Eyelid Surgery

The eyes are the most revealing feature of the face. When engaged in conversation, our eyes are the center of attention. Puffiness, dark circles around the eyes or droopy upper eyelids give the appearance of fatigue and old age. In some individuals, the excess skin of the upper eyelids can actually obstruct the field of vision, which can be dangerous when driving. Surgery can remove the excess fat and drooping skin on the upper eyelids, minimize bags under the eyes and tighten the lower eyelid skin. The result is a fresh, youthful and more rested appearance. Men and women of all ages who want to improve their self-image receive eyelid surgery. For upper eyelid surgery, doctors remove excess skin that hides the natural folds of and hangs down from the upper eyelids. This procedure helps reduce puffiness in the upper eyelids that creates a tired look. The surgery of the lower eyelid involves removing extra skin and fine wrinkles and reduces puffy bags under the eyes as well as unsightly dark circles. In many instances, excess droopy skin on the upper eyelids causes a lowered eyebrow ridge. As we age, gravitational pull and decreased elasticity of the skin leads to a downward fall or ptosis of the eyebrows. Naturally occurring low set eyebrows are sometimes genetic, in which case an endoscopic forehead lift or brow lift is necessary. It is imperative, however, to address low eyebrows in addition to eyelid surgery (blepharoplasty) to avoid excision of excess skin of the upper eyelid. Returning the eyebrow to its aesthetic position decreases the amount of skin necessary for excision in the blepharoplasty. The surgeon conducts the procedure under light sedation or general anesthesia. Long acting local anesthetics assure pain free after the procedure concludes. The incision at the upper eyelids typically begins within the natural crease of the inside corner of the eye and extends to the crow's feet or laugh lines. The surgeon removes excess skin and fatty tissue through this incision. The incision line follows the natural contour of the upper eyelid and is not very visible when healed. If the upper eyelids are droopy and have excess skin, the physician tightens the muscles underneath the eyelid to correct the placement of the upper eyelid. There are two components to lower eyelid surgery, depending on individual needs. The first component is to remove excess skin that wrinkles or unevenness of the lower eyelid. To address this problem, a surgeon makes an incision just below the eyelashes and excises the excess skin. The physician re-drapes the remaining skin is over the eyelid and the closes the wound to create a well- concealed scar. The second component addressed by lower eyelid surgery is excess puffiness or bulging due to excess or protruding fat. A doctor makes an incision at the lower eyelid crease just at the base of the eyelashes, where eyeliner is normally applied, and the doctor removes excessive skin, adjusts muscle folds, reduces puffiness and removes fatty pockets. When neither skin nor muscle fold removal is required, doctors address puffiness and "bags" with a hidden incision made inside the lower eyelid without any visible external incision. Physicians close incisions with very fine specialized plastic surgery stitches, some of which are absorbable by the body, while others require removal five to seven days after an operation.

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PREVENTING CONFLICTS OF INTEREST

  (C) PREVENTING CONFLICTS OF INTEREST.—VerDate 0ct 09 2002 13:03 Jun 09, 2010 Jkt 000000 PO 00000 Frm 00619 Fmt 9001 Sfmt 6601 F:\P11\NHI\COMP\PPACACON.005 HOLCPC
(i) The hospital submits to the Secretary an annual
report containing a detailed description of—
(I) the identity of each physician owner or investor
and any other owners or investors of the
hospital; and
(II) the nature and extent of all ownership
and investment interests in the hospital.
(ii) The hospital has procedures in place to require
that any referring physician owner or investor
discloses to the patient being referred, by a time that
permits the patient to make a meaningful decision regarding
the receipt of care, as determined by the Secretary—
(I) the ownership or investment interest, as
applicable, of such referring physician in the hospital;
and
(II) if applicable, any such ownership or investment
interest of the treating physician.
(iii) The hospital does not condition any physician
ownership or investment interests either directly or
indirectly on the physician owner or investor making
or influencing referrals to the hospital or otherwise
generating business for the hospital.
(iv) The hospital discloses the fact that the hospital
is partially owned or invested in by physicians—
(I) on any public website for the hospital; and
(II) in any public advertising for the hospital.
(D) ENSURING BONA FIDE INVESTMENT.—
(i) The percentage of the total value of the ownership
or investment interests held in the hospital, or in
an entity whose assets include the hospital, by physician
owners or investors in the aggregate does not exceed
such percentage as of the date of enactment of
this subsection.
(ii) Any ownership or investment interests that
the hospital offers to a physician owner or investor are
not offered on more favorable terms than the terms offered
to a person who is not a physician owner or investor.
(iii) The hospital (or any owner or investor in the
hospital) does not directly or indirectly provide loans
or financing for any investment in the hospital by a
physician owner or investor.
(iv) The hospital (or any owner or investor in the
hospital) does not directly or indirectly guarantee a
loan, make a payment toward a loan, or otherwise
subsidize a loan, for any individual physician owner or
investor or group of physician owners or investors that
is related to acquiring any ownership or investment
interest in the hospital.
(v) Ownership or investment returns are distributed
to each owner or investor in the hospital in an
amount that is directly proportional to the ownership
or investment interest of such owner or investor in the
hospital.
(vi) Physician owners and investors do not receive,
directly or indirectly, any guaranteed receipt of
or right to purchase other business interests related to
the hospital, including the purchase or lease of any
property under the control of other owners or investors
in the hospital or located near the premises of the hospital.
(vii) The hospital does not offer a physician
owner or investor the opportunity to purchase or lease
any property under the control of the hospital or any
other owner or investor in the hospital on more favorable
terms than the terms offered to an individual who
is not a physician owner or investor.
(E) PATIENT SAFETY.—
(i) Insofar as the hospital admits a patient and
does not have any physician available on the premises
to provide services during all hours in which the hospital
is providing services to such patient, before admitting
the patient—
(I) the hospital discloses such fact to a patient;
and
(II) following such disclosure, the hospital receives
from the patient a signed acknowledgment
that the patient understands such fact.
(ii) The hospital has the capacity to—
(I) provide assessment and initial treatment
for patients; and
(II) refer and transfer patients to hospitals
with the capability to treat the needs of the patient
involved.
(F) LIMITATION ON APPLICATION TO CERTAIN CONVERTED
FACILITIES.—The hospital was not converted from
an ambulatory surgical center to a hospital on or after the
date of enactment of this subsection.
(2) PUBLICATION OF INFORMATION REPORTED.—The Secretary
shall publish, and update on an annual basis, the information
submitted by hospitals under paragraph (1)(C)(i) on the
public Internet website of the Centers for Medicare & Medicaid
Services.
(3) EXCEPTION TO PROHIBITION ON EXPANSION OF FACILITY
CAPACITY.—
(A) PROCESS.—
(i) ESTABLISHMENT.—The Secretary shall establish
and implement a process under which a hospital
that is an applicable hospital (as defined in subparagraph
(E)) or is a high Medicaid facility described in
subparagraph (F) may apply for an exception from the
requirement under paragraph (1)(B). oAs revised by
section 1106(2)(A) of HCERA.
(ii) OPPORTUNITY FOR COMMUNITY INPUT.—The
process under clause (i) shall provide individuals and
entities in the community in which the applicable hospital applying for an exception is located with the opportunity
to provide input with respect to the application.
(iii) TIMING FOR IMPLEMENTATION.—The Secretary
shall implement the process under clause (i) on
February 1, 2012. oAs revised by section
10601(a)(2)(A).
(iv) REGULATIONS.—Not later than January 1,
2012, the Secretary shall promulgate regulations to
carry out the process under clause (i). oAs revised by
section 10601(a)(2)(B).
(B) FREQUENCY.—The process described in subparagraph
(A) shall permit an applicable hospital to apply for
an exception up to once every 2 years.
(C) PERMITTED INCREASE.—
(i) IN GENERAL.—Subject to clause (ii) and subparagraph
(D), an applicable hospital granted an exception
under the process described in subparagraph
(A) may increase the number of operating rooms, procedure
rooms, and beds for which the applicable hospital
is licensed above the baseline number of operating
rooms, procedure rooms, and beds of the applicable
hospital (or, if the applicable hospital has been
granted a previous exception under this paragraph,
above the number of operating rooms, procedure
rooms, and beds for which the hospital is licensed
after the application of the most recent increase under
such an exception).
(ii) 100 PERCENT INCREASE LIMITATION.—The Secretary
shall not permit an increase in the number of
operating rooms, procedure rooms, and beds for which
an applicable hospital is licensed under clause (i) to
the extent such increase would result in the number
of operating rooms, procedure rooms, and beds for
which the applicable hospital is licensed exceeding 200
percent of the baseline number of operating rooms,
procedure rooms, and beds of the applicable hospital.
(iii) BASELINE NUMBER OF OPERATING ROOMS,
PROCEDURE ROOMS, AND BEDS.—In this paragraph, the
term ‘baseline number of operating rooms, procedure
rooms, and beds’ means the number of operating
rooms, procedure rooms, and beds for which the applicable
hospital is licensed as of the date of enactment
of this subsection (or, in the case of a hospital that did
not have a provider agreement in effect as of such date
but does have such an agreement in effect on December
31, 2010, the effective date of such provider agreement).
oAs revised by section 1106(2)(B) of HCERA.
(D) INCREASE LIMITED TO FACILITIES ON THE MAIN
CAMPUS OF THE HOSPITAL.—Any increase in the number of
operating rooms, procedure rooms, and beds for which an
applicable hospital is licensed pursuant to this paragraph
may only occur in facilities on the main campus of the applicable
(E) APPLICABLE HOSPITAL.—In this paragraph, the
term ‘applicable hospital’ means a hospital—
(i) that is located in a county in which the percentage
increase in the population during the most recent
5-year period (as of the date of the application
under subparagraph (A)) is at least 150 percent of the
percentage increase in the population growth of the
State in which the hospital is located during that period,
as estimated by Bureau of the Census;
(ii) whose annual percent of total inpatient admissions
that represent inpatient admissions under
the program under title XIX is equal to or greater
than the average percent with respect to such admissions
for all hospitals located in the county in which
the hospital is located;
(iii) that does not discriminate against beneficiaries
of Federal health care programs and does not
permit physicians practicing at the hospital to discriminate
against such beneficiaries;
(iv) that is located in a State in which the average
bed capacity in the State is less than the national
average bed capacity; and
(v) that has an average bed occupancy rate that
is greater than the average bed occupancy rate in the
State in which the hospital is located.

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