From: Becker Scott <>
Subject: [Becker's ASC E-Newsletter] 3 Best Practices for Better Outpatient Anesthesia; Fraud and Abuse Judgments and Settlements Recoup $1.5 Billion for Medicare
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February 21, 2008
In This Issue
3 Best Practices for Better Outpatient Anesthesia
Fraud and Abuse Judgments and Settlements Recoup $1.5 Billion for Medicare
News and Notes
Companies to Watch
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3 Best Practices for Better Outpatient Anesthesia

Since the administering of safe and effective anesthesia is such an essential component of the procedures performed in your ASC, you should approach the decision of who will provide anesthesia to your patients with due diligence. Here are three best practices offered by Robert Welti, MD, medical director and administrator of the Santa Barbara (Calif.) Surgery Center, to help you identify and attract the right anesthesia provider to your ASC.

1. Make your ASC an appealing setting for anesthesiologists. Your ASC will likely compete with hospitals for the service of anesthesia groups. If these groups use a salary system based on anesthesia unit production, they may look for reasons to stay with "big unit" cases such as cardiac procedures or neurosurgery performed in the hospital, even if they find working at your facility more enjoyable. You must make sure your ASC remains an attractive setting for anesthesia providers or risk overpaying for services.

"If your cases are scheduled back-to-back with little down time and volume is consistent, your ASC will be a very attractive location," Dr. Welti says. "Conversely, lots of down time between cases, slow days and a shortage of anesthesia practitioners in the area could render the center subject to demands for anesthesia stipends."

2. Find anesthesia care fit for your ASC. Despite the advances in anesthesia pharmacology, the skills and attitudes of successful hospital-based anesthesiologists may not always transfer to the ASC setting, Dr. Welti says. If practitioners cannot adapt their services to your setting, do not hesitate to find an option that better suits the efficiency of your ASC.

"Whereas the number one priority in both hospital and ASC setting is patient safety, the ASC anesthesia practitioner must provide this safety in a highly efficient setting where turnover time, cost effectiveness, and a more personalized service to both patient and surgeon play a much larger role," he says.

3. Don't overlook the service provided by your anesthesiologists. As ASCs perform new and more complex procedures, ASC anesthesia providers must also adapt and tackle this new challenge. It is important to recognize their efforts in maintaining the high quality of care offered by your center.

"As ASC administrators, we must not lose sight of the incredible job that our anesthesia practitioners do with respect to handling the increasingly aging and physically challenged patient population that we now accept into our facilities," Dr. Welti says.

Although you may struggle to secure an optimum small, core group of anesthesia practitioners who limit themselves to the ambulatory setting and understand the priorities of ASCs, you can make small or large gestures to keep your ASC as an attractive source of business for anesthesiologists.

"In the ideal world, the ASC would ... provide to the practitioners some sort of incentive to sign-on to the mission of the center and align their common interests," Dr. Welti says. "Such incentive could range from the very simple, such as the all-too-often missing expression of appreciation for the services provided, to the more complicated, such as ownership positions when permitted by state or federal law."

Note: This article shares some of the thoughts and insights from a larger article discussing clinical and business issues in ambulatory anesthesia that will appear in the May/June issue of the Becker's ASC Review.

ASC Society
Fraud and Abuse Judgments and Settlements Recoup
$1.5 Billion for Medicare

The Health Care Fraud and Abuse Control Program (HCFAC) recovered approximately $1.5 billion in 2006 as a result of fraud and abuse judgments and settlements, according to a report from the Department of Health and Human Services and the Department of Justice.

The efforts of the program also yielded $177.1 million in Medicaid money. HCFAC has returned more than $10.4 billion to Medicare since the program's inception in 1997

In 2006, 547 defendants were convicted for healthcare fraud-related crimes. U.S. attorneys' offices opened 836 new criminal healthcare fraud investigations in 2006, involving 1,445 potential defendants. The DOJ initiated 915 new civil health care fraud investigations in 2006.

Perhaps the notable accomplishment of HCFAC's efforts in 2006 was Tenet Healthcare Corporation's agreeing to pay more than $900 million over a four-year period to settle whistleblower lawsuits accusing Tenet of overbilling Medicare and other federal healthcare programs.

Of the $900 million, "more than $788 million to resolve claims arising from Tenet's receipt of excessive 'outlier' payments (payments intended to be limited to situations involving extraordinarily costly episodes of care) resulting from the hospitals' inflating their charges substantially in excess of any increase in the costs associated with patient care, and billing for services and supplies not provided to patients," according to the report.

Read the complete report here.

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News and Notes

Welcome, new advertisers. We are delighted to welcome some new advertisers and welcome back some returning advertisers to the March/April issue. A special thank you to RMC Medston Capital, a development and acquiring firm founded by Mike Lipomi and Dodd Crutcher; Pinnacle III, a leading ASC management and development firm led by Rob Carrera; Affinity Insurance Services, a leader in all types of insurance for ASCs and providers, and specialists in understanding risk reduction strategies; Implantable Provider Group, a firm focused on expediting delivery and payment for medical devices and implants; Medtegrity Medical Laundry; McKesson Medical; as well as Amkai, Source Medical, Surgical Notes and zChart, four of the best firms that focus on either software for ASCs or electronic health records software and technology or transcription and other efforts.

We are also pleased to welcome back as an advertiser leading architectural and planning firm Marasco and Associates. Marasco has an outstanding history in the ASC business.

Thank you, sponsors. We are down to 20 exhibits remaining out of nearly 73 for the June meeting. We are also delighted to have great sponsors for the meeting. The lead sponsors include the following:

We have a handful of sponsorships remaining, including semi-exclusive sponsorships in the financing, information tech and construction categories. For information on sponsorships or exhibition space, e-mail Jessica Cole or e-mail Dan Bragaw.

Welcome, Rob Kurtz. We are delighted to welcome Robert Kurtz aboard as director of communications. Rob joins ASC Communications after working with the AAASC in a similar capacity and having worked for several years with HCPro as editor of the Ambulatory Surgery Compliance & Reimbursement Insider and Briefings on Ambulatory Accreditation newsletters. He will be specifically involved with helping ensure that the Becker's ASC Review covers specialty-specific topics such as items related to opthalmology, urology, GI, pain management, ENT, orthopedics and spine. He will also help write the Orthopedics and Spine Medical Device Market Letter, a hospital corner, and on issues regarding anesthesia in ASCs. Finally, Rob will help direct and produce ASC Communications audio conferences. Please feel free to welcome Rob.

New white papers now online. To view two white papers added to the Becker's ASC Web site -- "Four Cornerstones of Strategic Planning for Ambulatory Surgery Centers" and "Effective Diligence for Healthcare Real Estate Acquistions" -- go to

Attend the PHA Fly-in and Legislative Conference. With the potential for legislation to be introduced against physician hospitals in April 2008 by the Senate Finance Committee, the PHA needs to show a united front at its March event. Surgical hospitals need to demonstrate to their senators and representatives how important the issue of physician ownership is to healthcare; prove the level of interest that exists in support of the industry; and need to again establish themselves as strong players in healthcare and make sure no one on Capitol Hill feels that they are an easy target.

Please plan to attend the PHA Fly-In and Legislative Conference on March 11 and 12 in Washington, D.C. The event will feature first-rate speakers on a number of political topics and will provide the best, most up-to-date information regarding physician hospitals in 2008. The conference is followed by a day of Capitol Hill visits during which attendees can personally ensure that their stories is heard by their elected officials.

Register to attend today! If you have questions, please call (605) 275-5349 or e-mail. This is a very busy time of year in D.C., and reserved hotel rooms are limited. If you have difficulty booking your hotel room, please call Kim at (605) 275-5349.

Handling Complex Orthopedic and Spine Procedures in an ASC audioconference. ASC Communications will present an audioconference, "Handling Complex Orthopedic and Spine Procedures in an ASC," on Wednesday, March 19, at 2 p.m. Central. Attendees of the 60- to 90-minute program will learn

  • which spine procedures can be safely and properly performed in an ASCr;

  • which knee, hip and shoulder procedures can and can't be performed in an ASC;

  • how to assess patient selection criteria for spine and advanced orthopedic procedures;

  • how to determine which special safety procedures an ASC should have in place as it handles more complex spine and orthopedic procedures; and

  • the requirements for reimbursement for more advanced spine and orthopedic procedures.

Speakers include Dr. John Caruso, who has more than 16 years' neurological surgery experience; Dr. Phillip A. Davidson, the founder and CEO of Tampa Bay Specialty Surgery Center; and Mr. Jeff Leland, the CEO of Blue Chip Surgical Partners. Attendees can earn 1.5 CME or AEU credits. If you are an orthopedic physician, neurosurgeon, ASC administrator, ASC director of nursing, medical director or anesthesiologist, this program is not to be missed. Registration is limited to 60 attendees.

There are four easy ways to enroll:

Make checks payable to ASC Communications.

Excellent upcoming events. Please note there are two great upcoming events that touch on the ASC industry.

First, there is the ASC 100, an executive business forum for freestanding ambulatory surgery, hosted by Lincoln Healthcare Events, from March 16 to 18 in Scottsdale, Ariz. For more information, e-mail Rachel Brenha, call her at (203) 846-2600 x114, or visit the ASC 100 online.

Second, the annual meeting of the ASC Association will be held in May 15 to 18 in San Antonio, Texas. It promises to be a huge and terrific meeting covering a wide variety of business and clinical issues for ASCs. Please contact the ASC Association at (703) 836-8808, or visit the ASC Association 2008 meeting site for more information.

McGuireWoods teleconference: "Structuring Physician Hospital ASC Joint Ventures." McGuireWoods is holding a teleconference, "Structuring Physician Hospital ASC Joint Ventures," on Tuesday, March 13, from 12:30 to 1:30 Eastern. Speakers include Brett Brodnax, the executive vice president and chief development officer of United Surgical Partners International; Joseph Zasa, managing partner with Woodrum/Ambulatory Systems Development; Amber McGraw Walsh, an associate at McGuireWoods; Elissa K. Moore, an associate at McGuireWoods; and Scott Becker, co-chair of the healthcare department at McGuireWoods, who will moderate the conference. Join members of the healthcare industry to discuss the development and maintenance of effective hospital joint-ventures, including best practices and case studies -- register today.

Becker's ASC Review special offer. The Becker's ASC Review is published six times a year. To receive a hard copy delivered and never miss an issue, subscribe. As a special introductory offer, if you sign up for a two-year year subscription to the ASC Review between now and March 15 for $299, you'll also receive a free registration to the March 19 audioconference on handling complex orthopedic and spine procedures in your ASCs, a $199 value. To subscribe, either fax this form to (866) 678-5755 or mail to ASC Communications, 315 Vernon Ave., Glencoe, IL 60022. Please mark on the subscription form "special offer -- free audioconference," and be sure to check two-year subscription.

As a bonus, each subscriber will also receive a PDF version of the entire and extremely useful VMG Health Intellimarker, the single best benchmarking resource. Please call (214) 369-4888 for more information on VMG Health, a leading healthcare valuation firm.

May-June issue promo
Companies to Watch

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

HealthMark Partners. HealthMark Partners owns and operates single and multi-specialty ambulatory surgery centers throughout the United States by creating joint-ventures with physicians or physicians and hospitals. HMP's expertise includes ASC turnaround and de novo projects with the same goal to maximize patient and physician satisfaction while realizing healthy returns on investment.

Founded in 1996, HMP is led by a talented management team with extensive experience in facility development, acquisition and syndication, financial management, business office management, clinical operations as well as human resources and payroll services. HealthMark Partners is committed to making a difference with a turn key approach which provides a comprehensive level of service at the center level and beyond.

HealthMark Partners looks forward to the opportunity to make a difference for your ASC. Please visit the company Web site, e-mail Senior Vice President -- Development Kenny Spitler, or call him at (615) 341-0701, to get started on your road to success.

CIT Healthcare. CIT Healthcare offers a full spectrum of financing solutions and related advisory services to companies across the healthcare industry. Through its client-focused and industry-centric model, CIT Healthcare effectively leverages CIT's extensive knowledge and understanding of the healthcare marketplace and approximately $80 billion "A" rated balance sheet. Financing solutions include real estate debt and equity financing; M&A advisory services; cash flow loans; asset-based loans; large/small leases/loans; and working capital lines of credit. For more information, please visit or contact CIT Healthcare at (800) 547-7026.

Surgical Management Professionals. Surgical Management Professionals, is an organization of healthcare executives and physicians who have created a model for successful ASCs and specialty hospitals. SMP is in the business of development, management and equity partnerships with other physicians and organizations whose vision encompasses the concept of physician ownership and management of ambulatory surgical facilities. SMP can assist in the development of a comprehensive surgical facility vision; offer expertise in designing, building and operating a state-of-the-art surgical facility; develop a culture of quality, service and efficiency; manage the day-to-day challenges of a surgical facility, as well as the long-term strategic positioning required for physician and community confidence; and provide a facility for physician owners and practitioners that demonstrates quality, stresses efficiency and encourages productivity. SMP's team of experts can also make sure that the business side of your practice -- billing coding, auditing, insurance contract review and negotiation, charge master review, IT, accounting, payroll, and human resources - performs to the same high standards as your clinical side. For more information, visit SMP's Web site.

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

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    Upcoming ASC Conferences
    Handling Complex Orthopedic and Spine Procedures in an ASC -- An Audio Conference
    Presented by ASC Communications
    March 19, 2008
    2 p.m. Central

    Orthopedics-, Pain Management- and Spine-Driven ASC Conference
    Presented by ASC Communications
    June 19 to 21, 2008

    Improving Profitability and Business and Legal Issues for ASCs
    Presented by the
    ASC Association
    and ASC Comms

    Oct. 23 to 25, 2008

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