Extended care adds revenue potential
(This month’s issue includes the first part of a two-part series on extended recovery care. In this month’s issue, we explore options for how to provide extended care, information on state regulations, an overview of the financial picture, and information from a recent survey. In next month’s issue, we’ll cover how to select patients and procedures.
Advances in technology as well as clinical areas such as anesthesia have increased the number of procedures that can be safely performed outside the hospital inpatient surgery department, but how can same-day surgery programs take on the more complicated cases within the parameters of outpatient surgery?
The best answer for many centers may be the addition of a unit designed to handle overnight stays. If you are considering this move, be aware of the benefits you will enjoy as well as the obstacles you might face, say experts interviewed by Same-Day Surgery.
A major benefit of adding recovery care or short-stay to your same-day surgery program’s service mix is the ability to attract a more diverse mix of cases, physicians, and patients, says Joni Steinman, managing principal, AUSMS Health-care Consultants in San Diego.
The ability to keep patients for 23 or more hours gives a surgery program manager a chance to accept more complex cases, but you need to plan carefully to address the financial and regulatory issues, she says.
The first step in setting up a recovery care unit is to decide what you want to accomplish, says Steinman.
"What level of care do you want to provide? What type of setting do you want to offer?" she asks. Once you’ve figured out what cases you’ll handle, how long you want to keep patients, and what ancillary services you’ll provide, look at your state regulations from the perspective of what you want to do, she adds.
It is tough to say which states permit recovery care, says Steinman. "Some states permit 24-hour care in licensed surgery centers but don’t have any regulations to govern overnight’ stays, while others do have governing regulations." (See regulatory challenges, p. 103.)
Only Illinois has an active demonstration project that permits designated sites to keep patient up to 72 hours, she adds.
The Recovery Care Survey 2000 conducted by the Federated Ambulatory Surgery Association (FASA) in Alexandria, VA, shows that the state in which a same-day surgery program is located plays a significant role as to whether the program offers recovery care, says Kathy Bryant, JD, executive director of FASA.
"Although 34 states have recovery care centers in 1999, 50% are in four states [California, Texas, Indiana, and Colorado]," she says.
Colorado leads the country with 63% of freestanding ambulatory surgery centers offering recovery care centers, says Bryant. The FASA study looks only at freestanding surgery centers with recovery care centers. (See survey results, p. 106.)
Some centers are simply one or two beds designated as 23-hour care; others are separately licensed facilities that are adjacent to the outpatient surgery center. There are also special units designated within hospitals as short-stay or surgical recovery care, Steinman says.
Another approach to set up a recovery care center for freestanding centers, is to license the recovery care center as a hospital, says Jackie Street, chief executive officer of the Idaho Falls (ID) Recovery Center. Her surgery center is not licensed as a hospital, but the attached recovery care center does have that license.
When you are licensed as a hospital, the building codes are stricter and the staffing requirements are well-defined," explains Street.
"In our state, there are no staffing requirements for an ambulatory surgery center, but as a hospital, our recovery care center must have an RN on duty at all times," she points out. "Our staff also has to have the same level of training to handle patient emergencies, such as codes, as hospital staff."
A major obstacle for Street’s application was the threat to the local hospital’s Medicare status, because the recovery care center and the hospital are only two miles apart. Because Medicare’s definition of outpatient surgery does not allow a recovery care stay, Street’s recovery care center cannot accept a Medicare outpatient surgery patient; however, her center can offer other services such as chemotherapy and infusion services to Medicare patients.
This ability to offer some services raised the concern that hospital services were duplicated within a small geographic area and were reducing the cost efficiency of services to Medicare patients, she says.
"We had to make it clear that although we would be eligible to provide service for some Medicare patients, we could not duplicate hospital services such as inpatient care, emergency service, and inpatient surgery," she says.
Once it was clear that the Idaho Falls Recovery Care Center was operating with a hospital license that was very limited in scope of service, the center received Medicare approval.
Even if your state regulations are not amenable to recovery care centers now, be sure to look at them periodically, says Steinman. "There are changes from time to time that may be related to changes in your state’s administration."
Monitor regulatory issues through involvement in state associations, informal networks, and national organizations, she suggests. "Stay on top of the proposed changes or opportunities to re-address the issue so you can make changes when possible."
For more information about recovery care, contact:
• Joni Steinman, Managing Principal, AUSMS Healthcare Consultants, P.O. Box 16948, San Diego, CA 92176-6948. Telephone/Fax: (619) 283-0245. E-mail: [email protected].
• Jackie Street, Chief Executive Officer, Idaho Falls Recovery Center, 1957 E. 17th St., Idaho Falls, ID 83404. Telephone: (208) 529-5285. Web site: [email protected].
• Kathy Bryant, JD, Executive Director, Federated Ambulatory Surgery Association, 700 N. Fairfax St., Suite 306, Alexandria, VA 22314. Telephone: (703) 836-8808. Fax: (703) 549-0976. E-mail: [email protected].
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