additional drug information to health plans, doctors, and patients.
“PBMs perform a valuable service, but there is little oversight of their practices and little competition,” said New York State Health Commissioner Richard Daines, M.D., in the release. “The three largest PBMs—Medco, Caremark, and Express Scripts—manage pharmacy benefits for 200 million Americans, 95% of those who have prescription drug coverage.”

Under Paterson’s bill, PBMs would be required to disclose the actual use of drugs by the health plan’s participants, any conflict of interest that the PBM might have with the health plan, any increase in the net price to the health plan for a covered drug and the reason for the increase, and all contracts entered into by the PBM with a network pharmacy or pharmaceutical manufacturer. The bill would also notify patients and disclose any relevant clinical and financial information to prescribers before a PBM could switch a patient to a more expensive drug, the governor said in the press release.

Gene expression may be linked to retinoblastoma progression

The inactivation of the 16INK4A gene may play a key role in the progression of retinoblastoma, said researchers at Thomas Jefferson University’s Sbarro Institute for Cancer Research and Molecular Medicine (Philadelphia, Pa.) in a press release.

In a recent study, published in the Journal of Cellular Physiology, researchers focused on the 16INK4A due to its suspected role in retinoblastoma progression and its link to familial cancer predisposition.

In the study, Marco G. Paggi, M.D., Ph.D., and colleagues assessed blood samples taken from 29 patients and their parents. They found low to moderate 16INK4A protein expression in five of 11 (45%) retinoblastoma tumor specimens. They also found reduced p16INK4a RNA expression in blood in 16 of 29 (55%) retinoblastoma patients compared to normal controls. This reduction was associated with the depletion of the p16INK4a gene, the researchers said in the release.

The researchers also found reduced expression in at least one parent among nine of the 16 (56%) patients with reduced p16INK4a RNA expression. This suggests a heritable susceptibility to retinoblastoma, the researchers said.

Lead-based eye makeup may have fought infection in ancient Egypt

Lead-based eye makeup used by ancient Egyptians appears to have had antibacterial mechanisms that may have helped prevent common infections, said researchers from Paris’ École Normale Supérieure in a news report.

In a study originally published in Analytical Chemistry, Christian Amatore, Ph.D., and colleagues used electron microscopy and X-ray diffraction to assess 52 samples from containers of preserved makeup at the Louvre.

The makeup consisted primarily of four lead-based chemicals: galena, cerussite, laurionite, and phosgenite, the researchers said in the news report. Due to deterioration of the makeup samples over the centuries, the researchers were unable to identify what percent of the makeup was lead. The researchers contend that during periods in which the Nile River flooded, the population was particularly vulnerable to infections caused by particles that entered the eye, causing inflammation.

The dosage of lead in the makeup was a key factor in its potential benefits, Dr. Amatore said in the news report.

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