Be persistent against regulatory roadblocks
Even if you are located in a state with fairly clear rules written to govern recovery care centers, there might be gray areas, says Carol Blanar, administrator and director of nursing for Sagamore Surgical Center in Lafayette, IN.
In 1996, when Blanar started planning for her center’s recovery care service, she was told that her center could keep patients up to 24 hours and it didn’t matter when the clock started.
"We decided that we would start the clock when the patient arrived in the recovery care center, but after we built our five overnight suites, the state then said the clock starts as soon as the patient arrives at the surgery center," says Blanar.
Starting the 24-hour clock at the patient’s arrival is impractical because it doesn’t allow for delays such as the prior case running long, the surgeon arriving late, or delays in lab results, she explains.
You also run into the problem of patients who checked in at 7 a.m. for surgery having to go home at 7 a.m. the next morning, says Blanar. "Physicians may not be able to see them early enough to discharge them by 7 a.m., she says. "Most patients want something to eat, or they may not be able to get a ride home that early."
After fighting to change the rules for three years by lobbying legislators, meeting with key people within the proper departments and by garnering support from all surgery centers, Blanar says she has won. "We can start the clock as early as the patient’s arrival but no later than when they enter the operating room."
Blanar who is president of the Indiana Federa-tion of Ambulatory Surgery Centers, has begun lobbying efforts to support proposed legislation that will allow stays of 48 hours to 72 hours within Indiana recovery care centers.
State may try to protect hospitals
While Blanar ran into trouble with different interpretations of the state statutes, Trent Kaufman, executive director of Gem City Bone and Joint, an orthopedic same-day surgery center in Laramie, WY, faced a more serious challenge when he contacted the state department that oversees licenses for health care facilities.
"I was told that they would do everything possible to stop us from setting up a recovery care center because it would threaten the smaller hospitals in the state," says Kaufman.
Gem City Bone and Joint is located in an area that is not just rural, but frontier, he explains. The organization has seven clinics statewide that feed into the primary facility in Laramie, he says.
"While the local hospital claimed we would be stealing their patients, the reality is that 70% of our patients using the recovery care center come from outside Laramie and would have gone outside Wyoming for their hospital stay," he says.
"Our argument was that we could keep Wyoming patients in Wyoming by offering this service," Kaufman explains.
Although it took one year and an opinion from the state attorney general’s office for a final ruling, Kaufman was able to set up his recovery care center.
Requirements differ from state to state
"We were required to have a 1½-hour firewall between the two areas; we discharge patients from the surgery center and admit them to the recovery center; and we cannot float staff from one area to the other," says Kaufman.
Hospital-based programs have fewer regulatory challenges, but if you’re in a state with certificate of need requirements, you may have to redesignate beds or ask for additional beds to set up a recovery care center, says Debbie Proctor RN, department head of the outpatient center and surgical admissions center at Promina DeKalb Medical Center in Decatur, GA.
"When we set up our 23-hour stay unit in 1992, we used existing beds, but we redefined them as short-stay unit beds," explains Proctor.
If the facility had not had bed count available to transfer to the short-stay use, the hospital would have needed to submit a certificate of need application for additional beds, she adds.
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