Archive May 2018 XIX, No. 5

Editor's Page

Are ASC Sleepovers a Good Idea?

Dan O

Dan O'Connor, Editor-in-Chief

BIO

Sleepover

The only thing preventing some ambulatory surgery centers from hosting more complex cases that require an overnight stay is not having a place for patients to rest their heads and recover for a night or 2 after, say, joint replacement or spine surgery.

Not long ago, pain control was the hard limit on what patients can migrate from hospitals to ASCs. Regional blocks, take-home pain pumps and other pain management techniques broke that barrier.

Now, it's housing. As usual, surgery centers have bobbed and weaved their way to a fix. Yes, what's stopping us, they said, from attaching a "recovery" or "convalescent" center to our facilities where patients can sleep over? ASC B&Bs!

As you'll see in "Overnight Stays for ASCs" on page 54, growing numbers of patients are showing up for surgery with their tooth brushes and a change of clothes. A handful of states have passed laws that let patients recover in ASCs for 1, 2 or 3 overnights. Last year, more than 400 patients stayed in the overnight recovery center at an ortho and spine ASC in Pueblo, Colo.

The center was rarely reimbursed for the overnight care — and when it was, it was at the Econo Lodge nightly rate. But that's not the prize, not even close. It's the amazing boost in surgical volume that overnight care can give to ASCs.

"If reimbursement for the procedure itself covers the ASC's expenses and those associated with the recovery center as well as a reasonable profit margin, we'll still take the case," says Jennifer Arellano, CASC, the director of operations at Pinnacle 3, which manages the Orthopedic & Spine Center of Southern Colorado. "Without the ASC convalescence center, our surgeons would have to perform these procedures in a hospital."

Speaking of hospitals, they should be concerned about surgery center sleepovers. If the recovery center model catches on, it could only lead to more high-acuity winding up in ASCs.

"The real value in a convalescence center is not insurance reimbursement," says Ms. Arellano. "It lets us see those types of patients that would typically be seen in a hospital setting. "

Medicare limits ASCs to patients whose "expected duration of services would not exceed 24 hours following an admission," (Note: the guidelines don't specify that they must be discharged on the same calendar day). Medicare also prohibits planned overnight stays in an ASC for Medicare patients.

Even without a change in law, ASCs across the country have developed increasingly elaborate workarounds for patients who need an extended stay to recover. An orthopedic center near Buffalo, N.Y., considers the 2-bedroom condominium it owns in the building across the street to be its "recovery suite." And an ASC in Bloomington, Minn., runs a hotel recovery program for total joint patients: 1 night for total hips, 2 nights for total knees.

Not everyone's in favor of ASCs trying to broaden their turf. More than half of the nearly 500 hospital and ASC leaders we surveyed recently don't think ASCs should be able to keep their patients overnight. But where there' a will, there's a way. OSM

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