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Let's take a relook at old procedures
By Stephen W. Earnhart, MS
Earnhart & Associates
There is an interesting thing happening, seemingly nationwide. Outpatient surgery is off way off! Some centers are reporting as much as a 23% decrease over last year.
The first thing that comes to mind is that, for the most part, much of outpatient surgery is elective. If you don't have a job, you're worried about losing a job, or you don't want to take time off because some backstabbing office creep will take your job as soon as you take sick leave, you might postpone surgery. On the flip side, inpatient surgery is up over the same time period.
So, let's find a way to get more surgery into your hospital or surgery center from procedures that you might not have been attracted to before. Below are some real questions from clients:
Question: We have been approached by a group of dentists that want to use our surgery center to provide routine dental care to children and adults in the community. They tell us that many patients need general anesthesia for the more basic and routine dental care, including cleaning, fillings, extractions, and the like. We are skeptical and don't know if we want to do this. Do you know of any others that are doing these types of cases, and are they financially viable?
Answer: Yes. We know of many centers that are providing this service. Some things you need to know though. Since almost all of these cases are under general anesthesia, they need to be done in the operating room, not a treatment room like the group told you.
While the overall supply cost is low, often under $45 per case, you need to factor in the cost of the general anesthesia drugs and gases. Reimbursement, especially under the "special needs programs," generally are funded through Medicaid, and payment varies greatly from state to state. Because it is difficult to attract providers to perform these important cases, often the reimbursement can be profitable. One difficulty is finding anesthesia providers willing to do the cases.
Question: We have shied away from doing urology cases at our center because of the low reimbursement and the need for a "wet room." We understand that a wet room with the floor drain essentially restricts cases that can be done in that room, which is a real issue for us. What have you found around the country when it comes to urology cases?
Answer: Actually, you are missing the boat by not looking at urological procedures, of which there are many! The issue of the "wet room" is solved a couple of different ways that eliminates the need for that floor drain, thus eliminating the restriction for other cases. One method is a collection method that turns the fluid into a jell-like substance that is tossed at the end of the case. The other method is using a self-contained drainage table.
Many of the urology cases are quite lucrative in reimbursement. Ask the urologist for the CPT or ICD-9 codes, and look up the reimbursement. I think you will be pleasantly surprised.
Question: Is lap band still a viable surgical procedure for the OR? We have surgeons asking for equipment, but we don't want to get sucked into buying more equipment and no one using it.
Answer: Welllllllllll ... look up the gastric sleeve procedure. It is rapidly gaining in popularly. Unlike the reversible gastric bypass or the lap band with which you lose weight rapidly but can cheat, the gastric sleeve (vertical sleeve gastrectomy or VSG) results in removal of two-thirds of your stomach. The result is that your stomach cannot stretch anymore, and you don't overeat. The weight gain is slower than with the other two methods, and a plus from that slow weight loss is the avoidance of saggy skin. So before you invest, ask them about this procedure.
While this might not increase your overall surgery from last year, any time you have the chance to look at a new procedure, you increase your opportunity to perform more cases. [Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Contact Earnhart at 13492 Research Blvd., Suite 120-258, Austin, TX 78750-2254. E-mail: firstname.lastname@example.org. Web: www.earnhart.com. Tweet address: Earnhart_EAI.]