Rosenfield mentions the need to be clear about plans in the event of a complication. “Many of our patients are savvy and well-educated and want to be well-informed before they go in for the surgery,” he says. “We are very clear about our relationships with local hospitals in the event of a surgical complication. While we perform better in the ASC environment, there is a great deal at stake with abdomino-pelvic laparoscopy, and the surgeons and the staff need to have disaster plans in place in the event of a major complication.” The center also informs its patients

Performing hysterectomy in the ASC setting is in the best interest of the patient and our health care system.”

—Richard Rosenfield, MD, Pearl SurgiCenter

tive medical director and director of gynecology at the center.

“Our complication rates dropped dramatically when we moved to an ASC setting,” he says. “In an ASC, as a surgeon, I am able to control most variables, leaving very little to chance, resulting in a successful program. Unlike the hospital where I am often placed in an unfamiliar room with new staff or with equipment I have not selected, the ASC allows me to hand pick everything from the instruments to the nursing staff. An auto mechanic performs better in his own garage with tools for his particular trade. The same holds true for surgeons.”


From the patient perspective, sur- geons need to make certain that they talk about expectations with their patients.

“It starts with the initial

patient consult,” Rosenfield says. “The patients need to know what they will go through before, during and after surgery, and this needs to be empha- sized a few times. The discharge and postoperative instructions must be reviewed more than once. We try to prepare patients for what to expect pre- and post-surgery, reducing anxiety for the patient and the family. The surgeon also needs to be available for postop- erative questions or concerns.”

that there is less chance of infection, less stress and shorter recovery periods with the minimally invasive approach to hysterectomy, compared to the tra- ditional approaches of surgery per- formed in the hospital setting. “We have created a spa-like environment at our Women’s Center,” Rosenfield says. “From our smiling front office person who immediately engages with the patients and family members, to our efforts of keeping patients comfortable in temperature-controlled gowns, to our low ambient lighting and pleasant music in the operating room (OR), we try to keep patients calm and comfort- able. And the overall cost to the patient is typically much less in the ASC as compared to the hospital or HOPD.” The patients are usually absolutely stunned at how good they feel after surgery, he says. “They are in and out in less than four hours. In the first 850 cases in the ASC, the average surgical time was 60–120 minutes with 60–90 minutes of after care, followed by dis- charge home.”

Insurance For certain procedures that were pre- viously performed only in hospitals, some insurance providers have not structured a facility fee for the ASC setting or have set their reimburse- ments for those procedures in the ASC setting very low, Lerner says. “As we

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