2. Operating on patients with MRSA. Patients with untreated or newly diagnosed MRSA or other drug-resistant infections could be a risk to other patients in the ASC, says Dawn Q. McLane, RN, MSA, CASC, CNOR, chief development officer at Nikitis Resource Group. An ASC should assess the risk and develop policies on how patients with drug resistant infections, including respiratory, contact- or wound-based infections, will be treated.
3. Procedures requiring an overnight stay. Many ASCs do not have overnight facilities for patients, often because their states won’t allow it. Ms. McLane says these facilities should avoid procedures that might require an overnight stay, such as some prostate cases, hysterectomies, some bariatric procedures and some scope cases where there is a high probability the surgeon might have to “open” the patient to complete the surgery.
4. Inserting a pacemaker. In contrast to specially designed cardiac centers, ASCs that deal mainly with orthopedic or ophthalmologic procedures should steer clear of pacemakers, says Sandy Berreth, administrator of Brainerd Lakes Surgery Center in Baxter, Minn. A facility needs to perform a high volume of pacemaker insertions to do them well, she says.
5. Procedures with a high level of pain. Operations linked with concerns about post-op pain might best be performed in a hospital, Ms. Berreth says. For example, a knee surgery with an autograft requires two incisions, producing unmanageable pain levels. An ASC may have aggressive pain management but if it lacks a 23-hour bed it would have to discharge these patients to their homes, where dealing with this amount of pain could be overwhelming, she says.
6. Procedures reimbursed in groupers. Payors who use a grouper methodology tend to group services that have very different costs into the same payment level, Ms. Berreth says. For example, payors might group all bills involving endoscopes and laparoscopes into the same payment rate, despite a wide range of cost. For example, an EGD that costs $300 might be grouped with a sinus scope that costs more than $2,000. Similarly, the payor may group all bills for arthroscopes together, without accounting for extra procedures that might have to be included in the case.
7. Cases requiring blood products. Some insurers won’t pay for blood products in an outpatient setting, says Russ Greene, administrator of Physicians’ Surgery Center in Fayetteville, Ark. He adds that some states, including Arkansas, don’t even allow ASCs to use blood products.
8. Tracheostomies. Although they can be performed in an ASC, tracheostomies are usually given to patients who are very sick, such as those with terminal lung cancer, and this type of patient really needs inpatient care, Mr. Greene says.
9. Very complex procedures. Procedures such as craniotomies are not usually performed in an ASC for clinical reasons, Mr. Greene says. But there are exceptions, such as using a craniotomy to treat chronic subdural hematomas in the elderly, which literature shows can be performed in an ASC, he says.
10. Some patients with severe sleep apnea. Many centers require patients diagnosed with sleep apnea to bring their C-PAP machine with them on the day of surgery, Ms. McLane says. The C-PAP machine helps patients maintain their airway during the post-anesthesia recovery period. In any case, the anesthesia provider should assess each patient to determine the risk. Some patients may be directed to a hospital for the procedure, depending on the center’s policy on patients with sleep apnea.
11. Some patients sensitive to anesthesia. Ms. McLane says patients who have had complications with anesthesia recovery or have a family member with a history of problems with anesthesia will probably need to go the hospital rather than an ASC. Examples may include patients with prolonged recovery, such as problems waking up from anesthetic or problems breaking down certain drugs, and patients who have a personal or family history of malignant hyperthermia.
12. Patients with latex allergies. While most hospitals are latex-free or near latex-free, some ASCs continue to use some latex, particularly for gloves, either because latex is less expensive or because some surgeons prefer the feel of latex gloves, Ms. McLane says. ASCs should have a policy addressing their commitment to a latex-free environment for patients with a known tested latex allergy and explain how these patients will be handled, she says.
Contact Leigh Page at leigh@beckersasc.com.
