May/June 2008

In this issue: 6 Considerations for Successful Outpatient Knee Replacement; Reimbursement, Profit and Patient-Selection Issues -- Spine and Orthopedic Cases; Physician/Hospital Joint-Ventures -- Incentives and Ownership for Hospital-Employed Physicians and for Primary Care Physicians; Regional Anesthesia: Benefits and Implementation in Your ASC; 10 Medication Management Ideas for Anesthesiology Services; 3 Hot Spine Device Trends; At a Glance: Anesthesia Products and Services; 10 Valuation Facts and Statistics for ASCs; Key Clinical and Business Developments in ASC Anesthesia; 7 Keys to Successfully Launching a Spine Program in the ASC; USP 797 and Its Effect on ASCs; Four Steps to Prepare for Malignant Hyperthermia; Five Practical Tips to Becoming a Top Spine and Orthopedic Hospital -- A Discussion With a Top-Rated Neurosurgical Hospital; The Ins and Outs of Outsourcing Implants; 7 Orthopedic Surgical Devices to Know; Sleep Apnea Screening for ASCs; New Financing Opportunities for Common ASC Challenges; Three Trends in the Implantable Device Industry; Tips to Tackle Four Common Orthopedic Coding Challenges; 7 Accounting Tips to Help Your Practice Be More Efficient.

May/June 2008

May/June 2008 Articles

6 Considerations for Successful Outpatient Knee Replacement
The ability to perform total knee arthroplasty, or TKA, in the ASC setting depends on state law — you must be allowed to keep patients up to 23 hours, if necessary — but if your state permits overnight stays, such a program can be a lucrative addition to your facility.
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Reimbursement, Profit and Patient-Selection Issues -- Spine and Orthopedic Cases
This article discusses the profitability of different procedures, out-of-network payment issues, patient selection issues and new procedures being performed in orthopedic- and spine-driven ASCs.
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Incentives and Ownership for Hospital-Employed Physicians and for Primary Care Physicians
1. Can an ASC offer hospital-employed physicians incentives to use an ASC?
It is generally improper to provide financial incentives to a physician in exchange for referring cases to a surgery center. For example, one could not offer hospital-employed physicians special bonuses, monetary gifts or any sort of monetary incentive in exchange for referring patients to physicians who would perform procedures at the new ASC or for such physicians directly performing cases on patients at the new ASC. In contrast, it may be permissible for the hospital-employed physicians to own an interest in the new ASC.
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Regional Anesthesia: Benefits and Implementation in Your ASC
Peripheral regional anesthesia has become a popular adjunct to general or intravenous anesthesia for surgeries such as knee, foot/ankle and upper extremity procedures. Regional anesthesia targets anesthesia to a particular part of the body such as a limb, through a single-shot injection near a nerve supplying the operative site, or by use of a nerve block catheter, which allows for the infusion of a dilute local anesthetic over an extended period of time.
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10 Medication Management Ideas for Anesthesiology Services
Accrediting bodies, safety organizations and other overseers of the healthcare industry are clearly focused on safe management of medications as underscored by recent surveys, media attention and aggressive advertising by legal firms to the public. In our practice, virtually every week, ASCs we work with are surveyed, and we continue to see the same theme: Safe medication management and performance assessment is front and center.
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3 Hot Spine Device Trends
New technology in the spine market is expanding faster than the size of the universe. There are three main areas of focus . . .
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At a Glance: Anesthesia Products and Services
Accu-Draw (AliMed), Turnkey Ambulatory Anesthesia Services (Anesthesia Health Partners), Syringe Pump Perfusor (B. Braun), AdvantX Anesthesia Billing (Source Medical), Univent Bronchial-Blocker Tube (Vitaid)
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10 Valuation Facts and Statistics for ASCs
Valuation mul les for ASCs were higher than ever in 2007, and orthopedics, ENT, ophthalmology and general surgery are the most desirable specialties, among other findings, according to the 2008 ASC Valuation Survey by HealthCare Appraisers. Thirteen management partners representing more than 300 ASCs nationwide participated in the survey.
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Key Clinical and Business Developments in ASC Anesthesia
"The best surgical outcomes, highest profits and greatest patient satisfaction are found at well-managed ASCs that have an awareness of how areas such as anesthesia affect ASCs’ general operations,” says Susan Kizirian, RN, MBA, the chief operating officer at Ambulatory Surgery Centers of America.
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7 Keys to Successfully Launching a Spine Program in the ASC
Increased reimbursement for orthopedic and spine procedures under the new Medicare ASCpayment system as well as rapidly developing minimally invasive technologies and techniques for spine procedures are driving a boom in outpatient spine programs. Whether you’re thinking about building an ASC around spine or adding the specialty to an existing facility (it works best, say our experts, when you’re already performing orthopedics or pain management procedures), there are several key clinical and business considerations common to both models.
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USP 797 and Its Effect on ASCs
By now, you have probably heard about USP 797 or simply 797. If you are at all involved in anesthesia, you are also probably generally aware of what 797 is all about. But it’s a big issue with many facets, so regardless, you may be wondering when, what, who, where and how this will affect your ASC. Here is a brief overview of 797 and the impact it will have on daily operations within ASCs.
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Four Steps to Prepare for Malignant Hyperthermia
The March death of Stephanie Kuleba, the 18-year-old Florida resident who succumbed to malignant hyperthermia (MH) following breast surgery, should serve as a reminder for ASCs. While this genetic condition is extremely rare, your facility cannot afford to overlook the possibility that one of your patients may experience this severe and potentially fatal reaction.
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Five Practical Tips to Becoming a Top Spine and Orthopedic Hospital
The Neurologic & Orthopedic Hospital of Chicago (NOHC) was ranked the top hospital in Illinois and among the top 5 percent in the country for spine surgery in 2008, according to the latest HealthGrades Hospital Quality in America study, released earlier this year. The study is an annual assessment of mortality and complication rates in nearly 5,000 hospitals nationwide performed by HealthGrades, a for-profit healthcare ratings organization.
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The Ins and Outs of Outsourcing Implants
The cost of implants — and getting reimbursed for them — continues to be imposing for orthopedic and multi-specialty ASCs (see “Reimbursement, Profit and Patient Selection Issues — Spine and Orthopedic Cases” on pg. 1 for more). Here, in an interview with Bill Cramer, CEO of Access MediQuip, and Brent Ashby, administrator and CEO of Audubon Surgery Center in Colorado Springs, Colo., we discuss one solution to that problem.
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7 Orthopedic Surgical Devices to Know
Oxford Partial Knee (Biomet), Qui-Connect Arthro Sheaths (Richard Wolf Medical Instruments), Ultra Fast-Fix Meniscal (Repair System), 560 Series High-Definition Camera System (Smith & Nephew), Vertier Surgical Table (Stryker Orthopedics), Visum LED Surgical Light (Stryker Orthopedics), Conserve Total Hip Implant (Wright Medical)
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Sleep Apnea Screening for ASCs
Stephanie Wasek: We all hear about the impact of overweight and obese patients on the population and healthcare system; obstructive sleep apnea (OSA) is just one of the conditions associated with these patients. How prevalent is this problem in ASCs?

Dr. Steve Burton: According to the National Sleep Foundation Report on Sleep Apnea, approximately 18 million people suffer from sleep apnea daily. Approximately 12 percent to 15 percent of the surgical population has sleep apnea. That’s 10 percent of men and post-menopausal women. It’s as common as diabetes or asthma; however, eight in 10 are undiagnosed or untreated. The balance of patients suffer from sleep apnea every day and don’t know why. It’s this high rate of unmanaged disease that presents the risk to ASCs.
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New Financing Opportunities for Common ASC Challenges
In this period of economic challenges, there may be many reasons a physician might want to cash out some of his investment in an ASC. Further, given the credit crunch, younger physicians who want to take the opportunity to buy into an ASC might have a hard time raising the capital.
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Three Trends in the Implantable Device Industry
1. Movement to outpatient settings. There is a global trend across specialties, including orthopedics, neurology and cardiology, that increasingly complex procedures are moving toward outpatient settings.
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Tips to Tackle Four Common Orthopedic Coding Challenges
Thile the expanded list of Medicare-approved procedures may have resulted (or will result) in your ASC’s performing new procedures this year, this does not mean you can or should be any less careful with how you code your older procedures. In fact, you will want to work diligently to perfect your coding of existing procedures so you can have more time available to spend on the new cases your ASC performs.
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7 Accounting Tips to Help Your Practice Be More Efficient
It’s easy to get caught up in focusing on the clinical side of your ASC; after all, bringing in procedures and performing them efficiently and at a high level of quality are the foremost keys to producing revenue. But when the cases are done and the patient files turned over to the business office, what can your back office staff do to ensure they, too, perform efficiently and at a high level of quality to complete the revenue puzzle? Here’s a look at seven best practices offered by our experts.
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