in the morning before the 23-hour rule would be an issue,” he says. “We often find that patients are ready to go as early as 7:00 am or 8:00 am, but family some- times struggles to get here at that time. We want to be sure our patients are not rushed and that we are following the CMS rules regarding overnight stays.” When considering overnight stays,


ask yourself several questions, Patter- son says: “Where will the patients stay? What about security for the patients and staff? What about food? What would you do in an emergency? Are all of your staff advanced


cardiovascular life


sup port


(ACLS) certified? Do you have a trans- fer agreement with your local hospital?” Patterson’s ASC has six rooms that are used for overnight care. “We allow one visitor to spend the night with the patient in their room,” he says. “We have relationships with local restaurants, and the patients can order off the menu. We have all the CMS required equipment, and the provider who operated on the patient, anesthesia and the medical director are on call.” The ASC bills for the overnight


stay. “Revenue depends on whether the payment is part of a bundle or stands alone,” he says. “If you are considering overnight


stays at your ASC, work with your state ASC association because they are very impactful from a legislative per- spective and they can help to identify opportunities for change if needed,” Patterson suggests. “The landscape is changing around models of care, and I believe we are going to continue to see more acute cases transition into the ASC space. Appropriate patient selec- tion will be a key component of these transitional models of care. If you are doing total joint, spine, bariatrics, etc., you will probably want the ability to provide overnight stays in your ASC. Our ENT and plastic surgery patients also sometimes stay overnight.” The ASC has seven ORs, performs more than 9,000 surgeries annually,


Maryland Governor Larry Hogan signed HB 327 on May 12, 2015, in Annapolis, Maryland. Following the Centers for Medicare & Medicaid Services' guidelines, ASCs in Maryland will now be able to keep patients for up to 23 hours and 59 minutes.


If you can convince your payers to reimburse for overnight stays, you can also offer the extended care option to some less healthy patients who would typically go to the hospital to get the shoulder or knee surgery that they need.”


—Randall Gross, Massachusetts Avenue Surgery Center


employs approximately 100 people, and has 30–40 providers on staff that routinely use the facility. It has two separate facilities: a multi-specialty center and a GI center.


Maryland Randall Gross, executive director of the Massachusetts Avenue Surgery Center in Bethesda, Maryland, says that the law regarding hours of stay in his state will change in October. “Right now, we cannot keep patients after mid- night,” he says. “We have been lobby- ing for this change and, as of October 1, we will be able to keep our patients for 23 hours and 59 minutes. The game has changed for us as we will be able to expand our patient base and operate on patients who may need to stay over- night for extended care.” There are some nurses who prefer


to work overnight with a lower ratio of patients, he says. “They clearly like the concept of a night schedule. As long as we have an acceptable ratio of patients to nurses, we are good. We will probably


have three to four postoperative patients with two nurses and one medical assis- tant. We will need an on-call physi- cian and an on-call anesthesiologist for potential problems, but our patients will be stable already, and we will be keep- ing them for pain control, not for other complications.” He expects


patients


who have undergone TJAs, certain urol- ogy procedures, hysterectomies and a few other procedures to stay overnight. “If you can convince your payers to


reimburse for overnight stays, you can also offer the extended care option to some less healthy patients who would typically go to the hospital to get the shoulder or knee surgery that they need,” Gross says. “It depends on the payers. Some will negotiate an addi- tional overnight rate and some will pay only a case rate. When they do, you have to make sure that the fee they pay for the procedure includes the cost of providing overnight care. An ASC should be able to charge a fraction of what a hospital would charge to pro- vide that care.”


ASC FOCUS SEPTEMBER 2015 11


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