Here’s why more patients turn to outpatient surgical clinics for complex procedures

Thanks to advances in medical technology, many surgery patients who would once have faced a few nights in a hospital are now getting complex procedures done at outpatient clinics that can get them in and out in less than a day.

The trend toward replacing lengthy hospital stays with an outpatient approach began in the 1970s, grew steadily and still appears to be gaining momentum. There is much more at stake than patient convenience: Outpatient surgery is far less costly to patients, insurers and the government programs that pay medical bills for millions of people.

That’s because hospitals must charge enough to cover their extensive overhead costs, which are far less in an outpatient clinic.

Pam Novotny, administrator at Bellingham Ambulatory Surgery Center at 2075 Barkley Boulevard, provided some examples:

▪ For cataract surgery, Medicare reimburses a hospital about $1,800. An ambulatory surgery center gets less about $1,100.

▪ For inguinal hernia repair, a hospital gets about $2,900, while a surgery center gets about $1,700.

▪ A breast lumpectomy costs Medicare about $2,500 in a hospital, compared to about $1,200 at a surgery center.

Gary Richberg is administrator at Pacific Rim Outpatient Surgery Center, 3009 Squalicum Parkway next to Peace Health St. Joseph Medical Center. Richberg said Pacific Rim is Bellingham’s largest surgery center, with about 5,000 surgeries performed there each year.

Richberg estimated that about 35 percent of procedures at Pacific Rim are knee and hip surgeries, including full joint replacements that once involved costly hospital stays of three to four days. Medical and professional journals report that an increasing number of such surgeries are being done at surgical centers instead of in hospitals, mostly because the cost is thousands of dollars less.

Shared savings

Patients with insurance policies that include high deductibles will share in the savings.

“Why would a patient want to pay more?” Richberg asked. “The patient really has to exercise their consumer rights.”

As Richberg sees it, Pacific Rim would be even busier if there was more emphasis on saving money wherever those savings don’t have a meaningful impact on the patient’s health.

“People have less health care because the cost of care is too much,” Richberg said. Pacific Rim and Bellingham Ambulatory clinics are the county’s only large, multi-purpose surgery centers equipped for a variety of procedures. Both those clinics were started by groups of local surgeons. Pacific Rim opened in 2003. Bellingham Ambulatory, which opened in 1986, is now affiliated with Surgery Partners of Nashville, Tenn. That firm partners with more than 100 surgery centers operating in 28 states.

Bellingham also has eight other state-licensed surgery centers that focus on one medical specialty, such as plastic surgeries or spinal procedures.

Richberg said Pacific Rim can keep a patient for up to 24 hours, meaning that some patients do spend the night at the center. Meals for patients can be provided from the hospital kitchen next door, or can be brought in by friends and family.

Novotny, the administrator at Bellingham Ambulatory, said new medical technologies have made many surgeries simpler, cheaper and less painful for patients. One example: gall bladder removal.

In the 1980s, Novotny said, gall bladder surgery involved a six-to-eight-inch incision. In the aftermath, a patient would feel sharp pain with each breath. Three to four days of hospitalization were routine.

Today, surgeons can remove a gall bladder in many cases via a laparoscopic procedure that involves a finger-sized hole. Patients have far less pain to contend with afterwards, and they are back home in three to four hours. That means that surgery centers can now handle these surgeries.

Careful screening

But isn’t it safer to have surgery done in a hospital, in case anything goes wrong?

Apparently not. Novotny said the key to a surgery center’s success is careful screening of each patient to make sure he or she is a good candidate for outpatient surgery, with negligible risk of complications.

The clinic also relies as much as possible on sedation and local anaesthetics to control pain during surgery, Novotny said. That eliminates the risk of complications from general anaesthetics. As a result, she said medical emergencies are rare.

“We get surprised two to three times a year,” Novotny said.

In the rare cases when a surgery center patient must be taken to the hospital, Novotny said the issue is typically nausea or pain control, rather than a life-threatening situation.

If something does go wrong, Novotny said her staff knows what to do. Novotny herself is an RN with ICU experience, and she said she seldom, if ever, hires a nurse who has no previous critical care experience. Surgical staffers also participate in regular drills to make sure they know what to do if a patient has an emergency.

Post-surgery infection rates tend to be lower at a surgery center, according to some studies.

Novotny said that’s because a hospital serves people with infectious diseases, while surgery centers restrict themselves mostly to otherwise-healthy people getting elective surgeries.

“Because we’re doing healthier patients, the risk to everybody who comes here is lower,” Novotny said.

Surgery centers also can provide both patients and surgeons with more reliable scheduling. At a hospital, a scheduled elective surgery might have to be postponed at the last minute if a hospital patient needs emergency surgery and there is no other operating room available. That doesn’t happen at a surgery center.

“I’m not going to get bumped for an emergency in a surgery center, because they (the centers) don’t do emergencies,” Novotny said. “There’s no cases here where somebody’s going to die if it doesn’t get done.”

Shift from hospitals

Both Richberg and Novotny believe the shift from hospitals to surgery centers will continue in the years ahead.

Richberg sees that move as inevitable as government, business owners, insurance companies and patients look for ways to bring down the cost of health care. Many procedures that could be done in surgery centers are still being done in costly hospital operating rooms, he said.

“We should be busier,” Richberg said. “It does make sense … I don’t see it being competition (with hospitals) at all. It’s a sign of the times. Health care is changing.”

Richberg said he typically goes to Washington, D.C., once a year to make the case for federal policies on health care reimbursements that would encourage the transition.

Novotny said advances in surgical technologies also are helping to shift more surgeries out of the hospital. As once-complex, invasive operations become simpler, more of those operations will qualify for the ambulatory surgery center’s lower-overhead approach.

Meanwhile, multi-purpose centers like Pacific Rim and Bellingham Ambulatory are scrambling to keep busy as more surgeons invest in their own specialty clinics.

“We’re constantly trying to recruit more physicians but the trend is for them to build their own centers,” Novotny said.

This story was originally published April 4, 2017 at 11:18 AM with the headline "Here’s why more patients turn to outpatient surgical clinics for complex procedures."