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FEATURE “They should be able to explain that

clearly and succinctly, and then show the physicians how much money they can make,” Mowles says. “Now that you’ve taught them this, it’s time to teach them what they will need to do to actually earn this money.” “You might want to start by remind-

How to Keep Pain Management Cases in Your ASC

ASCs offer important advantages to pain management physicians and their patients. BY ROB KURTZ

“When we look at it, we believe that if there were three possible places you could do a procedure—a clinic, an ASC or

a hospital outpatient department

(HOPD)/hospital operating room—the ASC is the best value for the patient and the payer,” says Marsha Thiel, chief executive officer of Medical Advanced Pain Specialists in Minneapolis, Min- nesota. “It is typically more convenient, it offers the same safety measures as an HOPD or the inpatient operating room (OR), and the clinic is more likely to be unregulated. When you look at it from the owners’ position, ASCs are deliver- ing a very high quality of care for the patient that’s convenient and oftentimes seamless.” Yet surgery centers sometimes face the prospect of losing these cases to oth- er settings.

The Office Setting: A Challenging Option If a surgery center knows that one of its physicians is considering moving pain


procedures from the ASC into his or her office, the ASC leadership should take it upon itself to educate the pain physi- cian on what this change would actually entail, says Amy Mowles, president and chief executive officer of Edgewater, Maryland-based Mowles Medical Prac- tice Management, an ASC regulatory development company. “The last thing you want to have to

say is, ‘We lost our pain because the phy- sician thought he or she could do it on its own,’” she says. “It’s your job to teach the physician how difficult it will be.” The most common reason pain phy- sicians consider moving their cases to their office is because they believe that they can earn more money from the site- of-service payment differential, Mowles says. “I think it is extremely important that ASC administrators be very well- versed on understanding the sight-of- service differential as it applies to Medi- care, commercial payers and workers’ compensation,” which, outside of Medi- care, will vary by payer and state.

ing the physician that their training origi- nated in a higher acuity environment like an ASC, which was designed to provide the safest, highest quality care to its pa- tients,” says Lori Ramirez, president and chief executive officer of Elite Surgical Affiliates, a Houston, Texas-based ASC management and development company that focuses on pain management, ortho- pedics and spine. “The benefit of doing these procedures in ASCs, from a qual- ity perspective, really boils down to two reasons. In an ASC, we can give them a higher level of anesthesia to keep the patients more comfortable. What you’re going to find is that these patients who are coming for pain management pro- cedures are obviously already in pain. Being in an ASC allows us to make the patient more comfortable if the patient needs additional anesthesia. Physicians can’t do this in their office because, at a certain level, they have to have an an- esthesiologist or a certified registered nurse anesthetist on site in order to give a higher level of sedation. “Second, we have a higher level of backup care should there be an emer- gency,” she continues. “You’re getting very close to the spine when you do a pain management procedure. While the chances of something happen- ing are slim, if something does, these patients are in a surgery center where there is an anesthesiologist and emer- gency equipment is plentiful. The fa- cility is better equipped from an emer- gency preparedness perspective than an office would be.”

Then there is the issue of what the

physician will need to spend to equip the office to perform the procedures. “C-arms are about $150,000 alone,

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