Becker's Spine Review

31 OUTPATIENT SURGERY California ASC Whistle-Blowers File Wrongful Termination Suit: 5 Things to Know By Laura Dyrda T wo former employees filed a lawsuit against Santa Barbara (Calif.) Surgery Center alleging they were wrongfully terminated after reporting noncompli- ance with medical regulations, failure to maintain sterile techniques and unlawful opiate control, according to Edhat Santa Barbara. The pair also alleged age discrimina- tion in their firing and made sexual misconduct claims. Here are five things to know: 1. Earlier this year, the center's clinical manager, Annette Eddy, and healthcare administrator and infection preven- tionist, Laura Dahlin, were fired after reporting several in- stances of noncompliance. The pair reported observing staff members who did not adhere to sterile techniques and an employee who accessed opioids for possible inap- propriate use. 2. Both employees contacted the ASC's medical director, Gary Anderson, MD, an anesthesiologist at the center, to report their complaints, but were allegedly told to ignore them because "doctors would take their business else- where if required to maintain sterile environments," ac- cording to the report. 3. The pair also complained that physicians forced nurses to forge their signatures, violated anti-kickback, discrimi- nated based on age — Ms. Dahlin and Ms. Eddy were the oldest staff members and faced comments about their ages — and mismanaged a sexual misconduct claim be- tween a patient and physician. They also noted a lack of disclosed justification for Dr. Anderson's stipend. 4. Ms. Dahlin claims she underwent an unscheduled perfor- mance review after urging Dr. Anderson to report the sexual misconduct claim. The review was negative, and she disput- ed the review with the board, providing evidence to support her claim. Soon after, she was fired, according to the report. 5. Santa Barbara Surgery Center, which provides gastro- enterology, orthopedics, ENT, pain management, ophthal- mology and spine surgery, did not comment on the suit in the report. NewsChannel 3 reported a spokeswoman for the center "look[s] forward to clearing the allegations." n How the CMS Final Rule Will Affect Orthopedic ASCs: 5 Key Notes By Laura Dyrda O n Nov. 2, 2017, CMS received the 2018 final payment rule, provid- ing a 1.2 percent increase in ASC reimbursement next year. e final rule also addressed several issues pertaining to ortho- pedic procedures in ASCs, including total joint replacements and spine procedures. Here are five ways the final rule will affect ortho- pedic ASCs, according to guidance from Ambu- latory Surgery Center Association: 1. Total knee replacements: CMS removed to- tal knee replacement from the inpatient only list, but did not add it to the ASC payable list. e agency will continue discussion on oth- er joint replacement codes before removing them from the inpatient only list as well. While some in the industry are excited by this move, which could bring total knee replacements a step closer to the ASC payable list, others feel it could have a negative impact on an ASC's ability to negotiate fair contracts with private payers if CMS sets the rate too low. 2. Total and partial hip replacements: In the proposed final rule, CMS solicited comments for adding total and partial hip replacements to the ASC payable list, but decided not to add them in the final rule, stating, "Our un- derstanding is that these procedures typically require more than 24 hours of active medical care following the procedure." 3. Spine surgery: CMS added two spine pro- cedures to the ASC payable list, including to- tal disc arthroplasty with discectomy (22856) and second-level cervical disc arthroplasty with discectomy (22858). 4. Quality reporting: A new quality measure was approved that will affect orthopedic sur- gery centers specifically: ASC-17 will collect data via claims for hospital visits aer ortho- pedic procedures in the ASC. Data collected over the next few years will affect payment determination in 2022 and subsequent years. 5. Payment rates: Overall, ASCs received a 1.2 percent reimbursement increase and hospital outpatient departments received a 1.35 per- cent increase. n Overall, ASCs received a 1.2 percent reimbursement increase.

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