An ASC With 72-Hour Post-op Stays?

Surgery center developers and hospital advocates in the St. Louis suburbs are sparring over the legality of patients recovering in ASCs beyond 24 hours.

Orthopod George Paletta, MD, wants to build an orthopedic surgery center in Chesterfield, Mo., where 6 or 7 patients would be able to recover for up to 72 hours following surgery. Extended patient stays create the possibility of the surgery center competing for more complex and high-paying orthopedic cases from local hospitals.

But a few miles down the road in Creve Coeur, a similar project was squelched by local officials after area hospital groups voiced their objections.

In both cases, town committees ruled strictly from land-use perspectives. "We reviewed Dr. Paletta's request against the city's zoning ordinance and determined that the it is most appropriately categorized as a medical office with a 72-hour stay, and not as a hospital," says Aimee Nassif, Chesterfield's planning and development services director.

Not surprisingly, the Missouri Hospital Association disagrees. "Their discussions didn't address the actual difference between a hospital and an ambulatory surgery center as defined by Missouri law, " says MHA spokesman Dave Dillon. Local law defines a hospital as a place devoted primarily to care for not less than 24 consecutive hours in any week of 3 or more nonrelated individuals.

"A plain reading of this state law indicates that the proposed Chesterfield facility will need to be licensed as a hospital," says Daniel Landon, the MHA's senior vice president of governmental relations, in a letter to the city council.

Jonathan Beal, JD, healthcare consultant to the ASC Association, isn't sure how 72-hour stays would fly in Medicare-certified facilities, unless the recovery areas were technically in a separate portion of the building.

Medicare does not prevent ASCs from keeping patients overnight. Mr. Beal says CMS proposed that patients couldn't stay in surgery centers past midnight on the day of surgery when conditions for coverage were expanded in 2009, but pushback from the industry got that changed before the rule was finalized. Patients can now be discharged within 23 hours of their procedures, regardless of whether that time limit extends past midnight.

But, points out Mr. Beal, each state has their own patient-stay requirements. While some local laws parrot Medicare, others, such as Colorado and New Hampshire, have robust allowances that let ASCs discharge patients to separate recovery centers for extended post-op stays.

"It's not yet a prevalent practice nationwide, but it could become a developing trend as more complicated cases migrate to the outpatient arena thanks to developing technologies," says Mr. Beal. "States will be looking for more cost-savings options."

Dr. Paletta is a partner in Regeneration Orthopedics and team doctor of major league baseball's St. Louis Cardinals. He did not return phone calls seeking comment.

Daniel Cook