ogy and equipment, and that becomes a cost-benefit analysis. Our top priority is always patient safety and the high- est quality of care. If a question arises about medical/anesthesia suitability for performance of a procedure in a freestanding ASC, the anesthesia med- ical director is consulted to review the patient’s chart accordingly.”

The numbers are not that high,

however, in other eligible and non- eligible cases done in the ASC setting. ASCA is working with the Centers for Medicare & Medicaid Services (CMS) on moving eligible procedures to the ASC setting.

Prepping Patients Urology

Easing the Transition

Advice for moving patients and procedures from HOPDs into ASCs BY SAHELY MUKERJI


natural byproduct of innovations in surgical care, ASCs offer the same procedures that used to require lengthier and more expensive inpatient care in less time and at less cost. Currently, Medicare reimburses ASCs for approximately 3,500 codes, not including ancillary codes, and ASCs save the Medicare system $2.6 billion a year. If just half of the procedures now being performed in hospital outpatient departments (HOPD) that are eligible to move into ASCs were actually moved, it would save the system another $2.5 billion. The savings would be even more substantial if Medicare reimbursed ASCs for providing all of the procedures that are now payable in the HOPD setting. The number of procedures moving to the ASC setting that have histori-


cally been performed only in the inpa- tient or HOPD setting is rising rapidly, says Brad Lerner, MD, CASC, part- ner at Chesapeake Urology Associates (CUA) in Baltimore, Maryland, and medical director of Summit Ambula- tory Surgical Center in Owings Mills, Maryland. CUA’s 15 centers are located in eight counties and Baltimore City and performed approximately 24,000 procedures last year, including prostate laser

treatment, cryotherapy, micro-

surgery including vasectomy reversal, penile implants and ureteroscopy. “Our ASCs are probably captur- ing about 80 to 90 percent of eligible urologic outpatient cases in the areas we serve,” he says. “If you can safely perform a procedure on an outpatient basis at a hospital, it can be done at an ASC. You do need the right technol-

Educating a patient who is prepar- ing to have a procedure performed in the ASC setting when that pro- cedure is typically done only in an HOPD setting calls for thoroughness and patience, Lerner says. “When we evaluate a patient for their candidacy for surgery, we discuss treatment options, benefits and alternatives,” he explains. “We stress that they will receive the highest quality of care in a safe environment. We give them a booklet on rights and responsibili- ties that describes our ASC, its staff, accreditations, how to file griev- ances/complaints, the center’s mis- sion, etc., so they see it up front and understand the process better.” Some patients choose hospitals over ASCs because of location, comfort level, concern over a health issue, trans- portation issues, patient preference and/ or insurance plans. “Lower deductible at a hospital may work out as a finan- cial reason for certain patients, such as those employed and insured through hospital systems,” Lerner says. Others might decline an ASC from a technol- ogy standpoint. “An ASC might not have a certain technology, such as the ability to do microsurgery even though it is an outpatient procedure,” he says.

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