You’re slated for surgery. A date is set. You arrive hours early for prep and anesthesia. Your doctor arrives to prep and scrub in. You’re wheeled into the OR, the procedure occurs, and you’re wheeled out to a hospital recovery room. Because that’s how it happens, right?
Sometimes, but increasingly often, procedures are moving away from the hospital OR and HOPD settings. It’s likely you’ve heard of an ambulatory surgery center, or ASC, which is a facility that supplies physicians with operating rooms, equipment, medications, anesthesia services, nursing, and other support staff in a freestanding facility outside of a hospital.
But are hospitals and ASCs the only option when it comes to surgical procedures?
One could make the argument that physician’s offices and clinics have always seen, to varying degrees, procedures performed therein. But in terms of modern medicine, surgeries and other procedures have taken place in office and clinic-based surgical suites since the 1970s, and with increasing regularity since the 1980s. Today, tens of millions of procedures are safely performed in offices and clinics every year in the US.
Advances in surgical equipment, minimally-invasive procedures, technology, and anesthesia (and sedation) facilitated a shift in sites of service. Physicians have benefitted from increased reimbursement when working from their own office rather than a hospital or ASC. Insurers have seen procedure prices decrease, and patients enjoy the savings and the convenience of having their procedure in a familiar and efficient location.
“Dentists have always been frustrated with the lack of hospital OR time they get and plastic surgeons wanted to better control the financial health and patient experience,” explains Mobile Anesthesiologists CEO Scott Mayer. “The 90’s were where specialties like GI, Urology, and Podiatry started seeing the financial incentives and realizing the technology and build-out were appropriate to make the leap. Gynecology, Pain, Ortho, and Vascular followed. The recent specialties were all driven by financial and technology enhancements. Private practice physicians needed to think of alternative ways to control and add to their procedure revenues and time given reimbursement cuts and additional consolidation and this was their best option.”
Likely the most well-known office-based procedures are extracting wisdom teeth, liposuction, and colonoscopy. But what other procedures are physicians regularly performing in office and clinic-based surgical suites, and which procedures are being adopted more and more in this setting? The answers will likely surprise you:
In-Office Procedures Performed
Knee Arthroscopy: This minimally-invasive procedure allows a surgeon to scope and repair minor damage to the knee and surrounding tissues. With this joint being particularly prone to injury and wear, knee arthroscopies are relatively-common. Thus, moving this – and other arthroscopic procedures – into the office setting could potentially have a major impact on overall healthcare spending.
Lithotripsy: Often physicians needn’t even enter a patient’s body to break up pernicious kidney stones, bezoars, and gallstones. In a standard office-based procedure, the physician can easily use extracorporeal shockwave therapy, laser lithotripsy, ultrasonic lithotripsy, and other methods to offer relief.
Vein Ablation: Vein issues can be painful and dangerous if not treated quickly and properly. In offices and clinics, vascular surgeons have a host of options at their disposal. Sclerotherapy treats spider and varicose veins with a simple injection, while endovenous laser and radio ablation procedures go deeper to deliver laser or heat related therapies to the affected blood vessel.
Myomectomy or Fibroid Removal: Uterine fibroids, benign smooth muscle tumors found in the structure of uterus, can be small and not require intervention. But larger fibroids often cause pain and other discomfort and warrant removal. What was once a surgery involving a large abdominal and uterine muscle incision, can now safely by performed in offices and clinics via laparoscopic and hysteroscopic methods, with recover time shrinking from weeks to days.
ACL Repair: In addition to knee arthroscopy visualization, physicians can safely repair elements of the joint, restoring ease of movement and alleviating pain using the same minimally-invasive technique. Tendon, either from the patient or a cadaver, is used to replace a damaged anterior cruciate ligament, and patients typically head home the same day as their procedure.
Ear Tubes: Surgery involving small children can be nerve-wracking, to say the least. So, to be able to perform any type of pediatric procedure in a physician’s office is usually a comfort to parents and guardians. One of the most common, the insertion of ear tubes for drainage and to mitigate frequent ear infections, is now regularly done in offices and clinics, allowing all involved the convenience and peace-of-mind needed when dealing with an infirmed child.
In-Office Procedure Safety
The question that remains is, with so many varied procedures being performed in office and clinic-based surgical suites, what is the safety track record?
While there are no official numbers kept for office-based procedures, there are numerous studies – such as this 2020 report from the Journal of Vascular Surgery– that point to an overwhelmingly positive patient safety record. Just like ASC’s seemed risky and foreign to healthcare decades ago and now are a mainstay, the surgical suite and physician office setting are the next evolution where care can be even safer than the traditional alternatives.
As healthcare spending in the nation continues to grow at an unsustainable rate and conversations around better access to quality care and value-based care grow louder, it is entirely reasonable to posit that more and more procedures will move away from HOPDs and ASCs and into in-office and clinic-based surgical suites.
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