Pain management ASC aids convenience, income

State, Medicare regulations require extra attention

Setting up an ambulatory surgery center is a complicated process in the best of circumstances, but when your same-day surgery center is a single-specialty center that handles pain management procedures, there are challenges not faced by other same-day surgery managers, says experts interviewed by Same-Day Surgery.

"You start with kid gloves because many of the health department or licensure department staff members don’t understand pain management," says Amy Mowles, president and chief executive officer of Mowles Medical Practice Management, an Edgewater, MD-based consulting firm that specializes in setting up and managing ambulatory surgery centers.

While many pain management procedures can be and are performed safely in a physician’s office, a same-day surgery center enables the anesthesiologist to expand the practice to include more invasive methods of pain control such as nerve blocks, epidurals, and radio-frequency procedures, notes Mowles. "If the anesthesiologist owns the center, not only is he or she collecting a physician fee, but the facility fee also will add to his or her income," she says.

Of course, the financial success of the center depends upon how well you plan, Mowles adds. "Be sure you understand at what point you will begin to show a profit," she says.

Don’t look only at numbers of procedures, Mowles suggests. "Look at staffing costs and be sure you research how payers will reimburse you," she says. One of her clients did not realize that some large payers in his community would reimburse invasive procedures only if they were performed in a hospital setting. This physician was $78,000 in the hole in his first year because he couldn’t perform procedures that generated the highest reimbursement in his own facility, Mowles points out.

An advantage of a same-day surgery pain management center is the convenience to patients who can be scheduled more easily for procedures because there are fewer physicians jockeying for operating room time, she adds.

"We have actually seen our business grow some because patients don’t have to wait so long to see the physician," says Christine Yoder, RN, director of nursing for Wyomissing (PA) Surgical Services, a pain management same-day surgery center. "Prior to opening our own same-day surgery center, a patient would have to wait two months to see the doctor. Now the physician can evaluate the patient within two weeks and schedule treatment with no delay," she says.

"We don’t have a certificate of need process in our state, so the regulatory process was simpler for us than for facilities in states with certificate of need requirements," says Yoder.

An advantage to opening a pain management center rather than a multispecialty center that includes pain management is an easier approval process in states that have do have a certificate of need process, Mowles notes. "You are less likely to have the local hospital or local same-day surgery centers oppose your request because you are offering a specialized service that doesn’t directly compete with their business," she adds.

Regulations do differ from state to state, Mowles points out. "There are 43 states that require state licensure for ambulatory surgery centers and specify criteria that must be met," she says.

About 85% of all ASCs are also Medicare-approved, which means there are additional conditions of participation that must be met by the facility, Mowles says. "There are some states, however, that do exempt single-specialty or physician-owned surgery centers, so it is important to know your own state’s requirements," she explains.

If your state does have a certificate of need requirement, check to see if there are exemptions, Mowles suggests. For instance, Georgia exempts single-specialty centers, Maryland exempts surgery centers with only one operating room, and Massachusetts exempts physician-owned centers, she points out. Some states allow a petition for an exemption or base the need to undergo the entire process on a cost of project basis, she adds.

When planning your same-day surgery program, remember that it is a surgery center, says Mowles. "Even if most of your procedures are percutaneous and endoscopic in nature, from the regulatory bodies’ perspective, a surgery center is a surgery center and you must meet all requirements," she notes.

In most cases, the requirements include a variety of rooms and equipment that seem unrelated to pain management, Mowles explains. "Even if you are just starting out with relatively simple cases, you must have a mechanical ventilator in order to provide resuscitation," she says. "You also need an air filtration system that keeps the operating rooms sterile, and you must pipe in oxygen."

Physicians who want to economize and utilize common space for the office practice and the surgery center need to be careful, Mowles suggests.

"The ASC must be a separate entity that exists to provide surgical services," she says. The two spaces must be separated by at least a semipermanent wall and doors, according to Medicare regulations as well as many state regulations, she says.

The two entities can use the same space if it is used on alternate days and times of day, Mowles says. "You also cannot have an employee who is performing duties for both the surgery center and the physician office at the same time," she adds.

Patients like the move out of a hospital setting, says Yoder. The patient surveys show a high level of satisfaction, she says. "Our patients rate their satisfaction on a scale of 1 to 5 with 5 representing extremely satisfied," she says.

"We always have over 90% of our patients rating their satisfaction level as 5," which is the highest score, Yoder adds. "In fact, the only complaint we got when we first opened was a lack of parking," she says. "When we realized that employees were parking in the most convenient spaces, we rearranged employee parking and opened up spaces for patients."