Q: How does a postsurgical recovery care center help ASCs?
Joni Steinman: These centers extend the amount of recovery time for the patient beyond what is allowed in a surgery center. This means the ASC can have higher-acuity cases and thus more volume. The limit placed on recovery centers is often 24 hours, but the definition varies in about 10 sates where some form of these centers is allowed. The center may or may not have to be attached to the ASC.
Q: How did recovery centers come about?
JS: While there were some earlier versions, the model was created in Fresno, Calif., by a diverse group of orthopedic and other surgeons in the 1980s. California officials agreed to a limited demonstration from the late 1980s to 1993 or 1994, involving just 13 recovery centers. Later Illinois launched another demonstration based on the California model. Similar models have sprouted up in Colorado, Georgia, Indiana, Illinois, Wisconsin, Oklahoma, Utah and, to a limited extent, Arizona.
Q: How does the hour limit vary?
JS: While states usually call for a 24-hour limit, there are different rules on when the clock starts. Oklahoma for example, starts it after surgery, which provides an extra couple of hours. Florida limits post-surgical recovery care to the “working day.” And there is a different definitions of care, the “PRC” and “PACU” models.
Q: Orthopedic surgeons in particular have promoted the PRC model. Why is that?
JS: Orthopedic surgeons have patients who are otherwise healthy and do not need all of the medical backup that a hospital provides. Basically, these patients need some post-op therapy, which the recovery center can provide. Patients can avoid hospitalization and reduce the likelihood of hospital-acquired infections.
Q: What has been the track record of these centers?
JS: Surgeons have found the centers to be a positive extension of their ASCs when part of a protocol that included pre-surgical home or outpatient physical therapy and followed up promptly by additional PT.
Q: What is the future of these centers?
JS: The growth of recovery centers has been stalling in the past decade because of political resistance against ASCs. However, hospitals have been getting interested in these centers as a less expensive alternative to an inpatient stay.
Contact Joni Steiman at ausms@cox.net.
