What are some of the fastest-growing medical procedures performed in the office space?

Hospitals are a vital part of our healthcare system. We’ve all had to interface with them in some fashion, and for good reason. The best hospitals efficiently address your medical needs in an almost effortless fashion with consideration for both your health and your overall experience.

But, by design, hospitals are complicated, intricate mechanisms. To care for – and in some cases house – multitudes of people with varying ailments and degrees of illness requires a brigade of staff, an array of equipment, stockpiles of medication, and layers of bureaucracy. So, it’s little wonder that people can find hospitals less than ideal for relatively-routine outpatient procedures.

a stethoscope on a desk with a portion of a laptop keyboard visible

Hospitals are a vital part of our healthcare system. We’ve all had to interface with them in some fashion, and for good reason. The best hospitals efficiently address your medical needs in an almost effortless fashion with consideration for both your health and your overall experience.

But, by design, hospitals are complicated, intricate mechanisms. To care for – and in some cases house – multitudes of people with varying ailments and degrees of illness requires a brigade of staff, an array of equipment, stockpiles of medication, and layers of bureaucracy. So, it’s little wonder that people can find hospitals less than ideal for relatively-routine outpatient procedures.

Is there an alternative to the hospital?

Outside of hospitals, ambulatory surgery centers (ASCs) offer a convenient alternative to the hospital, with many of the same trappings, such as surgery suites, recovery rooms, and advanced tools. But even ASCs can be burdensome when it comes to physicians booking space, procedures running over time, and expensive facility fees. That’s why many physicians are choosing to perform certain procedures safely, conveniently, and affordably in their own office or clinic.

Advances in anesthesia medications, surgical techniques, and mobile technology have allowed what once seemed impossible to become the norm. Everything from colonoscopies to knee arthroscopy happen countless times a day in offices across the U.S. Patients benefit from lower out-of-pocket costs incurred in a convenient, familiar setting, physicians stand to collect more of the overall reimbursement for procedures performed in their own space, and payers ultimately dole out less money than they would to a large, complex hospital.

So, let’s take a look at some of the procedures that are growing fast in the office space.

Fast-growing Procedures

ENT

A wide variety of ENT procedures are being done in the office, clinic, and big-box setting, providing patients and physicians with convenience, comfort and savings. These include, but are not limited to balloon sinuplasty, turbinate cautery, septoplasty, concha bullosa reduction, maxillary antrostomy, myringotomy tube insertion, and ethmoidectomy. This isn’t a new advent in ENT care, either. A 2005 paper published in Otolaryngologic Clinics of North America outlines how nasal endoscopes enable ENT surgeons to visualize the cavities and middle meatus of the nose, allowing them to perform biopsies, debridements, polypectomies, and turbinate reductions, along with limited ethmoidectomies and sphenoidotomy revisions. That list is only further growing, as today, physicians successfully perform concha bullosa reductions, coablations of the tongue base, and balloon sinuplasty, to name just a few of the now common in-office procedures.

Orthopedics

If you are someone who sits a computer all day, hands perched over a keyboard, then you might know the pain of carpal tunnel syndrome. This occurs when the median nerve running through wrist is squeezed or otherwise compressed causing numbness, tingling, and progressive pain. To relieve the issue, physicians no longer need to book a hospital OR, with all of the incumbent costs and headaches. As outlined in this 2021 Healio article, carpal tunnel release is now being performed in office-based surgical suites and procedure rooms under wrist block anesthesia aided by ultrasound guidance. In minutes, patients can get the relief they seek without the hassle of a hospital. Additionally, orthopedists are increasingly bringing knee arthroscopies and fracture repair procedures into office and clinics.

Gynecology

As we’ve discussed on The Scope before, gynecologists are performing a range of in-office procedures, including endometrial ablation. Further, hysteroscopy and uterine polypectomy procedures are expanding their presence in the office space, as patients seek a quick, comfortable alternative to the hospital setting for these more intimate procedures. Given that many women have a closer relationship to their gynecologist than other specialists, the familiarity and ease-of-care offered in the physician’s own office is unparalleled.

Ophthalmology

With more than half of Americans over 80 affected by cataracts, according to the National Eye Institute, it’s not surprising that cataract surgery is routine, so much so that it is often-performed in the ophthalmologist’s office or clinic. A cloudy area of vision, cataracts form on the lens of the eye. While some are small enough to be removed on their own, most require removal of the lens and replacement with an artificial lens. This relatively quick procedure can be performed under either class A (oral and topical non-dissociative drugs) or class B (IV-delivered dissociative drugs) anesthesia, with the majority using class A requiring minimal perioperative screening and monitoring.

Anesthesia’s role

The above procedures represent just a few of the fast-growing surgeries being performed in the office and clinic setting. While many of these require only local anesthesia, such as cataract surgery, there are some that necessitate putting the patient under general anesthesia. This can give some patients – and even physicians – pause, but office-based anesthesia has a proven track record of safety. In fact, the American Society of Anesthesiology issues detailed guidelines for their members – physician anesthesiologists and nurse anesthetists – covering the all aspects of safe administration of anesthesia outside of acute care hospitals and ambulatory surgery centers.

It’s important to remember that significant positive strides in anesthesia have been made in recent years that have facilitated office-based procedures. Where discomfort from nausea and vomiting – sometimes lasting days after an operation – was once the norm, drugs like Propofol and Ketamine allow for a much quicker sedation process with few adverse side effects. Couple this speedier and more-pleasant intra-operative experience with the convenience and comfort of being in your physician’s office, and it is easy to see the appeal of office-based procedures

For providers considering bringing procedures into their practice, there are a few key elements to keep in mind when searching for an out-sourced anesthesia partner. As covered by Scott Mayer, CEO of Ambulatory Management Solutions, in a 2019 Becker’s ASC Review article, physicians should seek an anesthesia provider with the ability to handle critical emergency care, the capacity to assign a dedicated and familiar anesthesiology team to handle most, if not all cases, and an understanding that anesthesiology should match the needs of the specialist.

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