July/August Issue of Becker's ASC Review

In this issue: Letter from the Editor; Office of Inspector General Issues Advisory Opinion — Physician/Hospital Joint-Venture;  10 Things You Should Know About Construction; Lessons from 3 Construction Projects; Cost to Build: Sample 2-OR ASC; Four Current Issues in Real Estate Development; Lease Vs. Own: Cost Estimate Sample for 2-Surgery-Suite ASC Development; 40 Physicians to Know; The Future of Spine: Freestanding Spine Centers; Cost of Doing Orthopedic Surgery. July/August 2008

July/August 2008 Articles

Meeting the Current Business Challenges in Ophthalmology
Ophthalmology has never been an extremely high-reimbursement specialty, and CMS’s new ASC payment system did little to change that. Further, Medicare patients remain the largest patient group for these procedures, so there isn’t much in the way of opportunity for compensating for minimal reimbursements. In other words, the challenges in this mature ASC specialty remain the same.
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Merging Two  Centers - Can it Solve Certain Problems?
The merger of two centers with each other has not been a traditional strategy for surgery center growth over the past 10 years. Traditionally, merging two centers, absent certain motives such as redeeming certain physicians, has been viewed more as a negative than a positive. Mergers would often expand annual fixed costs and leave more physicians owning interests in two centers with less of a definite connection between the physicians that practice at the specific centers.
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Expert Guidance to Help You Capitalize on New Urology Opportunities
The new Medicare payment system and expanded list of procedures brought with them new, profitable opportunities for centers performing urological procedures or considering offering urology in the future.
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Should You Add These Complex Urology Procedures?
In both single-specialty urology and multi-specialty ASCs, longer, more complex procedures can be a good fit and good for
profitability. The key for either type of facility is having a dedicated fluoroscopy unit, with a cysto-fluoro table and a C-arm.
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Prostate Brachytherapy: 2008 ASC Coding Changes
Anyone associated with ASCs is aware of the sweeping changes CMS has instituted to the facility payment system. Few specialties or procedures have undergone more changes than prostate brachytherapy.
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Four Steps to Profitable Retina in the ASC
Unlike cataracts, retina procedures are not ideally suited for the ASC: They can be unpredictable, time-consuming and expensive in terms of supplies and equipment. But the Medicare ASC payment system's increased reimbursement for these cases makes them an intriguing possibility at the very least. Here's what you need to know to add retina as a profit line in your surgery center.
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Per Click and Ophthalmologist - Vendor Payment Arrangements
This article describes a situation in which an ASC pays a physician such as an ophthalmologist as a supplier on a per-case or per-click basis for disposables, equipment and other items needed for surgery; the ophthalmologist then performs procedures at the ASC. This type of arrangement is fairly uncommon and, further, we believe it raises very significant legal concerns under the Stark Act and the Medicare Medicaid Anti-Kickback Fraud and Abuse Statute (the Anti-Kickback Statute).
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12 Reasons to Consider Cataract Outsourcing Services as an Option for Providing Cataract Surgery
As the Medicare patient base continues to grow, so will the number of instances of cataracts affecting these patients. While Medicare reimbursement for cataract procedures saw small increases with the new payment system, cataract cases are still a potentially solid addition for a surgery center looking to increase profits and case volumes.
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127 People to Know in the ASC Industry
Sami S. Abbasi. Sami Abbasi leads National Surgical Care as its chairman and CEO. Before National Surgical Care, Mr. Abbasi served as president and CEO of Radiologix, a leading national provider of diagnostic imaging services.
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Benchmarking Statistics
Gross Charges and Net Revenue Per Case for  ENT, Ophthalmology and Urology

For ENT, ophthalmology and urology, here are the gross charges per case and net revenue per case:
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Five Current Business and Clinical Issues for ENT in ASCs
Overall, much like ophthalmology, the keys to success and profitability in ENT lie in being able to perform a large number of procedures, and to do them as efficiently as possible.
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Follow Example Operative Note to Help Code Common ENT Procedure Correctly
The reimbursement rates for many ASC procedures have benefited and will benefit under the new Medicare payment system. One such procedure seeing a noticeable reimbursement boost is endoscopy with ethmoidectomy (surgical drainage of the ethmoid sinus). Total endoscopy with ethmoidectomy (CPT code 31255) will see its reimbursement increase 31 percent at the 2008 fully implemented rate. If your ASC performs ENT procedures, this is a case that you may see more often because of this reimbursement boost.
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Recent Attacks on Out-of-Network Practices Highlight the Need for Careful Assessment of Efforts
Two recent actions, one by the Office of the New York State Comptroller, and one a court decision that comes out of a New Jersey case, further highlight the need for ASCs to be very cautious in their actions relating to out-of-network payments.
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4 Case Studies: How You Can Use Benchmarking to Improve Practice
You know you have to track quality and patient satisfaction indicators. Your accreditation agency requires it; increasingly, your third-party insurers may require reporting of data; and, soon, CMS will ask you to track and report selected indicators.
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What's New for Ophthalmology Surgery
Infiniti Vision System
OZil Torisional handpiece
Alcon Laboratories
(800) 862-5266
FYI: The Infiniti Vision System features a patented low compliant fluidic management
system that decreases post-occlusion surge and a dual sensing of the vacuum and irrigation pressure sensors to detect and adjust to changing intraocular conditions. The proprietary OZil Torsional handpiece delivers controlled, side-to-side ultrasonic shearing, and the Intrepid
Micro-Coaxial System includes IOL, phacoemulsification and incision technologies that let surgeons transition to micro-incisions.
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3 Urology Products to Know
Precise Cryoablation System
Galil Medical
(877) 639-2796
FYI: The Precise Cryoablation System lets urologists offer minimally invasive cryoablation treatment to prostate and kidney cancer patients. Precise features multi-point thermal sensors to record temperatures throughout the gland or tumor for a high level of procedure control. In addition, new i-Thaw technology eliminates the need for helium tanks for space and cost efficiency and supports the 17-gauge cryoablation needle family.
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5 Products for ENT Surgery
Relieva Luma Sinus Illumination System
(877) 775-2789
FYI: Acclarent's Relieva Luma Sinus Illumination System presents a new option for ENT surgeons trained to treat chronic sinusitis symptoms with balloon catheter dilation. Using trans-sinus illumination technology, Relieva Luma delivers full-strength, targeted fiberoptic light transmission and agile device handling, to let surgeons confirm sinus access under direct visualization.
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Q&A With Joint Commission's Michael Kulczycki
Here's what Michael Kulczycki, the executive director of the Joint Commission's Ambulatory Care Accreditation Program, had to say about some current issues affecting ASCs.
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