From: Becker Scott <>
Subject: [Becker's ASC E-Newsletter] Study: Surgery for Spinal Stenosis Provides More Long-Term Relief Than Non-Surgical Options; Physician-Owned Specialty Hospitals Receive Positive Coverage; Supreme Court Ruling Boosts Device Manufacturers
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February 26, 2008
In This Issue
Study: Surgery for Spinal Stenosis Provides More Long-Term Relief Than Non-Surgical Options
Physician-Owned Specialty Hospitals Positively Covered by Forbes Magazine
News and Notes
Companies to Watch
0221 newest audioconf ad
Study: Surgery for Spinal Stenosis Provides More Long-Term Relief Than Non-Surgical Options

Surgical patients for spinal stenosis saw improvement more rapidly and reported better physical function and less pain than did the non-surgical patients, according to a multi-center, multi-state trial led by Dartmouth clinician researchers in the Spine Patient Outcomes Research Trial, or SPORT. The study also reveals that patients who choose not to have surgery are likely to improve over time as well, though they report only moderate improvement two years after their diagnosis.

The paper, published in the Feb. 21 edition of the New England Journal of Medicine, is the third in a series of study results; earlier papers reported that, for herniated disk with sciatica, surgical patients did slightly better than non-surgical patients, and that, for spondyloisthesis, surgical patients did markedly better than non-surgical patients. Future studies from the SPORT trial will examine cost-effectiveness and other measures.

"Spinal stenosis is the most common reason for lumbar spine surgery in patients over 65," says lead researcher James N. Weinstein, MD. "For the first time, we have an evidence base on which to advise our patients."

The new study followed 803 patients, 398 of whom underwent surgery. After two years, 63 percent of those who had had surgery reported major improvement in their conditions, compared with 29 percent of non-surgical patients. Both groups reported improve pain and physical function, though surgical patients self-reported in the 60-point range and non-surgical patients (who underwent treatments such as physical therapy) in the low 40s.

Lumbar laminectomy is the most common surgical treatment for spinal stenosis, but there is another option that may be even more advantageous: The X-Stop, a titanium implant made by Kyphon, decompresses the spine to alleviate leg and lower back pain.

"What's interesting about it is that it's a 15-minute outpatient procedure, compared with laminectomy, where the gold standard is about 35 to 45 minutes," says David Abraham, MD, an orthopedic surgeon with Reading Neck and Spine Center in Wyomissing, Pa. "During laminectomy, the surgeon must identify the compressed nerve and remove parts of bones and joints. But when you use the X-Stop to separate the neuroframen, you don't see nerves, you decompress the nerve indirectly. While laminectomy is safe and efficacious, this is a smaller operation."

X-Stop implants cost about $4,400 each. Depending on the state, Medicare reimburses the procedure from about $300 per level to about $1,800 per level, plus a facility fee, plus a separate carveout that covers the majority of the implant cost (Dr. Abraham notes that he uses two implants about 50 percent of the time). This compares with roughly $800 reimbursement for laminectomy.

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Physician-Owned Specialty Hospitals Positively Covered
by Forbes Magazine

Specialty hospitals may represent only 200 out of the 60,000 hospitals in the United States, but they are prominent in the top tier of hospitals ranked by complication and mortality rates, according to quality review firm HealthGrades. The firm reports that three of the nation's top ten cardiac programs and three of the top ten hospitals for total joint replacement surgery are specialty hospitals.

The March issue of Forbes magazine provides this report in a feature story that explores the safety of hospitals in the U.S. and discusses the development of physician-owned hospitals, and past and current adversity to their growth; there is also an accompanying sidebar describing several cases in which specialty hospitals battled targeted efforts by general hospitals to restrict specialty hospital growth..

The report offers additional kudos to specialty hospitals by highlighting a recent University of Iowa study that found complication rates in thousands of Medicare patients were 40 percent lower for hip and knee surgeries at specialty hospitals when compared to big community hospitals, and a 2006 study funded by Medicare that revealed patients are four times less likely to die after undergoing orthopedic surgery in a specialty hospital than if the procedure was performed in a full-service hospital.

The column also details the challenges facing specialty hospitals, such as ongoing hospital lobbying efforts, Medicare rules passed by Congress banning development of new specialty hospitals, and the efforts of Pete Stark (D-Calif.), the chairman of the House subcommittee that controls Medicare spending, to further limit specialty hospital business on grounds that the physicians owning specialty hospitals are receiving kickbacks from referring patients.

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News and Notes

Supreme Court ruling gives medical-device manufacturers greater liability protection. The U.S. Supreme Court issued an 8-1 ruling on Wednesday in a decision that will protect medical-device manufacturers from patients who sue them for harm caused by a device with pre-market approval from the FDA, according to published reports.

The case, Riegel v. Medtronic, Inc., involved a New York man injured in 1996 when his doctor inflated a balloon catheter during an artery-cleaning procedure. The decision serves to reaffirm that the FDA approval process appropriately preempts state tort lawsuits because the process balances patient benefits and risks, according to a statement from Medtronic. The company claims the doctor failed to follow the labeling directions for the catheter, which Medtronic no longer manufacturers; and that the device was used in a patient for whom it was not recommended.

"This is a very important decision, which ensures that patients continue to have appropriate access to innovative, life-saving medical devices," says Bill Hawkins, Medtronic's president and CEO, in the statement. "The decision recognizes the rights and interests of the vast majority of patients who benefit from a medical device."

Colonoscopy screening for Medicare patients lacking. According to a new report, three-fourths of Medicare patients who are recommended screening colonoscopy don't receive them. For the story, visit

White paper of interest now online. "Physician-Owned Hospitals and ASCs -- Why the Political Chasm?" -- a white paper exploring and explaining the scrutiny of specialty hospitals compared with the attention paid to ASCs by Congress -- is now online at

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, Physician Hospitals of America 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 are 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 ASC;

  • 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 ASC Communications' 6th Annual Orthopedics, Pain Management and Spine Driven ASC Conference, June 19 to 21 in Chicago. This year's conference will be an outstanding event for clinical and business issues, and will feature national political commentator Tucker Carlson as keynote speaker. For more information or to register, visit our Web site.

Second, the annual meeting of the ASC Association will be held 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.

Third, the annual meeting of Physician Hospitals of America will be held Oct. 2 to 4 at La Quinta Resort and Club in Palm Springs, Calif. For more information, call (605) 275-5349, e-mail the PHA, or visit the meeting online.

Finally, save the date for the Ambulatory Surgery Centers -- Improving the Profitability of and Establishing ASCs -- Business and Legal Issues, presented by ASC Communications and the ASC Association. The conference will be held Oct. 23 to 25 at the Sheraton Hotel and Towers in Chicago. Stay tuned for more information.

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.

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Companies to Watch

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

Marshall Erdman & Associates. For more than 50 years, the name Marshall Erdman & Associates (Erdman) has been synonymous with the delivery of innovative healthcare facility solutions. As an integrated provider, Erdman offers service from facility conception to completion, including advance planning, development, design and construction. Headquartered in Madison, Wis., with six regional offices, Erdman has partnered with healthcare providers to deliver more than 5,000 facilities across the nation. For more information, visit

ProVation Medical. ProVation Medical has created, ProVation EHR is the first electronic health record designed for busy, cost-conscious ASCs. ProVation EHR offers robust electronic documentation and document imaging for all elements of the patient encounter, from past records to procedure documentation to follow-up care. With ProVation EHR, ASCs now have affordable access to a single, patient-centric documentation system that eliminates printing and chart storage costs, streamlines workflow and comes backed by a company ranked No.1 in KLAS for 2005, 2006 and 2007.

ProVation EHR helps your ASC by

  • increasing patient throughput and streamlining workflow;
  • eliminating patient chart storage space and costs;
  • interfacing seamlessly with vitals monitors and information systems; and
  • driving QI and pay-for-performance metrics

For more information e-mail Laura Gilbert or visit Provation Medical online.

McShane Construction Corporation. McShane Construction Corporation is an integrated design/build construction and real estate development firm offering comprehensive services for the healthcare industry. Established in 1984 and headquartered in Rosemont, Ill., the firm also operates regional offices in the southeast, southwest and western regions. McShane Construction's healthcare specialties include both construction and real estate services for medical office buildings, ambulatory surgery centers, specialty hospitals, critical access hospitals, diagnostic imaging centers and centers of excellence. Contact Mr. John Daly, vice president, healthcare, at 847-692-8616 or visit the firm's web site at for more information.

Ambulatory Surgery Centers of America.ASCOA (Ambulatory Surgical Centers of America) is a leader in the surgery center and surgical hospital industry, achieving exceptional quality of care and outstanding financial results. Since 1984, ASCOA's founders have helped physician-owners start and operate successful facilities -- from the initial feasibility study to accreditation and day-to-day management. ASCOA currently operates 21 facilities across the country with others in development. Physicians looking to start a new surgery center or surgical hospital venture, and existing facilites looking to improve their process and profits can find a partner in ASCOA. For more information, visit ASCOA online.

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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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    June 19 to 21, 2008

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