Patient advocate: What to ask when considering outpatient surgery
Having cataract surgery? Chances are it will be at a stand-alone ambulatory surgery center (ASC). Ditto for joint replacements, tonsillectomies, endoscopies, colonoscopies, some spine surgeries and a number of other procedures.
In fact, more than 23 million surgical procedures are performed annually at the nation’s 6,300 Medicare-certified ASCs. (I account for three of those: two knee replacements and one hip replacement.)
By and large, the safety records of ASCs and hospitals are comparable, but outpatient surgery is not suitable for everyone.
Why an ASC?
The ambulatory surgery market is expected to grow exponentially in the next decade because of a variety of factors. Our aging population means that more people require joint replacements and cataract surgery, and ASCs are helping to meet the demand.
The Centers for Disease Control and Prevention (CDC) estimates the surgical-site infection rate at ambulatory centers to be around. 1%, compared with about 1.0% for hospitals. In addition, more patients today prefer treatments that don’t require an overnight stay in the hospital, which can expose them to various pathogens and sicker patients.
The cost of ASC procedures tends to be lower than if they’re performed in a hospital. One study found that outpatient joint replacements at an ASC cost 40% less than those performed in a hospital.
Insurers certainly like that. So do patients, who experience lower co-pays and co-insurance — a win-win for health care costs. Meanwhile, technological advancements (lasers, robotics) are making surgeries safer, and ASCs (65% of which are owned by physicians) often have the latest and greatest equipment.
ASCs live and die by favorable patient reviews, so they tend to place greater emphasis on providing a patient-centered experience. Cost, convenience, customer service and positive experiences are all reasons why ASCs are growing in popularity.
Low risk, but not risk-free
Any medical procedure, especially if it involves sedation or anesthesia, has the potential for harm. Joan Rivers is the poster child for what can go wrong.
In 2014, while undergoing an endoscopy at a Manhattan surgery center, her oxygen saturation dropped to a dangerous level when her airway became compromised. She later died from brain damage caused by lack of oxygen. Her family sued and received a “substantial” settlement. Her treatment was described as “a perfect storm” of errors, leading to her death.
Think very carefully about whether to choose outpatient surgery if you:
- Are 80 or older
- Have cardiovascular disease, COPD or obstructive sleep apnea
- Have a history of complications, especially from anesthesia
- Have anxiety, depression or another mental health disorder
- Have poorly controlled diabetes
- Take pain medications, especially opioids
Questions to ask
If an outpatient procedure is in your future, you can give yourself peace of mind by asking a few questions — something a private patient advocate could certainly help you with.
Here are some examples:
- Accreditation: Is your facility accredited by the Joint Commission on Health Care or the Accreditation Association for Ambulatory Health Care (AAAHC.org)? You can also search for AAAHC-accredited organizations on the website.
- Ownership: Is this center physician-owned, or is it owned by a hospital or a corporation?
- Customer satisfaction: What is your patient satisfaction rating?
- Staff: Who will be performing my procedure?
- Track record: How many of these procedures have been performed here, and what is the complication rate?
- Just in case: What are your emergency procedures? If there’s an emergency, where would I be transported?
- Sedation: What kind of sedation will be used, and who is the anesthesiologist?
- Recovery and complications: What is my expected recovery time, and what are the most common complications?
- Financial: What is the estimate of my costs? If insurance isn’t available, do you have payment plans or other financial arrangements?
- Scheduling: What are your policies regarding cancellation and rescheduling?
Since the first ambulatory surgery center opened in Phoenix in 1970, ASCs have made surgical procedures more available and convenient in most regions of the country. Because of lower costs, they’ve allowed patients to access care who might not otherwise be able to afford a hospital stay. They are continually evolving, adding more procedures.
So, when deciding where to have a procedure, ASCs deserve your consideration because of cost, convenience and comparable outcomes. But do your homework and then choose the place that seems right for you: the hospital operating room or the ambulatory surgery center.
• Teri (Dreher) Frykenberg, a registered nurse, board-certified patient advocate and author, is the founder of Nurse Advocate Entrepreneur, which prepares medical professionals to become private patient advocates. Reach her at Teri@NurseAdvocateEntrepreneur.com. Readers with questions about patient advocacy may contact Margo Marasa, owner of Allegiance Patient Advocacy, for a free consultation. Contact her at margo@allegiancepa.org or (773) 732-0762.