Decreases in reimbursements, unpredictable schedules, inefficiencies, patient inconvenience; these are a few of the many reasons physicians are moving procedures out of HOPDs and ASCs and into their own clinic-based and in-office surgical suites.
Advances in surgical technology and methods along with the buzz created throughout the healthcare community about the benefits of this option have increased the utility and safety of minimally-invasive procedures performed in the office setting, while at the same time insurance providers have increased reimbursements to doctors who work in their own space.
“Traditionally, people think about things like doing a suture, removing a cyst, or doing a nasal tracheal endoscopy, small things, and automatically think about an operating room with the big overhead lights and the circulating nurse and scrub tech, being in a hospital,” says Dr. Meghan Valach, Chief Medical Officer for Mobile Anesthesiologists. “You can take those procedures outside of the operating room completely and do them in a regular office space, or surgical suites. The nice part about that is [physicians] can integrate it into their daily practice. They’re able to see patients over in their clinic, have the same staff using the same medical records, right on-site, actually have the people who know the patient take care of them for the procedure.”
But this shift in site of service is not without its list of considerations and due diligence items when implementing. We’ve compiled a list of the things physicians and their teams should keep top-of-mind as they weigh what office-based procedures could mean to their practice.
Staffing: Just like in an OR, HOPD, or ASC, physicians will need properly trained assistants in their surgical suites during procedures. At times, a nurse will need to be on hand, but in some cases a surgical technician, physician’s assistant, or medical assistant can provide the needed aid. These individuals may already be part of your staff, but keep in mind the knowledge and experience they’ll need to support various surgeries efficiently and safely.
Anesthesia: Most physicians are not equipped or certified to administer the level of anesthesia necessary for these procedures. If one does decide to move forward with an outsources or in-house option, they must consider training, credentials, liability and comfort of the anesthesia provider in this setting. Another necessary consideration is staffing the pre- and post-operative care elements of the procedure. A popular option, though, is an outsourced accredited anesthesia partner that provides, at their expense, anesthesia-related equipment, anesthetic medications and supplies, and peri-operative nursing care.
Physical Space: Different procedures have different equipment and special requirements, so it is important to carefully examine what you’ll need in terms of square footage for yourself, your patient, your staff, and other ancillary surgical items to comfortably operate. Also, evaluate the rest of your office; if a patient needs to be moved to a recovery room, are your hallways wide enough and do you have available rooms or post-op bays? If you decide to work with a consultant or an outside ambulatory anesthesia company, there are many that can assess your space and assist you in converting an area such as an exam room into a procedure-ready surgical suite as needed. This can save you the headache and added expense when there may be an option in your current space with little to no hassle
Equipment: As above, this varies greatly by specialty and procedure, but a procedure-appropriate recliner/bed or table is a must. Storage and sterilization of this equipment is also an important consideration as they can, in some case, add expense to a surgical suite build-out. Other procedure specific equipment can be found through distributors or medical device companies that will also assist in making this a more seamless process and pleasant experience.
While the shift to office-based procedures can seem overwhelming at first glance, it is important to remember it can add to your bottom line, help you regain control of your practice, add valuable time back to your life, your staff’s lives, and your patients’ lives, and be part of the move towards true value-based care in the U.S. The long-term benefits significantly outweigh the short-term investment and change, and one you will never regret
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