Office Based Surgery

Presented by: Alycia Viscardi,RN LHRM DoctorsManagement, LLC

aviscardi@drsmgmt.com941-234-6548 direct

About Your Presenter

• Registered Nurse

• Licensed Healthcare Risk Manager

• 20 years healthcare experience

• Experienced Leader

• Member of AORN, OEIS, SIR

• Previous Owner of Viscardi Medical-

a healthcare consulting company

RESULTS ACHIEVED Start up of one of the most successful office-based

interventional/vascular labs in the country (2008). Operational management for over 5+ years. Expanded service lines and performed over 50 procedures

in the office setting by creating effective marketing programs Designed and authored Perioperative Nursing Record for a

well known EHR company. Achieved perfect state inspections for 6 years straight. Served as Healthcare Consultant on multiple projects for

nationally known companies, as well as a multitude of existing facilities.

What is Office Based Surgery?Office-based surgery is any surgical procedure performed by a licensed physician in the office setting, requiring some level of anesthesia.

Billed as POS 11- “Non Facility”Different than an ASC- “Facility”“Global” billing- Higher reimbursementsCombined payment for professional & technicalOn average 10 x more than professional revenue in “Facility” (ASC or Hospital)

Statistics of Office Based Procedures• Out of about 80 million outpatient surgeries last year,

including those done at hospitals and free-standing surgical centers, more than 12 million were performed in doctor's offices.

• Health experts expect this amount will increase over the next decade.

Physician Advantages• Higher Reimbursement• Increased Revenue• Financial Independence due to increased take home

pay• Patient convenience/ease of scheduling• Control of patient care from the beginning to end• Decrease burnout• Don’t have to give up ownership- You control your

destiny• More control over his/her schedule, a better work-life

balance can be achieved.

Patient Advantages

• Cost Savings• Lower Risk of Infection• Comfort• Convenience• Better care, more personalized care• Patient Satisfaction• Continuity of Care

Increase Practice RevenueOffice based procedures can provide an increase in revenue to the surgical practice while lowering the overall cost of care to the Health Care System because fees are paid directly to the surgeon, eliminating overhead costs billed for the same procedure in a hospital setting

Office vs Hospital

MedicareHCPCS CODE SHORT DESCRIPTION NON-FACILITY PRICE

FACILITY PRICE(ASC/HOSP)

37220 Iliac revasc $3,241.93 $436.30 37221 Iliac revasc w/stent $4,781.73 $535.90 37222 Iliac revasc add-on $908.66 $196.51 37223 Iliac revasc w/stent add-on $2,665.23 $225.78 37224 Fem/popl revas w/tla $3,934.16 $481.02 37225 Fem/popl revas w/ather $11,324.30 $649.61 37226 Fem/popl revasc w/stent $9,312.42 $564.73 37227 Fem/popl revasc stnt & ather $15,293.65 $781.21 37228 Tib/per revasc w/tla $5,595.77 $586.87 37229 Tib/per revasc w/ather $11,170.96 $758.09 37230 Tib/per revasc w/stent $8,539.52 $747.75 37231 Tib/per revasc stent & ather $13,724.58 $812.68 37232 Tib/per revasc add-on $1,247.63 $212.98 37233 Tibper revasc w/ather add-on $1,508.18 $346.06 37234 Revsc opn/prq tib/pero stent $3,983.19 $299.28 37235 Tib/per revasc stnt & ather $4,276.93 $411.37 37236 Open/perq place stent 1st $4,258.25 $476.84 37237 Open/perq place stent ea add $2,552.92 $226.14

Specialties of Interest• Interventional Radiology & Cardiology• Vascular Surgery• Anesthesiology• Pain Management• ENT• Plastics• Gynecology• Dermatology• Urology• Orthopedic Surgery

Area of ExpertiseWhether developing a new office based surgery center or expanding service lines for added revenue in an existing center we can help develop a customized solution that is practical and cost effective.

Our Model• Physician remains in control• Independence is valued• Solutions to help eliminate headaches with opening and

running a surgical suite

Commitment to Patient Safety• Ongoing commitment to Patient safety• Ensuring the highest Standards• Adhering to ASA guidelines for outpatient anesthesia &

recovery

Dedicated to helping Physician achieve their Goals

• Valuable solutions to every aspect of clinical and operational needs.

• Flexible & customizable • New or existing practices• Ongoing Support Options• No matter which solution, the physician does not give up

ownership !

Pre Development

• Initial Consultation• Feasibility Study• Pro-forma Performed• Collect documents for

application to State• Facility Requirements • Timeline established

Development

• Hiring/Training• Training Process• Equipment & Supply • Vendor Negotiation &

Contracts• Inventory Requirements• Medical Records • Infection Control• Quality & Risk Program

Development

Operational Phase Ongoing Support• Standards• Quality & Risk Management• Regulations• Policy & Procedure • New service lines• Marketing• Ongoing Inspection support• Incident Reporting• Credentialing• Accreditation

• First Case• First Inspection• Mock Surveys• Patient Care Protocols• Standards of Care• Quality/Risk Program • Emergencies• Pharmaceutical Accountability

Additional Services

• Procedure Specific Guidance & Resources

– Kyphoplasty/Pain Management– PAD Awareness/Testing– Lower Extremity Revascularization– Venous Intervention– Vascular Access

Important Considerations in OBS suitesHave a solid business plan & review your finances:• Potential Revenue-

– Case Mix/Payer Mix/Average Payment Per Case

• State Laws-– Differ by State

• Building, Space Selection• Billing & Reimbursement • Lease & Interest Payments• Equipment & Supplies• Staffing• Operational Oversight

Procedure Reimbursement Comparison

HCPCS CODE SHORT DESCRIPTION In Office In Hospital

22513 Per vertebral augmentation(Kyphoplasty) $7,496.09 $563.08

37243 Vasc embolize/occlude organ $9,993.11 $619.49

37227 Fem/popl revasc stnt & ather $15,227.18 $786.94

Choose Wisely

• A surgeon developing an office-based center should be ready to dig into the details and seek out expertise in each specialty area involved with opening a procedural lab.

• Look for experts who can offer solutions that take into account your cost, quality and access objectives

• Choosing a consultant with clinical & operational expertise in several areas especially in vascular based labs will help ensure success.

In Conclusion• The future of expanded access to appropriate, cost

effective, quality interventional care lays in office interventional suites and same day intervention. With all its positive attributes and as more data comes forward to support it, it just may be the solution that patients, physicians and payers are looking for.

WHY WAIT?????