From: Becker Scott <>
Subject: [Becker's ASC E-Newsletter] OIG Set to Examine ASC, Hospital, Pain Management and IDTF Issues; How the Mental Health Parity Bill Affects Physician-Owned Hospitals; Medicare Fraud and Abuse Settlements; Key Accreditation Issues
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March 17, 2008
In This Issue
OIG Work Plan for 2008 to Examine ASC and Hospital Issues, Pain Management Payment and IDTF Issues
The House Version of the Mental Health Bill and How it Affects Physician-Owned Hospitals
Now Online: Discount Disclosure, New Drug on Fast Track, Medicare Fraud Crackdown, Private Equity Deals
Register Now for "Handling Complex Orthopedic and Spine Procedures in an ASC" Audioconference
June Orthopedics-, Spine- and Pain Management-Driven ASC Conference
Becker's ASC Review Paid Subscribers
Meridian and National Surgical Care Announce Acquisitions; Titan Health Expands; Indiana ASC Becomes Surgical Hospital
Accreditation Issues for ASCs: Disposing of Lead Aprons and Sodasorb, Reusing Syringes
Companies to Watch
Too much text June conf ad (NEW)
OIG Work Plan for 2008 to Examine ASC and Hospital Issues, Pain Management Payment and IDTF Issues

In 2008, the OIG plans to review several areas of interest to ASCs and hospitals:

  • the appropriateness of payments and oversight for interventional pain management, which now accounts for $2 billion in Medicare billing annually;

  • the appropriateness of ASC payment rates and the new rate-setting methodology;

  • patient care and safety in physician-owned hospitals;

  • coding on transfers versus discharges for hospitals and several other hospital issues;

  • areas with high density of independent diagnostic testing facilities (IDTF) and of high utilization of ultrasound;

  • several issues related to long-term-care hospitals; and

  • issues related to reassignment of physician payments and benefits.

To download a copy of the work plan, go to

Medtegrity 12 weeks consec
The House Version of the Mental Health Bill and How it Affects Physician-Owned Hospitals

The mental health bill (HR 1424) passed by the House of Representatives last week includes a section that effectively eliminates physician ownership of hospitals. The language of the bill touches on 14 key facets of physician-owned hospitals:

1. A grandfathered hospital must have physician ownership on the date of enactment.

2. A grandfathered hospital must have a provider agreement on the date of enactment.

3. No increase in beds or operating rooms, except per Department of Health and Human Services rules to be established.

4. Mandates annual reporting

  • of number and names of owners,

  • of manner and extent of all ownership,

  • of disclosure to patient of ownership of treating and referring doctor, and

  • on Web site and all advertising.

5. No conditioning of ownership on referrals.

6. Within 18 months, no more than 40 percent of total ownership by physicians, and no more than 2 percent per individual physician.

7. No more favorable terms of ownership for physicians.

8. No loans or financing of physician interests.

9. No guarantees or subsidies.

10. Returns must be proportionate to ownership.

11. No special rights to other business relationships.

12. No more favorable terms on other business.

13. Hospital must disclose whether a physician is on site or not 24 hours a day.

14. Gaining an exception to the ban on expansion will require building on-campus, within an aggregate limit and gaining Department of Health and Human Services approval per rules that are to be established.

You can download a PDF of HR 1424 at the Becker's ASC Web site. If you would like to help in the effort against the bill, please e-mail Molly Sandvig or call her at (605) 321-3483, and she can help tell you and your members whom to contact.

NovaMed (every other week/8 weeks)
Now Online: Discount Disclosure, New Drug on Fast Track, Medicare Fraud Crackdown, Private Equity Deals

Calif. appeals court: Hospitals needn't disclose patient discounts. A California state appeals court has ruled that Sutter Health and Alta Bates Summit Medical Center were not in violation of the state's consumer protection laws when they did not disclose the existence of a discount policy. Go here for the complete story.

Committee recommends that FDA OK new anesthesia drug for reversing muscle relaxants. After reviewing the data on the safety and efficacy of sugammadex sodium injection, which reverses muscle relaxation induced as part of anesthesia, the FDA's Anesthetic and Life Support Drugs Advisory Committee has unanimously recommended it for approval by the agency. Go here for the complete story.

Hospital pays $3.77 million to settle allegations as Medicare continues fraud crackdown. Yale-New Haven (Conn.) Hospital became yet another hospital to agree to a multi-million dollar fine to settle allegations by CMS that it billed Medicare for inflated charges, the U.S. Attorney's Office, District of Connecticut announced. Go here for the complete story.

Perpetrators in two Medicare fraud schemes sentenced, convicted. The Medicare Fraud Strike Force continues to make its mark, with two big announcements in South Florida cases. Go here for the complete story.

Private equity deals. To see a sample list of McGuireWoods 2007 private equity deals, go to and download the PDF.

March/April issue now online. The March/April issue of the Becker's ASC Review, featuring pieces of profitable endoscopy, establishing an ASC and the orthopedics and spine device markets, is now online. Go to to read individual articles or download a PDF of the full issue.

0221 newest audioconf ad
Register Now for "Handling Complex Orthopedic and Spine Procedures in an ASC" Audioconference

There are only two days left to register for ASC Communications' audioconference, "Handling Complex Orthopedic and Spine Procedures in an ASC," which will be held 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. Download a sample preview of the conference slides at our Web site.

Registration is limited to 60 attendees. Register through our secure Web site.

ASC Society
June Orthopedics-, Spine- and Pain Management-Driven ASC Conference

Orthopedics-Driven ASC Conference: June 19 to 21 in Chicago. Quick facts and highlights:

  • improving profits and business and legal issues

  • 70-plus speakers focused on strategic, practical, business and legal topics for ASCs

  • Chicago, Ill., Michigan Avenue site

  • program agenda and event brochure --

  • carefully selected topics to help you and your center immediately

  • networking with 500 owners, surgeons, administrators, exhibitors and speakers

  • keynote presentation on the election and healthcare by Tucker Carlson

  • outstanding pre-conferences

  • much, much more

  • visit

  • register before May 1 and save $100

  • CME, CEU and CASC credits available

  • additional discounts apply when registering two or more attendees

  • Register online through our secure Web site.

  • Call (312) 546-6042 or (800) 417-2035 for more information.

Only 15 exhibitor spots left for June conference. If you are interested in exhibiting at the June Orthopedics-Driven Conference, contact Jessica Cole or Dan Bragaw.

TY--Physicians Endo 3x
Becker's ASC Review Paid Subscribers

Beckers ASC Review paid subscriptions. If you are a Becker's ASC Review paid subscriber, you are entitled to the following benefits:

  • Discounts off audioconference and Webinar registrations.

  • $100 off registration for both main and pre-conference sessions at the June conference.

  • $50 off main session registration only at the June conference.

  • $50 off registration for both main and pre-conference sessions at the October conference.

  • Free copy of the VMG Health Intellimarker benchmarking survey, an extremely valuable guide.

To subscribe to the Becker's ASC Review go to

Seeking four proctors to attend June conference for free. We are seeking four persons to attend the June Orthopedics-Driven Conference free of charge. The persons must be administrators or surgeons and must be paid subscribers to the Becker's ASC Review. The four persons will each be required to proctor fully 20 sessions each and provide a detailed review of the quality of the presentations. They must not have done this before for ASC Communications. We need detailed feedback to help ensure the quality of our speakers. Please e-mail Scott Becker if you'd like to be considered for this role.

Meridian and National Surgical Care Announce Acquisitions; Titan Health Expands; Indiana ASC Becomes Surgical Hospital

Meridian Surgical Partners acquires Physicians' Surgical Center. Meridian Surgical Partners announced it has acquired a majority interest in Physicians' Surgical Center in Belleville, Ill. The multi-specialty ASC with 11 physician-owners operates in a 3,200-square-foot space with one OR and one procedure room. In the past 12 months, more than 1,700 outpatient surgical cases have been performed at the center across a range of specialties, including podiatry, gastroenterology, ENT, hand surgery, pain management and general surgery. Learn more about Nashville, Tenn.-based Meridian at its Web site.

Titan Health Corporation expands operations and facility development support. Titan Health Corporation has announced several new additions to its operations and facility development teams. Roseanne Ottaggio, RN, a veteran of the healthcare industry for more than 28 years, will serve as a vice president of operations; she will be based out of Yardley, Pa. Kathy Stout, who most recently served as revenue cycle operations support for a major ASC company, will be the new director of business office operations; she will be based out of Elizabethtown, Pa. Finally, Elaine Lang, RN, who has more than 20 years' experience in healthcare administration with an emphasis in ASC development and management, has been named director of facility planning and development; she will be based out of Cherry Hill, N.J. For more information, visit Titan Health online.

National Surgical Care acquires two multi-specialty ASCs. National Surgical Care announced the acquisition of a majority interest in Coral Springs Surgical Center in Coral Springs, Fla., and the formation of a joint-venture with Stamford Health System to acquire a surgery center in Wilton, Conn. Coral Springs Surgical Center is a multi-specialty outpatient surgery center with primary emphasis in gastroenterology, ophthalmology, pain management and orthopedics. Wilton Surgery Center focuses on ophthalmology and pain management. For more information on NSC, visit the company online.

Calumet Surgery Center becomes Surgical Hospital of Munster. Calumet Surgery Center, which has served the Northwest Indiana area for more than 20 years, has become Surgical Hospital of Munster, a physician-owned hospital. The four-OR, one-GI-procedure-room, nine-bed hospital will focus on general surgery, orthopedic, spine, GI, ENT, ophthalmology, gynecology, urology, pain management, family practice and internal medicine. Sixty-seven physicians with extensive training in their specialties will practice at Surgical Hospital of Munster. Regent Surgical Health, a Chicago-based developer of surgery centers and surgical hospitals, is a minority partner and manager in partnership with 30 area physicians. For more information, visit Regent Surgical Health on the Web.

Care Credit
Accreditation Issues for ASCs: Disposing of Lead Aprons
and Sodasorb, Reusing Syringes

Appropriate disposal of lead aprons and Sodasorb. Proper management and disposal of hazardous wastes is an integral part of maintaining a safe, sterile environment and meeting environment of care-related accreditation standards. Lead aprons and the absorbent material Sodasorb, used in anesthesia machines, are two wastes you should pay close attention to when addressing their disposal.

For lead aprons, it is important to note that they contain radiation, says W. Jan Allison, RN, director of quality and accreditation for Surgical Care Affiliates: "Since lead aprons are exposed to a countless number of X-ray hours, most states and counties require that they be discarded and handled as hazardous material," she says. As a result of this classification, local authorities will require that you dispose of the lead apron in an authorized and approved hazardous materials location.

The disposal of Sodasorb is the responsibility of the end-user and must be performed in compliance with federal, state and local regulations.

"Review state hazardous waste regulations as some states classify this product as a corrosive waste," says Ms. Allison. Specific disposal methods will vary with the chemical (such as anesthetic agents, acid-based vapors, etc.) or biological agents used with Sodasorb by the end-user.

For more education about hazardous waste, including a state-specific hazardous waste resource locator, visit the HealthCare Environmental Resource Center Web site, suggests Ms. Allison.

ASC Association advises review of CDC syringe reuse fact sheet. The ASC Association is advising organizations to review a Centers for Disease Control fact sheet on syringe reuse following national media coverage of a Nevada clinic that may have exposed thousands of patients to hepatitis C and HIV.

The Southern Nevada Health District alleges patient exposure occurred because the Endoscopy Center of Southern Nevada used sterile needles and syringes to withdraw medication from vials, then used new needles but the same syringes to withdraw more medication for the same patient. Clean needles and syringes were later used to withdraw additional medication from the same vials for different patients.

The ASC association is advising surgery centers to review the sheet in the event that patients ask questions about syringe reuse as a result of the coverage.

TY--MedHQ 5x
Companies to Watch

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

Surgical Notes. A preeminent nationwide provider of medical transcription, coding and other related value-added information technology services for the ASC market, Surgical Notes provides transcription, coding and practice management solutions to over 420 surgery centers and 6,300 physicians in over 40 states. Surgical Notes will be introducing two new products and services in 2008, the VMR Express, an electronic medical forms generator and document imaging solution and, an online, secure, interactive, personal health record portal for the general public to compile and organize all healthcare-related data. The VMR Express is designed for the ASC market. This proprietary application, interfaces with the existing practice management system (SIS, Advantx, Vision, etc.) to extract the patient label information (patient ID, last name, first name, date of birth, SSN, sex, age, physician name, date of service and case/encounter/account number). These generated documents print patient demographics on the facility's customized forms, allowing patient forms to be generated per operating physician's profile or according to specific procedures. Using the barcode from the forms version on each document, it will index the chart back into the patient record. Have old charts, or other loose documents, without a barcode? No problem, you can use the index fields to associate the paper work to a patient. This application will allow the user to perform advance searches for documents by account code, patient ID, type of document, or name. The VMR Express cost as little as $16 a day. For more, visit Surgical Notes online.

TRY Health Care Solutions. TRY Health provides consulting services to large healthcare systems, group practices, independent physicians and surgery centers throughout the United States. Tom Yerden, president of TRY Health, is a recognized leader in the industry with over 25 years of service spanning the development of more than 70 surgery centers and the founding of Aspen Healthcare in 1992. Tom is a member of the FASA board of directors and was a finalist for the 2003 Ernst & Young, Entrepreneur of the Year. Tom speaks at many national conferences each year and spends his free time assisting his wife Carol in raising their herd of 70 Alpacas in Salmon, Idaho. You can contact Tom at (208) 865-2400.

Prexus Health. Prexus Health is a 100 percent physician-owned company that specializes in the development and management of multi-specialty, physician-owned ASCs and small hospitals. Because Prexus believes in the "campus model" of development, it also assists with the development and operation of imaging centers, physical therapy services and anatomical pathology labs. About 75 percent of the company's business is "rescue" or "conversion" business, with the balance being "de novo" projects. Prexus charges a one-time development fee for each "de novo" project, and its ongoing management services cost (1 percent of net collections plus $5,000 per month) is also very reasonable. The company's governance model relies on a local board of directors who employ an onsite administrator, so physician partners obtain local physician control, with a higher level of management expertise than they could employ themselves. For more information, call (513) 454-1414, e-mail Prexus or visit the Web site.

Physicians Capital. Loans for ASC buy-ins -- to help bring new physicians into a partnership -- are among the unique financing options offered by Physicians Capital. This Nashville-based firm provides loans based solely on the future cash flow of a surgery or diagnostic center. Existing physician partners can get loans against the cash flow value with no loss of control or ownership interest and no need to pledge personal assets. Start-up capital and turn-key financing are available for corporate partners without chasing multiple financing sources. Learn more at or call 615-342-0824.

*           *           *

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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    Oct. 23 to 25, 2008

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