By: Juan Arredondo and Bri Driggers
When considering the establishment of an outpatient-based lab (OBL) or a freestanding Ambulatory Surgery Center (ASC), it is crucial to consider the nuances and challenges associated with each along with regulatory and compliance issues.
This blog post summarizes the points discussed in our webinar about the key factors that drive the decision-making process, such as procedure requirements, ownership models, reimbursement structures, regulations, staffing, and equipment. Additionally, we will explore the differences in patient experiences between ASCs and OBLs.
Procedure Selection and Center Setup
The choice between an ASC and an OBL primarily revolves around the procedures that physicians intend to perform. For example, procedures requiring light-conscious sedation are suitable in an outpatient setting like an OBL. The trend of performing IR procedures outside of hospitals has gained popularity due to its distinct advantages. ASCs, being freestanding facilities, possess unique ownership models and construction requirements, which may vary. Accreditation and staffing mix are tailored to the specific procedures conducted.
Ownership Models and Reimbursement
OBLs are limited to ownership by physicians or medical professionals, adhering to the corporate practice of medicine laws in certain states. Conversely, ASCs can be owned by non-medical professionals or corporations, potentially presenting a higher barrier to entry due to associated costs and potential Certificate of Need requirements. Reimbursement models are driven by Current Procedural Terminology (CPT®) codes. ASCs predominantly follow a split bill system, whereas OBLs operate under a single global fee that covers both physician services and costs. Reimbursement rates vary based on the procedure type and setting.
Procedures and Patient Experience
The choice of procedures to be performed in an ASC or OBL depends on factors such as reimbursement rates, the need for full anesthesia, and the complexity of the procedure. More complex procedures are typically performed in ASCs, while outpatient IR procedures are routinely performed in OBLs. Performing outpatient procedures in a hospital can be challenging due to the busy nature of trauma and emergency departments, potentially impacting the overall patient experience. Ensure a seamless patient experience learning how to set up an OBL.
Advantages for Patients in OBLs
When a procedure is performed in an OBL, patients benefit from shorter room turnover time, reduced pre- and post-procedure time, and a more tailored experience. OBLs provide a unique approach, treating patients as individuals with distinct needs including a consultation with the physician prior to their procedure appointment. Moreover, the cost for patients is often lower compared to hospital settings.
Given the constant changes in reimbursement codes, adopting a hybrid model offers flexibility in adapting to business needs. Strategic planning, meeting all requirements, and seeking legal professionals’ guidance is essential for successful transitions between the two settings. Ensure you are informed about Legal and financial implications of operating an OBL or ASC. Notably, OBLs cannot provide anesthesia in that setting but can provide sedation with Fentanyl or Versed. If a patient requires conscious sedation with propofol or something higher, it will need the involvement of an anesthesiologist and CRNA in the ASC setting.
Ultimately, the decision to establish an OBL or an ASC requires a thorough consideration and evaluation of various factors. Understanding the distinctions between ASCs and OBLs concerning procedure selection, ownership models, reimbursement structures, patient experiences, and anesthesia is essential for informed decision-making. While both settings offer advantages over traditional hospital environments, OBLs and ASCs offer patients a better patient experience for outpatient procedures where that setting is appropriate for the patient. By weighing these factors carefully, healthcare providers can optimize their practices to deliver exceptional patient care in the most suitable setting.