January/February Issue of Becker's ASC Review

50 Management and Development Companies to Watch for 2009; Will the Federal Government Shut Down Surgery Centers and Physician-Owned Hospitals?; Letter From the Editor: Recapping 2008, Looking Ahead to 2009; 17 Great ASCs to Work For; Larry Taylor of Practice Partners Discusses 3 Trends for Surgery Centers in 2009; 10 Steps to Prepare for and Respond to Anesthesia Subsidy Requests; 6 Critical Anesthesia Protocols and Procedures to Improve Efficiency; 5 Current Challenges in Ambulatory Anesthesia; 5 Things to Know About Gynecology in ASCs; CMS Establishes New ASC Conditions of Coverage; Update on Weight-Loss Surgery: 3 Current Trends; Turnaround Case Study: Minor Issue or Fatal Flaw?; Capture Your Partners’ Cases: The Carrot & Stick; Accounts Receivable Analysis for ASCs by Revenues From the VMG Health 2008 Intellimarker; 4 Critical Concepts From the Latest Stark Act Regulations; Rob Carrera of Pinnacle III Discusses 3 Trends for Surgery Centers in 2009; 10 Managed Care Best Practices for Bariatrics, General Surgery and Gynecology; Peer Review Q&A With Sarah Martin; 4 Observations on Orthopedic and Spine Devices and Equipment; 3 Ways to Get the Most Out of Generation Y; OIG Blasts CMS on HIPAA Security Gaps; Guidance for ASC Compliance; Election 2008: 5 Quick Observations; 10 Interesting Facts About Surgery Center Chains; 6 Best Practices for Proper Disposal of Pharmaceutical Waste; General Surgery Coding Guidance for 2009 Additions and Revisions

January 2009

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Current Issue Articles

50 Management and Development Companies to Watch for 2009
This article briefly highlights 50 companies that are active in ASC management and development. Note: This list is not an endorsement of any company. To see more information regarding ASC chains, see "10 Interesting Facts About Surgery Center Chains" on p. 50.
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Will the Federal Government Shut Down Surgery Centers and Physician-Owned Hospitals?
As the Democrats take control of the House, the Senate and the Presidency, many question the impact of such a change on ambulatory surgery centers (ASCs) and physician-owned hospitals. The most significant question is: Will the federal government shut down and/or restrict physician-owned hospitals and ASCs?
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Letter From the Editor: Recapping 2008, Looking Ahead to 2009
2008 was a remarkable year for surgery centers.
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17 Great ASCs to Work For
Ambulatory Surgical Center of Stevens Point (Stevens Point, Wis.)
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Larry Taylor of Practice Partners Discusses 3 Trends for Surgery Centers in 2009
Larry Taylor, president and CEO of Practice Partners in Healthcare, an Alabama-based  corporation dedicated to the provision of management and operational services to ASCs in the  United States, shares his observations of three trends he sees as developing in the surgery center  field as we head into 2009. 
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10 Steps to Prepare for and Respond to Anesthesia Subsidy Requests
As surgery centers and surgeons struggle with a Medicare payment system which reimburses at rates that are often barely high enough to break even on procedures, let alone make a profit, it is easy to overlook how reimbursement declines, along with rising costs and increases in the number of Medicare patients, is affecting another critical member of the surgery team: Anesthesiologists.
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6 Critical Anesthesia Protocols and Procedures to Improve Efficiency
A highly respected surgeon once told me, with absolute certainty, that it is impossible for any ASC business to exist longer than a dozen years. While I disagree with this view, it is shared by many stakeholders in our industry, thanks to a combination of regulatory factors, demographics and a few ineffective management practices that have become standard operating procedure for many ASCs.
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5 Current Challenges in Ambulatory Anesthesia
Here are five challenges affecting ambulatory anesthesia, and advice from a panel of experts for handling them effectively.
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5 Things to Know About Gynecology in ASCs
Gynecology is not generally thought of as an ASC standby, but it doesn’t have to be that way. Here’s what experts have to say about bringing the specialty into your facility.
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CMS Establishes New ASC Conditions of Coverage
CMS has issued the final Outpatient Prospective Payment System/Ambulatory Surgical Center Payment System (OPPS/ASC) rule, which establishes new conditions for coverage for ASCs that “reflect current ASC practice by focusing on the care provided to patients and the impact of that care on patient outcomes.” The final rule also sets the ASC update for calendar year 2009 at 0 percent and adds 27 procedures to the ASC list.
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Update on Weight-Loss Surgery: 3 Current Trends
When you consider that, according to the American Society for Metabolic and Bariatric Surgery, just 1 percent of the nation's 15 million morbidly obese, who make up about one-third of the total population, have undergone weight-loss surgery, it's clear the market has a lot of growth ahead. Here are three trends experts say will help drive that growth.
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Turnaround Case Study: Minor Issue or Fatal Flaw?
Understanding performance trends is key to running a surgery center. Unfortunately, trends are often contradictory. Revenue may be good, but profit per case is down. Market share is steady, but few new services have been added in the last three years. Physician relations are generally positive, but certain surgeons have become a bit more vocal with their complaints.
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Capture Your Partners’ Cases: The Carrot & Stick
Many of the acquisitions I have completed in the past several years have had a strong group of physician owners with poor initial commitment. You can often find substantial volume is controlled by your partners that are simply spreading their cases to multiple sites. I’ve heard all the excuses as follows:
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Accounts Receivable Analysis for ASCs by Revenues From the VMG Health 2008 Intellimarker
According to the VMG Health 2008 Intellimarker, here is an analysis of accounts receivable for all ASCs, followed by a breakdown by revenues. Note: A/R dollars are in thousands.
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4 Critical Concepts From the Latest Stark Act Regulations
The Centers for Medicare and Medicaid Services (CMS) has, over the last several years, grown increasingly concerned with percentage-based lease arrangements, indirect financial relationships, per click payments and “under-arrangements” transactions. It has long indicated that changes to the Federal Ethics in Patient Referral Act (the “Stark Act”) were required in order to address their concerns. The latest Stark Act rules were released on August 19, 2008, in the Federal Register as part of federal regulations covering a variety of subjects relevant to healthcare providers. The changes to the Stark Act regulations address several concepts that will directly affect physicians, hospitals and the entrepreneurial relationships between and of each. This article briefly discusses four of the more important changes.
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Rob Carrera of Pinnacle III Discusses 3 Trends for Surgery Centers in 2009
Rob Carrera, president of Pinnacle III, which offers operational development, management, select management and billing for ASCs and other healthcare facilities, discusses three trends he sees for surgery centers as we head into 2009.
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10 Managed Care Best Practices for Bariatrics, General Surgery and Gynecology
Contract negotiations adhere to a rule that 80 percent of time should be used to prepare for the negotiation and 20 percent to negotiate. To help be more effective in achieving results when you actually need to sit down at the negotiating table, here are 10 managed care contracting best practices for bariatrics, general surgery and gynecology, written in collaboration with Marty Winslow, director of reimbursement for Nueterra Healthcare and Gary Whiteaker, administrator for Apogee Outpatient Surgery Center in Redding, Calif.
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Peer Review Q&A With Sarah Martin
Sarah Martin, RN, BS, regional vice president of operations for Meridian Surgical Partners, discusses seven of the top ASC peer review and credentialing questions.
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4 Observations on Orthopedic and Spine Devices and Equipment
Here, John Cherf, MD, MPH, MBA, one of the nation’s leading orthopedic surgeons, discusses his thoughts on purchasing orthopedic and spine devices and equipment in four areas.
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3 Ways to Get the Most Out of Generation Y
Gen Xers and, to some extent, Baby Boomers created Generation Y, and now they need to figure out how to mentor them properly, says Lt. Col. Bruce Bright, CCIM, director of business development for The Sanders Trust. He are some takeaway points from a lecture he is giving on the topic, aimed at helping businesses learn to get the most out of Millenials.
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OIG Blasts CMS on HIPAA Security Gaps; Guidance for ASC Compliance
The OIG recently completed its review of CMS's oversight with regard to HIPAA Security, and the result is alarming. OIG had some harsh words for CMS's efforts, saying it has taken "limited actions," resulting in little oversight or enforcement, and that it has "no effective mechanism to ensure that covered entities [are] complying … or that electronic protected health information [is] being adequately protected." CMS agreed with OIG that it needs to step up oversight, specifically the conducting of compliance reviews. 
Would your facility be ready if CMS came knocking?
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Election 2008: 5 Quick Observations
1. It's clearly an historic moment in the United States when we have elected an African American president for the first time. Whether Republican or Democratic, we all can be proud and excited about this milestone. Moreover, I've known Barack since law school, and he is both a remarkable person and a very, very good person. He may lean left politically, but he has a great sense of not overplaying his hand. Except for those who desire him to fail so as to recover the White House, I think this will make many on the Republican side more comfortable over time. In the end, we strongly prefer a balance of power between Congress and the White House. If we don't have the balance of power I am glad that the Republicans retained more Senate seats than expected and my hope is that Barack Obama will not make wealth redistribution and other items that discourage business growth a core part of the next four-year plan.
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10 Interesting Facts About Surgery Center Chains
Here are 10 interesting facts about surgery center chains, according to SDI’s 2008 Outpatient Surgery Center Market Report.
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6 Best Practices for Proper Disposal of Pharmaceutical Waste
ASCs strive to offer a quality of care and operate at a level of excellence that at least meets the standards set by hospitals, and ASCs are often successful are exceeding these standards. But one area of operations where hospitals should serve as models for surgery centers is in the proper disposal of pharmaceutical waste.
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General Surgery Coding Guidance for 2009 Additions and Revisions
While ASC facilities can expect a reduction in reimbursement in the specialties of pain management and GI in 2009, general surgery sees several procedures new to CPT and also some to the Medicare-approved procedures list which may offer reimbursement opportunities. Here is an analysis of these coding changes in three areas of general surgery and best practices to ensure you code and continue to code correctly these procedures.
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