On February 8, 2007, Sen. Bax Baucus, Chairman of the Senate Finance Committee, Sen. Charles Grassley Ranking Member of the Senate Finance Committee and Pete Stark Chairman of the Health Subcommittee of the House Ways and Means Committee sent a joint letter to Leslie V. Norwalk, the Acting Administrator of Centers of Medicare and Medicaid Services asking for an investigation concerning the Medicare status of the West Texas Hospital in Abilene, Texas, which had to call 911 to transport a patient with respiratory arrest related to spinal surgery at the hospital. The patient later died. The case is reminiscent of a similar case in Oregon about two years ago which was the subject of much debate and outcry by politicians opposed to the development of specialty hospitals. One of the concerns raised by the three politicians was how the hospital could obtain Medicare provider status during the specialty hospital moratorium. The new hospital apparently came on line during 2005. The answer just might be that the West Texas Hospital is not in fact a specialty hospital. (It does look like a specialty hospital though and apparently has no emergency room.)
According to its web site the hospital is licensed as a 14 bed acute care general hospital, with six semi-private suites, 2 private suites three operating rooms and two endoscopy rooms. Why the patient died, whether or not the staff at West Texas were properly trained and took appropriate measures to resuscitate the patient, and whether the patient was an appropriate patient for surgery at West Texas are all questions that will probably have to be answered in the Courts. The surprising thing is that there or so few of similar kinds of incidents given the large growth of outpatient surgical procedures in doctors offices and in Ambulatory Surgical Centers.
In 1981 over 90% of all out patient surgeries were performed in hospital ambulatory surgery centers. As of 2004 that number has dropped to less than 50% with about 16% performed in doctors offices and roughly 38% in ASC's and similar facilities. While all states regulate surgical procedures in hospitals and 43 states regulate procedures in ASC's, very few states actually regulate surgical procedures in physicians offices. It is off course a truism that patients die of surgical complications every day in hospitals, there does not seem to be much statistical data on the number of patients who die of surgical complications in hospital ambulatory surgical centers. My guess is that there have been some, which begs the question as to why the attacks on specialty hospitals, given that the liability issues for hospital ambulatory surgery cases would be similar. Both have an obligation to have well defined and thought out emergency procedures and properly trained staff to handle a core situation.
It appears that the major objection by the two senators and the congressman are not really so much a concern about the West Texas incident itself so much as their ability to use the incident in their ongoing opposition to the concept of specialty hospitals owned by physicians. Physicians and ASC's beware. More regulation is coming down the pike, but the real issue is the economic viability of full service hospitals and whether competition really works in health care.
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