The recent Joan Rivers tragedy has thrust medical malpractice and ambulatory surgical centers (ASC) into the media spotlight. ASCs are a relatively new phenomenon. As I’ve learned, and heard on radio advertisements, local ASCs like to tout that one reason to consider having your surgery there is that there are fewer post-operative infections than in a hospital.
There are undoubtedly other reasons why ASCs may be right for the right patient and the right procedure, but as Ms. Rivers’ death highlights, there are some real risks associated with having certain surgical procedures done outside of a hospital setting. And perhaps most disconcerting, there are times when the doctors’ interest in making money (having the surgery done at an ASC) does not align with the best interests of the patient.
Doctors – both surgeons and anesthesiologists – can make more money at an ASC. Oftentimes there are two distinct ways in which insurance (or patients, or Medicare) is billed for a surgical procedure. One is the actual professional fee paid to the doctor. The other is a facility fee. So, if a surgeon performs a procedure in a hospital, he or she would get the professional fee but no cut of the facility fee.
To “solve” that problem, entrepreneurial doctors figured out ways to get at the facility fee (which can be as much as 10 times higher than the professional fee). They created ASCs and owned them along with fellow doctors who performed procedures there. That way, they would get their professional fee, and the facility (which they co-owned) would get the facility fee, a portion of which they would then get.
Normally this works out just fine for the patient. A patient may be coming in for a fairly routine procedure, and may not have risk factors that would predispose him or her to surgical complications. But the problem arises when a patient isn’t the right candidate for a surgical procedure outside of a hospital, but the doctor is influenced by the prospect of making much more money if it’s done at the ASC. In such situations, as it appears was the case with Ms. Rivers, the doctor took risks with the patient’s health (and life) for more money.
