The Mobile Way: Part 1 – Succeeding in an Office-Based Setting
The physician office surgical suite for outpatient procedures has drawn more and more interest and buzz given the benefits of increased physician utilization and patient satisfaction along with the reduced costs. The trend will only continue to grow exponentially given the pressure from insurance carriers, systems, and patients to be more cost conscious and experience focused. The only issue here is that this surgical environment is much different and has less regulation than hospitals and surgery center. For instance, in Illinois, there are no laws regarding what procedures and surgeries can be done in an office setting or if the doctor must be trained in that specialty to perform surgery on patients. As one can expect, this leads to a lot of unsafe and financially motivated decisions by certain individuals to take advantage of patients trusting their clinicians and not being able to understand what appropriate for their health and care in this environment. Even physicians that are trying to provide a high quality environment for their patients are too trusting of their close network on what can and cannot be done along with what liability they are incurring for themselves and their patients.
An experienced physician that has historically performed surgical procedures at both hospitals and ASCs has grown accustomed to depending on the facility and administration to make sure the setting is safe and meets all requirements and regulations. That allows the physician to simply go in and only worry about doing their job as the surgeon or proceduralist. But when someone brings those procedures to their office setting, they are now responsible for all facility and safety related items, which includes but is not limited to anesthesia, emergency medication/equipment, ACLS trained staff, and liability/risk management. Since this is outside their scope of training and expertise, they must trust others to make sure all of that is being taken care of and provided to match the standards and safety of a hospital or licensed surgery center.
Have you verified that the information your vendors, personnel, service providers, anesthesia partner, and consultants is accurate? It is your liability, as a provider, including the passed-on risk to the patient if you are not doing the proper due diligence and work to make sure you and your patients are in the best possible position for a successful experience. It only takes one bad outcome to ruin everything you have built so it is worthwhile to spend the time researching and finding the optimal setup, support, and teammates.
You would be amazed at what false information is out there or never mentioned. For instance, did you know that Illinois has a law that requires a physician to have a certain amount of CME hours on anesthesia to supervise a CRNA in their office? Or did you know that a CRNA has different professional liability coverage than a physician anesthesiologist does, and if something goes wrong on the anesthesia side the surgeon is exposed as the primary liability holder? Emergency equipment, medications, crash carts, airway management supplies, ACLS training, proper nursing support, safety training, and proper policies and procedures can be offered up by your perioperative, anesthesia, and/or equipment vendor at little or no cost to you. There are groups that provide all of this and more so why wouldn’t you want to take advantage of these models and relationships that minimize your risk and costs while maximizing your and your patients’ liability and experience?
In the end, doing procedures in the physician office setting is unlike a hospital or ASC and the only person holding the bag if something goes wrong is you. Don’t be the story everyone wants to avoid and don’t let it be you that is misled into providing an unsafe and ill-equipped environment for your patients. Being able to perform surgical procedures in an office-based setting has wonderful benefits, and this will be a mainstay in the future of the industry. The time is now to act, educate yourself, and fully embrace all factors to making this core function and differentiator of your current and future practice.