Wednesday, June 17, 2009

Manhattan's new office surgery rules causing surgeons headaches

New York doctor comrades, I feel your pain!

On July 14, all medical offices in New York performing surgery requiring anything other then local anesthesia will have to be accredited by one of the major ambulatory surgery regulatory boards. While this is imminently logical, it does create special problems in an older city like New York with mostly preexisting structures and high real estate costs. Many physicians are scrambling to find places that can be brought up to code when they get the sticker shock for potential remodeling costs, assuming their current space can meet code at all (which may not be possible in some buildings). Click here to read a feature on this in the NY Times.

Having just finished the build out of an office surgery suite in a blank shell, the easiest way to incorporate the special design needs of a modern O.R., I can attest to the fact of how complex it is. Out of the 4000+ sqf we have in our build out, almost 50% is just to accommodate the workings of a single O.R. Imagine trying to renovate a prewar building in Manhattan, many of which also have co-op boards to deal with as well.

Despite the headaches, it is a good move by New York to require this. Office O.R.'s and the doctor's who use them need closer scrutiny!



Anonymous said...

While I agree in principle with your take on this - that doctors doing procedures in offices need to be careful - the effects and motivation behind this law seem to have been missed in your post.

The likely proponent of this law was an association of hospitals in New York. Many procedures can safely be done in an office setting and simply do not require the workings of a level 1 trauma center or even a fully equipped hospital OR. As a consequence, many physicians perform minor surgery in the office. The effect of this for patients is that the costs are much much much lower. For instance, I removed a 1.5 cm lesion from a lady's hand in a hospital OR recently. Medicare paid me about $100. The lady came to my office with the hospital bill. Medicare paid the hospital $3600 for the 15 minute procedure.

What this really is about is the hospitals capturing back, by law, revenue that they have lost. Why did the hospitals lose the revenue in the first place? Oh let me see, 1.5 hour turnover times between cases, forced ER call coverage for privileges (read servitude), or any of the other problems that occur when hospital administrators do not recognize the true source of revenue for the hospital - the surgeon.

Apparently trying to limit patient choice in facilities wasn't accomplished well enough by things like the certificate of need law. The hospitals have found a new tact - make the doctors comply with regulations so onerous that office based surgery comes to an end.

Buy Soma Online said...

I really have a bad feeling about this. While this move will undoubtedly make services or establishments safer, I worry about how it will reflect on patients' health insurance or credit card bills? Because better buildings or offices cost more, what's saying that the higher clinic operating costs won't be foist off the patients coming for treatment?

Anonymous said...

As a solo private practitioner, I can tell you that the expense of an operating room ain't going to come out of my take home pay.

Elena Montes said...

Well this is a real hard fact to digest