Outpatient center wants to offer surgeries that require overnight stays

An outpatient surgery center in Bethesda, Md., will start offering procedures that require overnight patient stays, a move that could further encroach on services traditionally provided by full-service hospitals, the Washington Business Journal's Ben Fischer reports.

If the Massachusetts Avenue Surgery Center's (AVSC) proposed care expansion moves forward and receives regulatory approval, other ambulatory surgery centers (ASCs) may follow. It could have broad implications for hospitals already struggling to maintain anemic inpatient volumes.

'Overnight' stays: A regulatory gray area

AVSC's expansion plans fall into a regulatory gray area because federal and state laws do not clearly define what constitutes an "overnight" patient stay. Specifically, the laws do not clearly delineate whether stays at outpatient surgery centers are limited to fewer than 24 hours or to the calendar day of the procedure.

Ambulatory surgery centers may soon outnumber hospitals

Randy Gross, AVSC's executive director, told Fischer that he recently learned from a state regulator that "Maryland does follow [CMS] guidelines, and you can keep a patient in an ambulatory surgery center (ASCs) for 23:59."

However, the issue is not so clear cut, says Barbara Fagan, program manager of ambulatory care services in the state's Office of Health Care Quality, which ensures compliance with federal health care rules. "The intent of an [ASC] is not to do an overnight," she argues.

Fagan notes that federal statute does not prohibit patients with medical complications from staying at an ASC overnight, but she questions whether the industry could permanently adopt overnight stays without violating other care standards. ASCs are "not equipped for providing meals, changing linens, they're not set up with those types of services we'd normally see in hospitals," Fagan says.

Gross—along with Louis Levitt, the chair of AVSC—believe that certain investments and renovations will enable the facility to start offering around-the-clock care for low-risk patients. Even with the costly changes, the AVSC still is a more affordable alternative to a hospital stay, Gross says.  

A sign of more expansions?

According to Fischer, most outpatient centers are years away from being able to handle overnight stays.

However, regulatory approval for AVSC would provide a strong financial incentive for others to consider such a move. The service lines best suited for an expansion would be orthopedics, urology, and gynecology, but others could follow, according to Levitt (Fischer, Washington Business Journal, 1/8).