Healthy patients undergoing hip and knee replacements, along with certain spine procedures, only intended for in-patient settings now can undergo these procedures in an ASC. The problem is some patients will need pain control and monitoring beyond the 23 hours, 59 minutes recovery window CMS allows in an ASC.
Post-surgical options for patients who require 48-hour (up to 72-hour) pain control is needed in a separate recovery center that does not jeopardize the Conditions of Coverage for CMS-certified ASCs.
While there are no uniform solutions that solve all problems for everyone, there are some options that can help:
• Hospitality suite. This is an attractive and popular option because of the light regulatory burden and small operating cost. However, it is difficult for some facilities to maintain high-quality care standards that other options offer. Because of the lack of regulations and quality standards, this option is not reimbursed by most payors unless is it included in a bundled payment arrangement, through self-pay, or under some type of other contract with a payor.
• Skilled nursing facility (SNF). Strictly regulated and licensed with steep operating cost rules, SNFs can be troublesome.
Typically, Medicare requires a three-day qualifying hospital stay, and most patients do not need the higher level of acuity associated with SNF patients. However, these facilities do allow for private and federal reimbursement.
• A pain management and recovery care center. Some use another licensed ASC for post-op pain and monitoring to gain an additional 23 hours, 59 minutes.
The logistics could be difficult based on location, and reimbursement might not be enough to make this feasible.
• Medicare-approved 72-hour stay facility. This is the best option. ASCs need to be able to provide an opportunity to keep patients longer in an ASC or adjacent facility that will qualify for commercial and federal reimbursement.
This is the next logical step to keep patients out of the hospital, with adequate incentives for ASCs to develop facilities and programs to provide longer recovery times for many approved procedures.
(Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Address: 5114 Balcones Woods Drive, Suite 307-203, Austin, TX 78759. Phone: (512) 297-7575. Fax: (512) 233-2979. Email: firstname.lastname@example.org. Web: www.earnhart.com. Instagram: Earnhart.Associates.)