Having Surgery at the Doctor’s Office?

Before Having Surgery at the Doctor’s Office…

Just 30 years ago, more than 90% of all surgical procedures were performed in hospitals, requiring at least one night’s stay. But because of advanced surgical techniques and safer, easier to administer anesthesia, one-third (about 15 million surgeries) are now performed on an outpatient basis at hospital-owned or independent surgery centers. And still another 15 million operations — everything from the removal of a skin cancer to cataract surgery and knee arthroscopy — are performed in physicians’ offices.

In-hospital surgery, hospital-run outpatient centers and independently owned surgicenters are highly regulated by both federal and state governments, and most must be certified by well-respected accrediting organizations to be eligible to bill Medicare or private insurance companies. But surgical procedures performed in physicians’ offices are not tightly regulated. In fact, only 25 states regulate them at all — by monitoring infection control standards, for example. Before saying “yes” to any surgical procedure that is performed in a doctor’s office, ask these questions…

Does the doctor have the right credentials? Your doctor should have privileges at a local hospital. This helps ensure that he/she is well-trained because hospitals strictly control who gets privileges. Insider tip: Ask your doctor where he has privileges and in what specialties. Then call the hospital to double-check what you’ve been told. Doctors who have lost hospital privileges for safety or quality reasons have been known to continue doing surgical procedures in their offices.

Also: Check with the American Board of Medical Specialties (ABMS) (www.abms.org) to ensure that your doctor is board-certified in the specialty covering the procedure he is to perform. Nowadays, more doctors are attempting to bring in extra income by doing office procedures in areas in which they don’t have extensive training.

What happens if there’s an emergency? For older adults and those of any age with a chronic medical condition, such as high blood pressure, heart disease or diabetes, an in-hospital or a hospital-operated outpatient facility may be the best choice. These facilities are equipped to handle serious problems, such as surgical errors, that can occur during surgery. Insider tip: If you’re considering an office-based surgery, ask, “Do you have an arrangement with a local hospital and ambulance service in case of emergency?” This ensures a prompter response time than simply calling 911 — the approach taken by most doctors’ offices.

How is follow-up handled? Hospitals and outpatient surgical centers generally have doctors or nurses available to help you 24 hours a day if a problem occurs after you have gone home. Most physicians’ offices do not offer that service and simply tell you to go to an emergency room. Insider tip: Before you agree to an office procedure, ask if there are doctors or nurses on call 24 hours a day if there’s a problem. If not, book your procedure at a hospital or hospital-operated facility.

Source:  Charles B. Inlander is a consumer advocate and health-care consultant based in Fogelsville, Pennsylvania. He was the founding president of the nonprofit People’s Medical Society, a consumer advocacy organization credited with key improvements in the quality of US health care in the 1980s and 1990s, and is the author of 20 books, including Take This Book to the Hospital with You: A Consumer Guide to Surviving Your Hospital Stay.

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