Key Considerations When Starting an Office-based Surgical Practice

Advances in technology and medicine are enabling the rise of office-based surgical settings. And for physicians, the timing couldn’t be better. Increasing costs and shrinking reimbursements have driven physicians around the country to look for innovative ways to optimize revenue and their time. For many the answer is moving surgeries out of a hospital or ASC environment and into their office.

Office-based surgical practices enable physicians to invest in themselves rather than giving up revenue to a hospital or surgery center where they have limited financial claim. Furthermore, physicians gain greater control over their schedule, and improved quality of life.

While the move to an office-based surgical environment may seem overwhelming; it doesn’t have to be. There are many ways to protect yourself financially and liability-wise while taking advantage of everything the office-based surgical setting has to offer. Making sure that things are done correctly and methodically is key so quality of care and patient safety are never compromised. To get you started on the right path, following is a checklist of items to consider.

Accreditation. The requirements for an office-based surgery practice vary by state, with some states having no requirements at all. To determine your state’s requirements, the Accreditation Association for Ambulatory Health Care (AAAHC) and Joint Commission on Accreditation of Healthcare Organization (JCAHO) publish these lists online.

Medical malpractice. While not required by every state, liability coverage (AKA medical malpractice coverage) is highly recommended. Contact your insurance company to determine the cost of premiums for a medical malpractice insurance policy based on your specialty. Be prepared to provide them with as much information on your practice as possible.

Insurance carriers. When negotiating with insurance carriers on rates, it’s important to get a financial breakdown of the internal costs for each procedure you plan to bring in office. Look at your payer mix and what insurance the specific patient-base you want to bring to your office surgical suite is. This information will enable you to conduct an in-depth analysis of what you will make from each carrier for these surgeries.

Build out. While not necessary for every specialty, work with your accreditation consultant and/or medical device rep to understand whether a build out is required for additional space. For example, urology in-office procedures need larger equipment and, therefore, may require a larger room and wider hallways. Gastroenterology requires sterilization and other equipment such as gastroscopes and colonoscopes, so the planning and preparation is a bit more extensive.

Staffing and anesthesia. Unlike hospitals and surgery centers, physician offices aren’t equipped with the personnel, resources, and certifications required for different levels of anesthesia. Outsourced anesthesia services are a popular solution to this problem. A turn-key outsourced perioperative anesthesia partner eliminates the need to recruit and pay for critical care trained pre-op and recovery nurses. They will also provide all anesthesia-related supplies, equipment, and medications which will minimize costs and headaches. If you plan to keep anesthesia in-house, liability, costs associated with who will provide the anesthetic, and how patient flow will be handled (i.e. pre-op and post-op recovery) are some of things that need to be considered.

Physicians must look for ways to make up for lost revenue and secure their long-term financial health. For many, a site of service transition to office-based surgeries is the answer to a sustainable, profitable future.


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