Considering Office Based Surgery?

1. Office Based Surgery
Presented by: Alycia Viscardi,RN LHRM
DoctorsManagement, LLC
aviscardi@drsmgmt.com
941-234-6548 direct

2. 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

3. 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.

4. 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 reimbursements
Combined payment for professional & technical
On average 10 x more than professional revenue in
“Facility” (ASC or Hospital)

5. 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.

6. 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.

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

8. Increase Practice Revenue
Office 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

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

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

11. Area of Expertise
Whether 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.

12. Our Model
• Physician remains in control
• Independence is valued
• Solutions to help eliminate headaches with opening and
running a surgical suite

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

14. 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 !

15. 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

16. 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

17. Additional Services
• Procedure Specific Guidance & Resources
– Kyphoplasty/Pain Management
– PAD Awareness/Testing
– Lower Extremity Revascularization
– Venous Intervention
– Vascular Access

18. Important Considerations in OBS suites
Have 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

19. 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

20. 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.

21. 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?????