Archive March 2004 V, No. 3

My Turn

Why I'm Glad I Chose Office-Based Surgery

John O'Brien, Jr., MD


A wise man once said that the simplest choice is preferred when all else is equal. I thought about this principle of economy when I was faced with the choice of constructing a new ASC or an office-based surgical practice. Ultimately, I chose the latter because the office setting let me do just what I wanted to do - no more, no less. Despite the recent furor over office surgery safety, I stand by my decision.

Who needs an ASC?
Foremost, I wanted a single-specialty practice. Although I considered building a multi-specialty ASC, I felt this would dilute my focus. I wanted every nurse and every staff member to have expertise in plastic surgery and to understand my personal philosophy of practice. I didn't want nurses working for me doing plastic procedures one day and working for another surgeon doing cholecystectomies the next. In addition, cosmetic surgery patients want privacy and they're willing to pay for it.

Second, although I could have built a single-specialty ASC, my research showed that there was no need to go this extra step. Sure, I would have liked to do a mix of reconstructive and cosmetic procedures that a Medicare-certified, state-licensed ASC would have enabled. But the Medicare and private insurers' reimbursements for reconstructive procedures in my region are low, especially relative to cosmetic surgeries like $5,000 to $6,000 breast augmentations. I would have had to handle a very large volume of cases to make this case mix financially feasible and, frankly, I felt this would compromise patient care.

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