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.
Who are the nationally recognized accreditation organizations?
There are several nationally recognized accreditation organizations. Below are a few, including a link to their website where you can obtain additional information:
- Joint Commission on Accreditation of Healthcare Organizations (JCAHO) – www.jointcommission.org
- Accreditation Association for Ambulatory Health Care (AAAHC) – www.aaahc.org.
- American Association for Accreditation of Ambulatory Surgical Facilities (AAAASF) – www.aaaasf.org.
Are regulations similar across all states?
Regulations vary by state, with some states sharing similar criteria. A number of states follow the AMA guidelines and require a physician’s office be accredited by a nationally recognized accreditation agency when performing surgical procedures requiring Level II anesthesia (moderate sedation or “conscious sedation”) or higher. Strategy Anesthesia is familiar with regulations nationwide and will assist you with what is necessary in order for your office to be able to perform office based procedures.
Can you give examples of procedures that are within the definition of OBS?
Examples of procedures that are OBS include but are not limited to: upper endoscopy, colonoscopy, rhinoplasty, mammoplasty, lithotripsy or vascular access related procedures when accompanied by moderate or deep sedation, major upper or lower extremity nerve blocks, neuraxial or general anesthesia. Most procedures like botulinum toxin injections and minor integumentary procedures are performed with minimal or no sedation therefore can be performed in offices not requiring OBS accreditation. Generally, magnetic resonance imaging (MRI) procedures are not subject to this law.
Are there architectural requirements for office-based practices?
OBS practices must follow the accrediting agency’s standards and expectations for physical plant requirements. With Strategy Anesthesia’s expertise, we can assist you with any requirements so that your procedure room follows these standards.
How are levels of anesthesia defined?
The American Society of Anesthesiologists (ASA) defines the various levels of anesthesia (sedation) as follows:
- Level 1 – Minimal sedation (anxiolysis) A drug-induced state during which patients respond normally to verbal commands. Although cognitive function and physical coordination may be impaired, airway reflexes, and ventilatory and cardiovascular functions are unaffected.
- Level 2 – Moderate sedation (“Conscious Sedation”) A drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.
- Level 3 – Deep sedation/Analgesia A drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to URO/WH-228302-AA 01/2014 Page 2 of 3 Business Unit Name State Regulatory Environment Overview: “Office-Based Surgery” independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.
- Level 4 – General Anesthesia A drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.
Because sedation is a continuum, it is not always possible to predict how an individual patient will respond. Hence, practitioners intending to produce a given level of sedation should be able to rescue patients whose level of sedation becomes deeper than initially intended. Individuals administering Moderate Sedation/Analgesia (“Conscious Sedation”) should be able to rescue patients who enter a state of Deep Sedation/Analgesia, while those administering Deep Sedation/Analgesia should be able to rescue patients who enter a state of General Anesthesia.
How quickly can we get started with the anesthesia program?
We will have our practice manager come in and meet with your staff to determine the needs of your facility. After the initial meeting, we will identify an exemplary provider who is interviewed by our Medical Director and start the credentialing process with your facility. We can go live within 45 days.
Who will monitor the patient’s recovery after the surgery, and for how long?
A Recovery RN who is certified in ACLS, PALS and BLS will monitor the patient throughout the recovery process.
What Staff will Strategy Anesthesia Provide?
Strategy Anesthesia will provide anesthetists and talented resources to your center. The staff we provide will be in direct line with your particular needs and we will design a program that best fits your practice.
Are your anesthesia providers local? And will I see the same provider each day?
Our providers are local to your area, living in the area and will be dedicated only to your facility. They will not be shared with any other hospital or facility and you will see the same faces every day. Should you be unhappy with your provider for any reason, we will replace that person with someone that you approve. Additionally, we provide back up providers to cover vacations and unforeseen illness so you never have a lapse in coverage.
Who will manage the anesthesia supplies?
Strategy Anesthesia manages everything required to set up an OR suite in your office. The anesthesia equipment, IV Poles, fluids, IV tubing, and anesthesia drugs as well as IV’s, pads, monitoring equipment, crash cart, O2 and an AED will all be set up in your facility by our team. Everything required to create a safe and efficient OR for your patients will be managed by our team. Your staff will not be burdened with this responsibility. Strategy Anesthesia takes care of all the details so that your valuable time can be spent on what you do best: procedures.
How will performing procedures in-office vs. the hospital help me manage my time better?
By utilizing the services of Strategy Anesthesia to perform in-office surgery, physicians eliminate travel time to and from a hospital or surgical facility. Delayed starts and room turn-over at hospitals and outpatient facilities is reduced or eliminated. You set your own schedule at your convenience. Strategy Anesthesia will provide you with an in-house anesthesia program so that you can perform procedures when you want to, not when someone else tells you to. Your valuable time can be better utilized to be more productive and efficient with more income generating activities like seeing more patients.
How does your anesthesia program benefit my patients?
When a physician chooses to perform procedures in-office, there is less confusion for the patient. Your patient will already know exactly where to go, and they will welcome a familiar environment they know and trust. Many patients experience impersonal treatment from hospital staff, which produces more anxiety prior to their surgery. We like to think of ourselves as part of your family. Your patients are our patients and we treat them with compassionate care. Using Strategy Anesthesia allows you to better enhance your patient’s over-all experience by ensuring their interaction is with caring healthcare professionals that you have a relationship with. Repeat business and referrals will be limitless. With Strategy Anesthesia, you can schedule more procedures sooner and gain more control over your income stream.
How does using Strategy Anesthesia reduce costs and increase revenues?
When you use Strategy Anesthesia to perform in-office procedures, patients are not subjected to a facility fee associated with hospital and surgical center OR’s. The physician will make significantly more reimbursement for doing procedures in the office. This is because payors incentivize physicians for eliminating facility fees. This makes office-based procedures a more financially appealing option for the patient and for the physician.
It also saves money for the insurance company and the system as a whole. Win-win for everybody.
How can I increase my procedure capacity and patient volume?
Because you are no longer at the mercy of the hospital or ASC schedule, you can now schedule more cases in one day in the convenience of your own office. Your efficiencies will improve significantly. Strategy Anesthesia is dedicated in providing the best patient quality of care. Safeguarding that patients emerge from anesthesia safely and with minimal discomfort is our key focus. We actively assist your patients from the moment they arrive, until they depart our care. We believe that word-of-mouth marketing is the best type of marketing and this will be achieved through our high level of patient satisfaction.
Is there a cost for your services?
There will be no cost to your facility for start-up, implementation or ongoing management of the anesthesia program.