From: Becker Scott <>
Subject: [Becker's ASC E-Newsletter] The Jan./Feb. Issue Is Now Online; Physician Hospital Association Supports OIG Recommendations on Emergency Care Policies; Partial Knee Replacement a Success


January 24, 2008
In This Issue
The Jan./Feb. Issue Is Now Online
Physician Hospital Association Supports OIG Recommendations on Emergency Care Policies
News and Notes
Companies to Watch
March/April 2008 issue
The Jan./Feb. Issue Is Now Online

The Jan./Feb. issue of Becker's ASC Review is now online. Included in this issue:

  • Components of a Successful Weight-Loss Surgery Program in the ASC;

  • 40 Companies to Watch in 2008;

  • Orthopedic & Spine Medical Device Market Letter;

  • 17 Red Flags of HIPAA Security in ASCs;

  • Four Ways to Expand Your ASC's Business Reach;

  • Spotlight On: Selling the Real Estate to Enhance the Surgery Business.

Go to to download a PDF. To make sure you never miss an issue, subscribe here. As a bonus, you will receive the VMG Intellimarker Survey, a top benchmarking resource for ASCs, free!

The March/April issue will include cover a wide variety of topics, including

  • Establishing an ASC -- A Primer from A to Z;

  • Tips for Profitable Endoscopy in ASCs (plus 10 Key Products for GI);

  • Hospital-Physician Joint-Ventures: Current Tips for Success; and

  • the Orthopedics and Spine Medical Device Market Letter.

The deadline for advertising in the March/April issue of the Becker's ASC Review, Feb. 8, is fast-approaching. Don't miss out -- contact Jessica Cole, Dan Bragaw or Ryan Kiernan to reserve your space today!

Physician Hospital Association Supports OIG Recommendations on Emergency Care Policies

After last week's release of the HHS Office of Inspector General's study of emergency care and staffing policies in 109 physician owned specialty hospitals, Physician Hospitals of America has endorsed the agency's recommendations and called on CMS and Congress to conduct the same review of similar size tax-exempt community hospitals. The study and report were prompted by safety concerns after two recent deaths of specialty hospital patients have raised concerns about the ability of specialty hospitals to manage medical emergencies.

"In both instances, a patient experienced complications following elective surgery," writes the OIG. "Neither hospital had a physician on duty at the time the emergency occurred, and both hospitals called 9-1-1. The patients were then transferred to community hospitals, where they were both pronounced dead."

The study is limited, say critics, because it does not address whether there was any impact on quality of patient care as a consequence of the OIG's findings, and how these findings compare to the practices of comparable general hospitals.

"Of course, safety must be priority number one," said Rep. Sam Johnson (R-Texas), a member of the House Ways and Means Committee serving on the Health Subcommittee. "But I think that today's news comes with a big bias. The study did not examine the emergency services of any other kind of hospital. It's unfair to tarnish the reputation of one group when there is no true metric of comparison."

All hospitals that participate in the Medicare program must adhere to the conditions of participation:

  • All hospitals must have a physician on duty or on call at all times.

  • Hospitals are also required to provide 24-hour nursing services, furnished or supervised by a registered nurse.

  • In addition, the conditions of participation require that hospitals have written policies and procedures in place for addressing individuals' emergency care needs, regardless of whether the hospital has an emergency department.

  • Finally, according to CMS, a hospital is not in compliance with the CoPs if it relies on 9-1-1 services as a substitute for its own emergency services; however, there is no specific Medicare prohibition on a hospital calling 9-1-1 to arrange for the transfer of a patient to another hospital.

"According to the OIG, 93 percent of the hospitals reviewed complied with Medicare's staffing requirements," says Molly Sandvig, the PHA's executive director. "However, PHA strongly believes that all hospitals must meet Medicare's conditions of participation. Any hospital, regardless of ownership, that is not meeting its obligations under Medicare's rules needs to get its act together or suffer the consequences. CMS should examine the actions of the eight hospitals cited by the OIG and take all appropriate steps."

The OIG study found that about half of all physician-owned specialty hospitals have emergency departments, the majority of which have only one emergency bed; not all physician-owned specialty hospitals had nurses on duty and physicians on call during the eight sampled days; administrators report that less than one-third of physician-owned specialty hospitals have physicians onsite at all times; two-thirds of physician-owned specialty hospitals use 9-1-1 as part of their emergency response procedures; and some physician-owned specialty hospitals lack basic information in their written policies about managing medical emergencies.

Based on the findings, the OIG recommended that CMS take the following actions to improve the ability of physician-owned specialty hospitals to manage medical emergencies:

  • Develop a system to identify and regularly track physician-owned specialty hospitals.

  • Ensure that hospitals meet the current Medicare CoPs that require a registered nurse to be on duty 24 hours a day, 7 days a week and a physician to be on call if one is not onsite.

  • Ensure that hospitals have the capabilities to provide for the appraisal and initial treatment of emergencies and that they are not relying on 9-1-1 as a substitute for their own ability to provide these services.

  • Require hospitals to include necessary information in their written policies for managing a medical emergency, such as the use of emergency response equipment and the life-saving protocols to be followed.

Along with her and the PHA's endorsement of these recommendations, Ms. Sandvig notes that independent studies have confirmed the high quality of care provided in physician-owned hospitals.

"We are proud of the high quality of medical care that our members provide," she says. "Numerous government and private studies support the high quality of care offered to patients by the physician hospital industry."

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News and Notes

Partial knee replacement increasing in success, patient satisfaction. Due to advances in technique and technology, partial knee replacement is becoming a popular alternative to full knee replacement in patients with knee arthritis. According to a paper published in the January edition of the Journal of the American Academy of Orthopedic Surgeons, more arthritis sufferers are now benefiting from this procedure, which was previously performed mainly on patients who were older and more sedentary. As technology advances in the OR, minimally invasive variations of unicompartmental knee replacement are being used. In addition, some surgeons are getting aid from computers in the operating room. The paper points out the need to further study both minimally invasive and computer-assisted partial knee replacements, since more time is needed to review those surgical outcomes.

"A major challenge in orthopaedics is treating younger patients with knee replacements," said Todd Borus, MD, co-author of the study and an orthopedic surgeon at Northwest Surgical Specialists in Vancouver, Wash. "With baby boomers being more active and wearing out their knees earlier, partial knee replacements are an option in treating these younger and more active patients. [Still], the criteria for partial knee replacements are relatively strict. The arthritis has to be well confined to one part of the knee. Even though the techniques and implants are improving, not everyone is a candidate."

Advertise in the March/April issue. The deadline for advertising in the March/April issue of the Becker's ASC Review, Feb. 8, is fast-approaching. The issue will include Establishing an ASC - A Primer from A to Z; Tips for Profitable Endoscopy in ASCs (plus 10 Key Products for GI); Hospital-Physician Joint-Ventures: Current Tips for Success; and the Orthopedics and Spine Medical Device Market Letter. Don't miss out -- contact Jessica Cole, Dan Bragaw or Ryan Kiernan to reserve your space today!

Thank you, Surgery Consultants of America. We are delighted that Surgery Consultants of America, which provides a comprehensive scope of services including turn-key ASC design, development and management, as well as evaluation and consultative support for existing projects, has agreed to sponsor the conference tote bags and a gold exhibitor booth at the June Orthopedics-, Pain Management- and Spine-Driven Conference. For more information on what SCA can do for your ASC, e-mail Caryl Serbin.

For a complete June conference brochure or an exhibitor prospectus, please visit

June conf ad w Emily
Companies to Watch

We are delighted to highlight the following companies in this week's E-Weekly.

JCB Laboratories. JCB Laboratories is a compounding pharmacy that serves the ASC market place. Unlike most compounding pharmacies, JCB Labs focuses exclusively on preparing sterile products. By limiting the focus to sterile products, the company is able to provide exceptional safety, consistency and pricing. JCB Labs compounds preservative-free products for epidural use, pain management products, and sterile ophthalmics. In addition, JCB Labs provides products that are unavailable due to short supply issues and discontinuation. Contact CEO Brian Williamson, PharmD, at (877) 405-8066 or visit the company's Web site for more information.

Kaye/Bassman International. Greg Zoch is a partner and managing director with Kaye/Bassman International, a 26-year-old executive search firm. Mr. Zoch specializes heavily in the ASC world and, has fantastic depth of knowledge and level of experience in our industry. He has an excellent reputation for identifying and attracting that hard-to-find ASC talent so frequently sought in this competitive industry. Greg has served many of the industry's largest players by finding excellent administrators and clinical directors at the facility level and, at the corporate level, directors and VPs of operations and development. He's helped build start-up and early-stage ASC companies by filling key positions, as well as individual physician-owned ASCs. Greg has been an active FASA member for years and we invite you to speak with him should you have any urgent, critical or confidential needs. You can e-mail Mr. Zoch or call him at (972) 931-5242 x5290.

Somerset CPAs. Somerset's healthcare team is comprised of more than 20 dedicated professionals serving clients nationwide, including all types of healthcare organizations -- ancillary service providers, surgery, imaging, infusion and dialysis centers, therapy facilities, other relevant ancillaries and physician groups.

Somerset has extensive experience in development and/or renovation of single- and multi-specialty ASCs, MOBs and single-specialty hospitals. Somerset prepares feasibility studies, valuation of ASC and specialty hospital ownership interests, operations reviews, accreditation, revenue cycle assessment, benchmarking and succession/strategic planning.

The company provides strategic planning, change management, income distribution design, succession planning, business process improvement and revenue cycle management, tax and accounting services. For more information, visit Somerset CPAs online.

*           *           *

If you have any questions on any of the items listed in this letter, please contact me at (312) 750-6016 or by email at

Scott Becker, JD, CPA
(312) 750-6016

Becker's ASC Review
is a publication of
ASC Communications, Inc.
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