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Ambulatory surgery centers: now 33 freestanding facilities across Indiana.

If the sign didn't say Indiana Surgery Center, you might mistake it for a hotel. It has private patient rooms, wood-trimmed corridors, fashionable wallpaper, upholstered furnishings, reclining chairs for the patients, and best of all, food prepared for patients by a deli.

Sharon Dodd, business director, explains that the center tries to provide an atmosphere for its patients that is as much like home as possible.

The Indiana Surgery Center takes a markedly different approach than what one might expect from health care, and it is just one of the many free-standing outpatient surgery facilities that have been opening across Indiana during the past two decades.

In the spring of 1972, there were only two freestanding ambulatory surgery centers in the United States. One of them was the Fort Wayne Surgical Center, which recently changed its name to Premier Ambulatory Surgery. Today there are more than 1,500 such centers in the United States, 33 of them in Indiana. Cost is a big factor behind the growth.

According to Dale Krynak, administrator of The Lafayette Eye Center and the soon-to-be-completed Lafayette Ambulatory Surgery Center, "There are three or four costs involved with a surgery. There is the office charge for the pre-examination of the patient, the surgeon's fee, the anesthesiologist's fee, and the facility fee, which includes the cost of using the premises and all other overhead expenses."

Krynak explains that the cost difference between surgery in an ambulatory surgery center and a hospital show up in the facility costs. Typically, in a hospital each profit-generating department must cover a certain percentage of the costs of maintaining the services that don't generate a profit, such as security, maintenance and the mail room. In an ambulatory surgery center, those no-profit departments are much smaller than in a full-service hospital, if they exist at all. Because of these reverse economies of scale, Krynak says, ambulatory surgery centers need to recover just 60 percent of the facility costs that a hospital does.

A recent Blue Cross and Blue Shield survey compared the cost differences between outpatient surgery centers in hospitals and freestanding ambulatory surgery centers. What the survey found was that ambulatory surgery centers charge an average of 47 percent less for the same procedures.

Those paying the bills no doubt like what freestanding ambulatory surgery centers have to offer, but doctors do as well. "Surgeons have more control over their environment in a freestanding center than in a hospital," Krynak believes. "Surgeons don't have to deal with as much bureaucracy, they can get an operating room for the time they want and not just the time that it is open, and they don't get bumped because of an emergency procedure."

Patients, as well, have given the centers high marks. LaDonna Jergins, facility manager at the Evansville Surgery Center, claims ambulatory surgery centers "get patients back to work sooner, because they provide an experience that is more positive."

The Evansville Surgery Center opened in 1984, making it one of the oldest facilities in the state. It is owned by a partnership including Surgical Care Affiliates and local investors. Surgical Care Affiliates also operates the Indianapolis Surgery Center and the North Indianapolis Surgery Center.

Freestanding ambulatory surgery centers obviously have enjoyed a great deal of growth and success, but they continue to deal with the image that they are unregulated facilities that provide low-quality care. "Freestanding outpatient surgery centers are among the most highly regulated health care providers," says Shirley Rhodes, administrative director at the Grossnickle Eye Center in Warsaw and board member of the Indiana Federation of Ambulatory Surgical Centers. "They are so heavily regulated because the industry is new and expanding, and the state and federal governments want to make sure that patients are receiving the highest quality of care."

Hospitals have responded to the growth in freestanding ambulatory surgery centers by enhancing their own outpatient services. "Outpatient surgery is something that hospitals have geared up to do as the needs of the marketplace have demanded," says Bob Morr, vice president of the Indiana Hospital Association. Some hospitals even have opened their own freestanding ambulatory surgery centers.

Some people still may prefer to have surgical procedures done at hospitals, if for no other reason than the fact that hospitals offer a continuum of care. As Morr notes, hospitals offer intensive-care units and other emergency services that might be needed on occasion if a patient's condition worsens during surgery.

Finally, Morr wonders how the marketplace will transform as health-care reforms are discussed and enacted. While he acknowledges that costs of some surgical procedures may be higher at hospitals, he notes that part of the reason is the fact that the general community currently expects hospitals to care for patients even if they can't pay, which adds to everybody else's bills. Changes in health-care thinking may change some of these basic truths.
COPYRIGHT 1993 Curtis Magazine Group, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1993 Gale, Cengage Learning. All rights reserved.

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Author:Jones, Clay
Publication:Indiana Business Magazine
Date:Jan 1, 1993
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