5 Best Specialties for ASCs Now

1. Orthopedics. Rising ASC reimbursement for orthopedic surgery is transforming a sometimes break-even field into a money-making one, says William G. Southwick, president and CEO of HealthMark Partners in Nashville. For example, shoulder surgery used to be so underfunded it needed to be supplemented by income from other procedures, he says. Now, under Medicare’s ambulatory payment classification system, reimbursement for orthopedic ASCs is expected to increase 100 percent.

Orthopedics, along with otolaryngology and general surgery, is on Mr. Southwick’s list of specialties with enhanced value for ASCs. “These specialties are good for Medicare patients and are saving the healthcare system significant dollars,” he says.

Jerry Ippolito, director of perioperative services business development at Southeast Anesthesiology, Charlotte, N.C., also puts orthopedics at or near the top of his list. “Orthopedics is a big winner under APCs,” he says. “It has some lucrative cases, such as knee arthroscopies and it is not isolated to one payor population.” For example, while total joint procedures focus on Medicare patients, “some of the most severe joint injuries happen to younger people who are on private insurance,” Mr. Ippolito says.

2. Spine. Naya Kehayes, CEO of Eveia Health Consulting & Management in Issaquah, Wash., sees a great deal of promise for this specialty. “Spine is probably the newest, biggest most costly surgery done in the hospital that can be done outpatient,” she says, but she cautions that ASCs should contact payors before deciding to add any specialty. “The biggest mistake an ASC can make is to buy all the equipment and then talk to the insurer,” she says. Ms. Kehayes also sees great potential for ASCs that add cochlear implants, vaginal hysterectomies and some of the larger urology cases to their list of procedures..

Robert S. Bray Jr., MD, a neurosurgeon who runs a spine ASC in California, believes that “the future of spine surgery is in the ASC. “Spine will literally be a game-changer for ASCs in the next 10 years.” He warns that ORs have to be larger than at the average ASC to accommodate spine surgery equipment and ORs have to be “ultra clean,” so they cannot be shared with specialties like gastroenterology. And it takes a while to convince insurers that spine can be performed safely in an outpatient setting, he says.

3. Bariatrics. Along with spine and retina, bariatrics is on Mr. Southwick’s list of specialties with growing value for ASCs because they have been slowly moving out of the hospital setting. Laparoscopic gastric band procedures, or lap-bands, are the only bariatic procedures that are typically performed in an ASC, he says. In contrast, he says gastric bypass surgery requires two or three days of hospitalization and costs a great deal more.

Mr. Southwick notes that the recession has dampened demand for lap-bands, which cost $10,000-$15,000 and are often paid by the patient out of pocket. But popularity is expected to rebound, because an estimated 5-7 percent of the population is eligible for bariatric surgery.

However, “keep in mind that bariatrics needs the whole array of services [for the ASC] to be a bariatric center of excellence,” warns Ms. Kehayes. These include patient support services and features such as patient-lifting equipment, wide doorways, floor-supported toilets and sensitivity training for the staff.

4. Retina. Many ophthalmology ASCs limited to cataract surgery are adding retina surgery, which is usually handled by a separate subspecialty of some 1,300 ophthalmologists. These procedures are longer and more complicated and, until recently, were almost always done in the hospital.

While retina is now safe to do in ASCs, ophthalmology surgeons were discouraged from moving out of the hospital by low reimbursements that didn’t cover costs in the ASC. However, under the new Medicare APC system, retina payments will rise 100 percent, according to Leo T. Neu III, MD, a retina surgeon who runs an ASC in Springfield, Mo. He says the average payment for a standard pars plana vitrectomy, the most common retina procedure, will rise 145 percent by 2011, to $1,540.

On the professional fee side, Dr. Neu adds that declining reimbursement for some retinal procedures will lure retinal surgeons out of the hospital and into the ASC. For example, Dr. Neu reports that the Medicare professional fee for a vitrectomy with epiretinal membrane peeling fell by 24 percent in 2008.

5. Pain management. Along with gastroenterology and ophthalmology, pain management is on Mr. Southwick’s list of specialties with continued value for ASCs. “These specialties continue to be successful in ASCs, if expenses are managed carefully, even as reimbursements for them are cut,” he says. While most of the cutting has been due to Medicare APCs, “private payors are beginning to reflect those cuts,” he says.

Even though reimbursement to ASCs for pain management will fall 2 percent under APCs, volume is rising. A study conducted last year by KNG Health Consulting found that pain management was one of the few ASC-based specialties where most of the new procedures in centers were not simply moving out of the hospital. While 77-95 percent of new volume in orthopedics, ophthalmology and other specialties came from hospitals, the figure for pain cases was 15 percent. The new volume represents “significant changes in insurance coverage and advancement in the pain management clinical treatments [that] have evolved in the past seven years,” the study said.

Mock Surgery day

The 19^TH Annual Mock Surgery day at Brackenridge Hospital was a huge success. Approximately 1500 people attended the event. A wide variety of groups and organizations were represented as they shared information on various topics pertaining to good health and general safety. Those who attended learned about subjects like; kidney disease, diabetes, cancer, fire safety and more. The hospital also had staff on hand to show people how to bandage wounds and even the trauma department was represented.

Vantage Outsourcing was invited to participate in the event and for the first time ever cataracts were covered. Information was shared, which answered a variety of questions, such as:

• What is a cataract?
• How does it form?
• Who can get cataracts?
• How long does the procedure take?

Along with this information, the cataract surgery was described, the surgical instruments were on hand for viewing and some of the different types of lens implants were discussed. Overall, a lot of information was provided.

Vantage Outsourcing had a great time at this public event and is looking forward to further the publics knowledge when it comes to Cataract Procedures.

Mock Surgery Day

Brackenridge Hospital in Austin, Texas is having a “Mock Surgery Day” on 2/6/10 from 8:00am-3:00pm. In the Clinical Education Center, of the hospital, there will be designated areas set up as operating rooms. Each area will reflect different surgical procedures performed at the hospital. Medical staff will be on hand to talk about what happens during surgery.

The program is designed for kids and adults alike. Scrub attire and surgical masks will be provided for visitors so they can really “get a feel” of an OR environment. The event takes approximately 2 hours to go through.

For more information please contact: Elois Currivan or see their website at (http://www.seton.net/clinical_education_classes_and_events/classes/mock_surgery)

Supporters of the project included Vantage Outsourcing whom’s Cataract Division will be assisting the hospital in demonstrating the various aspects of Cataract Surgery.

Dr. Peter Colquhoun Discusses Four Opportunities for Ophthalmology at Surgery Centers in 2010

Peter Colquhoun, MD, a board-certified ophthalmologist at Southwest Michigan Eye Center in Battle Creek, Mich., and physician-owner of Brookside Surgery Center, also in Battle Creek, discusses four opportunities for ophthalmology in ASCs.

1. Multi-focal implants. Although the price of lens implants are bundled into payments for cataract surgery, if a physician and patient select a higher-end multi-focal implant, such as Alcon’s ReStor IOL or AMO ReZoom IOL, surgery centers, at least in Michigan, can balance bill a patient for the additional cost of the lens, says Dr. Colquhoun. Balance billing allows for cataract patients, who are often covered by Medicare, to receive the highest-level technology — a technology that Medicare would otherwise deny, he says.
2. Intravitreal injections. Dr. Colquhoun says his ASC is exploring offering intravitreal injections, such as Avastin and Lucentis, to treat various retinal disorders including age-related macular degeneration, diabetes and vascular occlusions. The ASC is currently analyzing potential reimbursement rates and demand for the procedure to determine if it is advantageous for the ASC.
3. Mini glaucoma shunts. Dr. Colquhoun’s practice is also considering bringing in a glaucoma specialist in the coming year. If the practice is successful in attracting an additional physician, Dr. Colquhoun says the new specialist could bring additional business to the ASC by performing implantations of mini shunts to treat glaucoma, which can be performed in an ambulatory setting.
4. Oculoplastics. Finally, although the volume of plastic surgery has dropped dramatically with the economy, Dr. Colquhoun expects some of that business to rebound in 2010. “With the economy improving in the next year, we are hoping lid corrections and other elective ophthalmic procedures, such as LASIK, will increase,” he says.

CMS Issues Corrections to the 2010 Physician Fee Schedule

The Centers for Medicare and Medicaid Services has announced corrections to the 2010 Physician Fee Schedule that includes changes to the Medicare anesthesia conversion factor, which went into effect on Jan. 1, 2010, according to a news release from the American Society for Anesthesiology and information from CMS.

The correction takes into consideration calendar year 2010 anesthesia practice expense revisions, according to the ASA release.

The nationwide unadjusted conversion factor for anesthesia services provided between Jan. 1 and Feb. 28, 2010, will be $21.114, according to the release. Anesthesia practices located in Alaska will receive the highest conversion factor at $29.51, whereas practices in Puerto Rico and the Dakotas will receive the lowest at $17.66 and $18.95, respectively. 

A list of conversion factors by locale is available here.

Additionally, CMS corrected the 2010 conversion factor across specialties, fixing a technical error in adjusting relative value units, reflective of the agency’s policy with consultation codes, according to CMS. 

Here is a list of some of the new 2010 payments under the corrected schedule:
•    CPT 27130 (Total hip arthroscopy) (facility) — $1,082.21
•    CPT 27447 (Total knee arthroscopy) (facility) — $1,157.72
•    CPT 43239 (Upper GI endoscopy, biopsy) (facility) — $134.00
•    CPT 66984 (Cataract surgery w/ IOL, I stage) (facility) — $548.77

A complete listing of corrected 2010 payments can be found here. 

After Feb. 28, CMS will impose a 21 percent Medicare payment cut across all medical practices, which will directly affect the payments and conversion factors.

For more information on the 2010 Physician Fee Schedule, click here. 

Read the ASA release on the revised 2010 Medicare anesthesia conversion factors. 

Read the CMS transmittal on the 2010 Physician Fee Schedule. 

Read the Federal Register article on corrections to the 2010 Physician fee schedule (pdf).

Free Webinar: Hospital-Doctor ASC Joint Ventures: A Highly Efficient Physician Engagement Tool

Title: Hospital-Doctor ASC Joint Ventures: A Highly Efficient Physician Engagement Tool

Date: Feb. 11, 2010

Time: 1:15-2:15 CST

Sponsored by: Medical Surgical Partners

Overview: The era of loose cooperation and occasional competition between hospitals and their private practice medical staff members is drawing to a close. As a result, hospitals and health systems must align with physicians to meet the demands for price, quality, efficiency and community service imposed by private payors, government and empowered consumers. Hospitals and health systems are faced with a wide range of physician engagement tools and strategies to meet this challenge.

Nearly 1,700 hospital-physician surgery center joint ventures exist in the United States. These arrangements facilitate service line development, offer market development opportunities, ameliorate the compensation needs of employed surgeons, provide a vehicle for real estate investment by non-surgeon staff, reduce the cost of care in the community, enhance access to care and care quality and are an incubator for development of physician leaders. Most importantly, such joint ventures are efficient to organize and offer a win-win situation for hospitals and physicians seeking to align the hospital’s mission and economic interests with those of its physicians.

Notwithstanding the power of ASC joint ventures, many hospital executives find them counter-intuitive because of short term loss of hospital surgical revenue.

Topics covered will include:

• Examination of the market drivers behind ASC joint ventures;
• Economic factors underlying their performance and impact on hospital operations; and
• Joint-venture structure issues central to successful hospital-physician surgery centers.

Correctly approached, hospital-physician ASC joint ventures are a powerful physician engagement tool that produces reliable results quickly and efficiently and without substantial capital and operational investment by the health system.

Speaker information:
David Thoene, Managing Partner, Medical Surgical Partners — Mr. Thoene has 27 years’ experience consulting for and developing ASC throughout the United States and was instrumental in perfecting the hospital-physician ASC joint venture model used by many major health systems and hospitals throughout the country. He has published articles in national trade journals on topics such as evaluating real estate options for surgery center development and has been a speaker at national conferences on topics related to ASC development. Mr. Thoene was the vice president of development for FSC Health and Titan Health Corp., founded the development arm of Randlett Associates Incorporated and is the founder of Medical Surgical Partners. Mr. Thoene has developed surgery center investments for physicians, academic medical centers and health systems.

Registration:
To register, click here.

#1 Priority for Your Front Office Team

A surgeon can be the best surgeon in the area or the world, for that matter. But, if his/her front office isn’t doing its job right, this expertise means nothing. It’s the equivalent of having the best quarterback on the field, but the front line can’t block, the running back can’t run and the receivers can’t catch. A team simply can’t win, with only one effective player. So how effective is your team?

As in football, a front office must know the drills and apply them daily. First, they need good people skills. It’s a MUST that they always put the patient first. As the saying goes, “if Mama ain’t happy, ain’t nobody happy!” How does this apply to your patients? Think about it, if your staff mishandles an issue in the front office, they’ve not only upset the patient, but the patient’s family/friends and everyone sitting in your front office, i.e. other patients and potential customers. If you can do one thing for your staff, teach them how to handle difficult situations. First, train them to live and breathe the two rule standard as an initial reaction to a disgruntled patient: “Rule #1 – The patient is always right, Rule #2 – If the patient is wrong, refer to Rule #1.” By making the patient feel that they are right, the anger and emotions surrounding the situation are diffused immediately. Second, in resolving a patient issue, take them to a private area and work through the patient’s issue in a positive manner. If a staff member has done something wrong, require that the staff resolving this issue with the patient do 4 things: (1) admit wrong doing, (2) openly acknowledge what was done incorrectly, (3) apologize for the mistake, and (4) come up with an action plan that you will implement immediately to ensure this doesn’t happen again. If your staff does this, it’s a guarantee that your patients will come back, as well as become life-long customers and most importantly, tell their family and friends of the great experience they had at your office and/or surgery center and what a top notch ophthalmologist you are.

The second most important duty of front office staff is how they treat each other. The Golden Rule is always a good place to start. This rule is “treat others, as you would like them to treat you.” If you instill this in each and every one of your people and let them know that you expect them to live this daily, your personnel issues will be minimal. In the last year, one of cataract outsourcing team members violate this rule. Rather than treat it as an isolated incident and address with only this particular staff, the supervisor gathered the entire group together the day after the episode and presented them with a one page statement. He read it out loud and had discussions with them what this meant on an individual level, as well as a team. He went over points about how our society, as a whole, has become less professional and respectful of each another. They discussed this and it was agreed that the team needs to work harder in making sure these types of behaviors/attitudes don’t permeated their work environment. They discussed how they could have handled the situation differently. In the end, the supervisor, along with each staff member, signed this document acknowledging their pledge to treat each other professionally and with the utmost respect, at all times.

Another aspect of front office service applies to your facility staff. If you haven’t already done so, you need to encourage, promote, and require your facility staff to treat your office staff with the upmost respect and view them as a key customer. In addition, they need to do the same for all surgeon users’ office staff. Your people must view these groups of people as key customers, i.e. same top notch customer service, as the staff gives the patients. Granted not all physician offices have the greatest customer service-oriented people working their front desks. But, encourage your staff to look beyond this and to keep reminding themselves that a surgeon’s staff is the gatekeeper of the facility’s patients. Again, if these key people are happy, I’ll guarantee you the facility case load will increase.

Finally, your staff needs to be dutiful in completing the tasks of scheduling, pre-certing, registering, preparing patient for surgical protocol and expectations, billing and collecting payments. However you might remind them that if poor customer service exists and/or prevails, there will be no need to pre-cert, register, etc…, as customers will be non-existent. Therefore, the #1 priority must always be customer service to both external and internal customers.

Red reflex test to all newborns recommended

Physicians at The Vision Center of Children’s Hospital, Los Angeles, are strongly advocating a basic eye exam, including a red reflex test, be given to all children shortly after birth, the center said. Angela Buffenn, M.D., M.P.H., Director of the Orbit and Eye Movement Institute and Diana Dennis, M.A. of the Therapeutic Living Center for the Blind, reported on the problem of inadequate childhood vision screenings in Pediatric News. The red reflex test involves looking at the infant\’s eyes through an ophthalmoscope in a dimly lit room to see if there are any abnormalities in the back of the eye or white spots in the eyeball. The test is used to screen for abnormalities in the eye itself as well as ocular misalignment. If the red reflex is found to be abnormal, the child should be examined by a pediatric ophthalmologist in order to test for strabismus (crossed eyes), cataracts, glaucoma, retinoblastoma, retinal abnormalities, and high refractive errors. Oftentimes, the test is first administered by a pediatrician or family physician. The red reflex test has been endorsed as an important part of a well child visit by the American Academy of Pediatrics and the American Academy for Pediatric Ophthalmology and Strabismus.

“Too often we see children with developmental delay whose visual system has not been properly evaluated. Sometimes, parents also think that vision loss is less important than treating the seizure disorder or developmental disability, when the truth is we can address both at the same time,” said Dr. Buffenn.

Retina tops online health forum inquiries

According to an analysis of questions asked on MedHelp, the American Academy of Ophthalmology’s health information Web site, concerns related to the retina topped the list—almost 20% of the 4,485 questions posed over a 6-month period from Sept. 2008 through March 2009. According to John C. Hagan, M.D., and colleagues, many people asked about or retinal detachment. About 19% of questions were related to the cornea. Cataract and implanted lens questions were next in prevalence, followed by brain-eye problems (neuro-ophthalmology), children’s eye alignment (), eye cancers, and general discomfort or blurry vision.

Two-to-three percent of questions related to each of three vision correction topics: refractive surgery . A smaller number were related to eye care products or medical insurance. The analysis also found many people submit postings to express their gratitude for the medical advice provided.

Cataract does not affect AMD progression

Age-related macular degeneration (AMD) does not appear to progress at a higher rate among individuals who have had surgery to treat cataract, contrary to previous reports that treating one cause of vision loss worsens the other, according to a study in Archives of Ophthalmology. Because both conditions are strongly age-related, many individuals with cataract also have AMD, the journal said in a news item. There has been a long-standing controversy among clinicians as to whether cataract surgery is contraindicated in eyes with non-neovascular AMD. A major concern has been whether cataract surgery increases the risk of progression to neovascular AMD in eyes at risk of progression such as those with intermediate AMD.
Li Ming Dong, Ph.D., of Stony Brook University School of Medicine, N.Y., and colleagues studied eyes of 108 individuals with non-neovascular AMD who underwent preoperative assessments for cataract surgery between 2000 and 2002. Photographs of the retina were taken and fluorescein angiography, which uses a special dye to investigate blood vessels in the eye, was performed. A total of 86 evaluated eyes had non-neovascular AMD before surgery, and 71 had follow-up assessments between one week and one year after surgery.
Neovascular AMD was observed in nine (12.7%) of these 71 eyes at one or more follow-up assessments. Five eyes displayed signs of neovascular AMD at the 1-week follow-up point; the size and location of the lesions identified indicated that they may have been present before surgery but not visible due to the opaque lens caused by cataract. When these eyes and one eye that did not have 1-week follow-up photographs available were excluded, the progression rate between 1 week and 1 year decreased to three of 65 eyes (4.6%). The rate of progression to neovascular AMD was similar among participants other, cataract-free eyes over the same time period (3%).
The authors do note earlier reports may be biased with the absence of immediate postop fluorescein angiography. An accompanying editorial notes the diversity in study findings may be due to study design and that much work is still needed before steadfast conclusions may be made.

Next Page »