No Time for Down Time: Outpatient Surgery Keeps Farmer in the Field

by Ann Ring (for Radish Magazine)

In August of 2007, the X-rays and MRI finally told the whole story: Lynn Van Damme, of Atkinson, Ill., who for years suffered from neck pain, would have to have surgery. With Van Damme working two jobs — as a part-time farmer on the 80 acres where he grew up and as a full-time employee at Bos Machine Tool Services, Hillsdale, Ill. — he asked the same question any devoted ag producer would ask: “Can it wait until I get the crops out?”

Due to an increasing number of doctors with specialized training and the growth of ambulatory surgery centers (ASCs), it turns out Van Damme needn’t have worried too much about downtime. Although his procedure may sound complicated — he had an anterior cervical discectomy and fusion (ACDF) — his physician, Dr. Michael Dolphin, DO, handled the case with ease, and Van Damme left the Mississippi Valley Surgery Center in Davenport, Iowa, by mid-afternoon one day after surgery. Van Damme hasn’t had any trouble since. “The pain’s gone,” he says.

With a lot of us multitasking through life at breakneck speeds — farmers included — downtime for anything, even our health, isn’t an option. Doctors who have direct control over their surgical practices and ambulatory care centers may be two antidotes for those needing specialized health care and those who are concerned about how to offset the rise in health-care costs.

What if we combined both solutions? What if doctors could focus on what they do best in an outpatient setting? Van Damme, and many others like him, are benefiting from what some health-care workers say is a new, cost-effective and convenient alternative to hospitals. Rather than having to wade through what can be a lengthy administrative process and days spent in bed recuperating, Van Damme’s abbreviated visit and recovery may have been due to his doctor’s capabilities — and an ambulatory surgery center (ASC).

ASCs, which have been rising in popularity all over the U.S., are health-care facilities designed to specialize in selected same-day or outpatient surgical procedures. With approximately 4,000 ASCs in the U.S. and growing, they seem to be changing the face of health care.

Davenport’s Mississippi Valley Surgery Center looks like most medical center lobby areas: clean carpet, friendly staff behind glass, reading materials and a child’s play area. But once inside, Dr. John B. Dooley, MD (anesthesiology, critical care medicine, pain medicine), MVSC’s administrator who spearheaded the center in 1996 and oversees its operations, and MVSC’s manager, Alison Beardsley, proudly walked me through what might be described as a mini hospital.

Seven operating rooms, separate rooms for pre-op and post-op, a pain clinic, a conference room and a full-service lab are neatly compacted into one building, one floor. “As you can see,” says Dooley, “we’re very efficient here. There’s not much downtime.”

ASCs are not new. Anesthesiologist Ralph Waters, MD, opened what could be defined as the nation’s first ASC in Sioux City, Iowa, in 1919. Then in 1970, several anesthesiologists opened an outpatient surgicenter in Phoenix, Ariz. ASCs became massively popular in the 1980s, when Medicare approved reimbursement, and ASCs then doubled in number between 1990 and 2000. Most ASCs, like MVSC, are solely physician-owned, yet others are owned by hospitals and physicians, while a small number are owned by corporations.

ASCs are either single specialty, like the Regional Surgicenter Ltd., in Moline, Ill., which focuses on gastroenterology cases, or multi-specialty, like MVSC, the Surgery Center Cedar Rapids, Cedar Rapids, Iowa, and the Ambulatory Surgery Center at University of Iowa Hospitals and Clinics in Iowa City, which manages specialties like anesthesia, general surgery, ophthalmology, urology, orthopaedics, otolaryngology (ear, nose and throat) and gynecology.

Some news articles have compared hospital infection and mortality stats against ASCs’ infection and mortality stats, but the two facilities are not the same; one cannot make the perverbial apples-to-apples comparisons. “They’re not the same,” says Meg Wiebel, administrative director for Crow Valley Orthopaedic Surgery Center, Bettendorf. “ASCs are only for those who require same-day services or perhaps overnight.” Dr. Doug Merrill, MD, medical director for University of Iowa’s ASC, agrees. “Hospitals have to be all things to all people. They not only have the sickest patients but those with more complications.” And ASCs do not handle emergency room cases.

Perhaps it’s no coincidence that the development of ASCs across the medical landscape have been physician-driven. Frustrated by numerous inefficiencies doctors experience within hospitals, ASCs provide physicians opportunities to side step these frustrations and have more direct control over their surgical practices – in scheduling, staff selection, profitability and patients they see. And they can focus their attention on their specialty or subspecialty.

Beardsley says that of the 20 physicians who own the Mississippi Valley Surgery Center, most are fellowship trained or have subspecialty training, though it’s not required. “ASCs give you the opportunity to be in an environment to do this (a specialty) a lot, and we get very efficient at it,” says Merrill.

Yet ASCs have their critics. The same arguments against physician-owned hospitals could be made for physician-owned ASCs: they drain hospital revenue, avoid low-income populations, reduce specialty care access at hospitals, make exceptionally high profits, offer the most profitable services, are subject to less demanding federal standards than hospital outpatient departments, and “cherry pick” staff and patients. And doctors financially can benefit from self-referrals.

On the other hand, although some studies have proven otherwise, a number of business experts and physicians themselves assert that ASCs are very efficient because their concentrated focus leads to higher quality care and ultimately produces cost savings.

ASCs would be foolish not to be nationally accredited, and they have to be Medicare-certified in order to receive Medicare payments. Most ASCs are accredited by the Accreditation Association for Ambulatory Health Care (AAAHC). AAAHC is the largest crediting organization, and was the original multi-discipline accreditation organization to focus exclusively on ambulatory health care.

Capable of handling at least 12,000 cases a year, the “facility has become very skilled at taking care of patients and getting them back home. With us, even though we’re physician-owned, doctors can choose to have procedures done here or elsewhere,” says Beardsley.

Van Damme would agree. He was pleased with Dr. Dolphin’s expertise and the care he received at the Mississippi Valley Surgery Center. “It’s very good service,” he says. “Very comfortable.”

Regular Radish contributor Ann Ring lives in Woodhull, Ill.