FEATURE Options for Post-Acute Services
Convalescent centers, skilled nursing facilities or home care? BY SAHELY MUKERJI
A
s more complex procedures move to the outpatient setting, ASCs
should be looking at where patients can receive the best post-acute recov- ery care, recommends Rebecca Craig, RN, CASC, ASCA Board president and chief executive officer of Har- mony Surgery Center and Peak Sur- gical Management in Fort Collins, Colorado. Whether an ASC offers overnight care, uses extended recovery care, relies on home health services or discharges patients with friends and family, ensuring the most appropriate option to help patients return to health should be the top priority when select- ing the appropriate provider and site of service for this care, she says.
Convalescent Centers State laws vary when it comes to extended recovery care in an ASC and a surgery center should always check
its state and federal laws for guidance, Craig says. Colorado allows for a separately licensed convalescent center (CC), with the same ownership group and administrative staff, located in the same building but separated by a firewall, she says. “Colorado ASCs that also hold a separate CC license are ahead of the value equation,” she says. “They are not only able to provide high-qual- ity, low-cost surgery but also have the capability to ensure their patients can recover comfortably and affordably in a safe, private setting for one or mul- tiple nights, if needed, in their CCs. “With superior nurse-to-patient ratios, CCs are quiet, high-quality and approximately 1/3 of the cost of an overnight stay in a hospital,” Craig says. “So, just like the ASC, patients and payers can save a tremendous amount of money using this model.
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Medicare could also save a tremen- dous amount if it recognized this site of service for beneficiaries.” Thanks to advances in technology and anesthesia, Craig says, most ASC patients are discharged the same day whether they had a total knee replace- ment or a mastectomy with reconstruc- tion. Recovering in the comfort of their own home with loved ones is still the recovery location of choice. “However, if extended recovery is needed for pain and/or nausea control or observation, the CC model allows the patient to stay close to the ASC and avoid transfer expense and inconvenience,” she adds. Audubon Surgery Center in Col- orado Springs, Colorado, recently opened a CC on a different floor of the same building where the ASC is housed, says Brent Ashby, administra- tor of the ASC. “At the present time, the vast major-
ity of ASCs are doing procedures that do not need overnight or extended care because Medicare does not accept more complex procedures done in an ASC,” he says. “As a result, less than 10 percent of ASCs in Colorado have a CC license.”
CCs are licensed separately, Ashby
adds, but are billed as part of their ASC facility fees. “Most of our ASC con- tracts have a provision for additional payment for overnight care provided in the CC,” he says. “This does not have anything to do with rules or regu- lations but is simply a contract matter with the commercial payers.” In 2014, the Colorado Department of Public Health and Environment (CDPHE) worked with the Colorado Ambulatory Surgery Center Asso- ciation (CASCA) to combine the CC licensure with the ASC licensure, Craig says. Since the 1990s, insurance carri- ers have been very responsive because they see the financial savings coupled with the high quality outcomes—“it’s a win-win,” she says. “Carriers under- stand that patients are shopping around looking for high-quality, cost-effective
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