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November 18, 2010

Ambulatory surgery centers offer another option

by admin

by Erin Snelgrove
Yakima Herald-Republic

ANDY SAWYER/Yakima Herald-Republic
Orthopedic hand surgeon John Adkison, left, marks Patricia McGinty’s arm where he will perform surgery for carpal tunnel syndrome while LPN Joye Dunn prepares McGinty for the procedure at Yakima Ambulatory Surgical Center in Yakima, Wash. Friday, Sept. 17, 2010.

YAKIMA, Wash. — In the past three years, Patricia McGinty of Yakima has had surgeries on her neck, back, shoulders and wrists. For the big stuff, she goes to hospitals. But for minor surgeries — like fixing the numbness in her hands caused by carpal tunnel syndrome — she heads to Yakima Ambulatory Surgical Center. Not only is the staff qualified, she says, but she appreciates the added convenience the center provides.

“You’re just in and out,” the 67-year-old retired nurse said. “There are less people, less confusion, less everything. … They are safe. They have very high standards.”

McGinty is a part of a growing number of people who frequent ambulatory surgical centers for everything from colonoscopies and breast augmentations to cataract and knee surgeries — which, depending on the procedure, can save them money. With less administrative overhead and contracts that often mandate cheaper rates, advocates say the centers perform the same procedures for far less than federally subsidized hospitals. The facilities also boast a small rate of infections, a nurse-to-patient ratio of at least 1-to-1 and outcomes as good or better than hospitals.

“The beauty of this model is it’s small, it’s nimble and it’s efficient,” said Rob Schwartz, executive director of the Washington Ambulatory Surgery Center Association. “If you do something enough times, you should get good at it. And you do.”

But some hospital officials question the safety of such centers and argue that additional oversight is needed. Cindi Butcher, chief operating officer for Yakima Regional Cardiac and Care Center, said in an e-mail that ambulatory surgical centers are a good option for some patients, but those with underlying health conditions may experience a better outcome in a hospital environment. Tammy Smeback, director of surgery for Yakima Valley Memorial Hospital, agrees, adding that patients need to take many factors into account before deciding where to seek treatment.

“There is truly a place for both,” she said. “If it’s something where you’re planning to go home, (ambulatory surgical centers) are the place to go if you can. If you need to stay (to recuperate), the hospital is probably a better option for you.”

Ambulatory surgical centers are medical facilities that specialize in elective, same-day or outpatient procedures. They do not offer emergency care, and patients are not admitted because they are well enough to go home after the procedures. The facilities are different from urgent care and community health centers in that patients are referred there or they are operated on by a specialist who has privileges there. These centers also maintain dedicated operating rooms. They are typically owned by hospitals, physicians or hospitals and doctors. Since the 1970s, more than 5,000 surgery centers have opened across the nation, about 300 of which are in Washington.

In Yakima County, there’s an ambulatory surgical center at Memorial and there are several others owned by physicians who specialize in fields such as urology and ophthalmology. Yakima Ambulatory Surgical Center is the only physician-owned, multispecialty care center. It opened in 1998 and averages 3,500 surgeries a year. It has 30 full-time staff members and several part-time workers. All the doctors have privileges at either one or both Yakima hospitals.

“There is certainly room for all of us to take care of patients,” administrator Kimberly Tude Thuot said.

According to the U.S. Department of Health and Human Services, health insurance premiums have nearly doubled since 2000 — a rate three times faster than wages. In addition, an estimated 72 million, or 41 percent, of nonelderly adults have accumulated medical debt or had difficulty paying medical bills in the past year. Sixty-one percent of those experiencing financial hardship had insurance.

The Obama administration has begun implementing controversial, and costly, initiatives to reform America’s health-care system — such as by making insurance available to people with pre-existing conditions and by providing tax credits to help defray health insurance costs.

Another way to save money for both the government and consumers is to increase usage and accessibility of ambulatory surgical centers, Schwartz said. Studies from around the country have confirmed the average cost of a procedure — such as a colonoscopy — is less expensive when performed at an ambulatory surgical center. This often means patients pay less in out-of-pocket costs.

However, Schwartz believes hospitals have an unfair, competitive edge. First, surgical centers are limited in what types of procedures they can provide, and he’d like the options to expand. Second, he said some insurance carriers — not wanting to jeopardize their relationships with hospitals — won’t contract with surgical centers. And many insurance providers reimburse surgical centers at hospitals at varying rates for similar procedures. For example, Medicare reimbursed surgical centers an average of $398.95 in 2009 for a diagnostic colonoscopy, while they paid hospitals $593.76 for the same procedure. This year, those rates are expected to decrease to $376.55 for surgical centers and increase to $614.11 for hospitals, according to the WASC. The reimbursement rates are decided at the federal level. According to a statewide study commissioned by his organization last year, one in five facilities reported this problem.

“The incentive for all of us should be the public interest,” he said, adding that patients have the right to shop for the best prices. “We have a proven track record and our research shows it.”

Smeback said these centers do offer cheaper procedures, but not always. Depending on the type of surgery and the patients’ health insurance carrier, sometimes hospitals are the more affordable route.

Schwartz is familiar with the arguments against surgical centers. Opponents say the centers “cherry pick” the best patients and leave the worst for hospitals. They highlight cases where providers were found reusing needles or engaging in other, dangerous practices. They also allege doctors line their own pockets by referring patients to their own surgical centers.

Schwartz admits rare safety problems have surfaced across the country due to staffing shortages, but those issues have been addressed. He believes there’s no shortage of patients who need care from both hospitals and surgical centers, and he said doctors wouldn’t risk their careers by doing self referrals. Besides, patients must first qualify for the procedures from their insurance carriers, which then decide if the operations are necessary, he said.

“We don’t want to throw bricks at hospitals,” he said. “We’re saying, let us compete.”

* Erin Snelgrove can be reached at 509-577-7684 or

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