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Same-Day Surgery's Overnight Expansion

A Maryland ASC sees advantages in extended recoveries for ambulatory patients.

Published: June 26, 2014

A Bethesda, Md., surgery center is one step away from a bold expansion for ambulatory surgery. As soon as it receives the state's final approval — and it's anticipating the memo any time now — it's ready to host same-day surgery patients overnight.

Overnight stays for outpatient joint replacement, spine surgery, hysterectomy and radical prostatectomy patients represent a sea change for patient care as well as for the procedures that ASCs can undertake. "I think it's the next trend, and a huge change for us, as more and more cases move outpatient," says Randall Gross, executive director of the Massachusetts Avenue Surgery Center. "I'm betting on it."

Mr. Gross and the center announced plans in January to extend patient recovery periods in order to host cases whose post-surgical follow-up could not be completed in the short span of the ambulatory day.

They'd received clarification from state and federal healthcare authorities that overnight recoveries for outpatients were within their regulations. According to CMS guidelines, ambulatory surgery patients must be discharged in under 24 hours, but the guidelines don't specify that they must be discharged on the same calendar day.

A major renovation had doubled the size of the facility to accommodate the overnight guests, and staffing, linen service, catering and other necessities for the extended stays were easily arranged, says Mr. Gross. The only challenge, he says, has been negotiating with and convincing insurers that the center can do the joint replacements and other overnight-recovery cases — which aren't on Medicare's ASC list — as safely and more cost-effectively than acute care hospitals.

While the center had originally intended to begin the service in March, they haven't yet received the final approval of Maryland's Office of Healthcare Quality, which has been considering their plans.

Critics have questioned whether an ASC is the ideal setting for surgeries that require beyond-the-routine recoveries, but Mr. Gross points out that careful patient selection will ensure safety.

"Everyone is going to win here," he said in a published report. "Patients are going to win because they don't have to go to the hospital and be subjected to that environment. And the extra rates that they are paying, their coinsurance and deductibles, are much higher in the hospital. Payers win because they pay us a lot less money. And we win because we get the ongoing business."

David Bernard

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