Joseph Banno, MD, a board-certified urologist and founder of Peoria (Ill.) Day Surgery Center and past chairman of the American Association of Ambulatory Surgery Centers, suggests ASCs should consider adding and performing the following six urology procedures to satisfy patient needs and maximize profits.
1. Endoscopic procedures. Dr. Banno says that endoscopy allows him to view the urethra, prostate and bladder. "Performing these procedures allows me to treat simple and complex urethral strictures and to laser and resect obstructing prostate tissue," he says. He can also resect small and large bladder tumors and fragment small and large bladder and urethral calculi. Private insurers usually pay $1,000-$1,500 for a typical cystoscopy procedure. Medicare would pay much less.
2. Incontinence procedures. Dr. Banno says that sling procedures, used for male and female incontinence, are quick and simple surgeries safely done in an outpatient surgery setting. "These procedures involve using sling material, either from a cadaver or synthetic, to elevate the urethra and prevent incontinence. Reimbursement is good and ASCs are much more efficient than the hospitals for this type of surgery," he says. "Because of the price of some of the slings, many urologists are substituting generic slings, which lower the cost of the total procedure, thus allowing some Medicare patients to have their surgery at ASCs." Commercial payors would average $1,500-$2,250.
3. Neurostimulation to treat urinary frequency. With the growing number of overactive bladder therapies on the market, some patients are not cured with currently available medications. "These patients often are great candidates for neurostimulation," Dr. Banno says, citing the use of, for example, Medtronic's Interstim device, to perform the procedure. Initially, the patient undergoes a test procedure and over a two-week period, if successful, a permanent placement is performed. Typically, 65 percent of the patients who are tested for Interstim are candidates for the permanent procedure, he says. Reimbursements average around $15,000 for this procedure.
4. Penile implants. Dr. Banno says that surgically placing inflatable penile implants is both safe and effective for patients in ASC settings. "These surgeries have been performed in patients as young as 19 and as old as 90," he says. Since the approval of Medicare patients to be covered for penile implant surgery, ASCs can negotiate with the various insurance companies and vendors to make this surgical procedure financially feasible in the ASC setting. He says the popularity of the implants is likely to grow with the aging of the Baby Boomer generation. The ASC receives between $9,000 and $10,000 for the implant procedures.
5. Extracorporeal lithotripsy. This procedure, which is primarily performed in hospitals, now can be completed safely and easily at surgery centers, Dr. Banno says. "It is a non-invasive procedure which involves using high-density, acoustic pulse shock waves from a lithotripter to obliterate kidney stones and urethral stones."Private insurers pay $1,500-$2,250.
6. Vasectomy reversals. Dr. Banno says that procedures such as vasectomy reversals are typically not covered by the insurance companies, but noted that patients can save $15,000-$20,000 by having the procedure performed in an ASC, which he says is a safe setting. Most reversals are self-paid and bring in $1,500-$3,900.
Dr. Banno (jjbanno@gmail.com) is a board-certified urologist with Midwest Urological Group and founder of Peoria Day Surgery Center, which opened in 1990 and is staffed with seven urologists and used by 43 other physicians of various specialties. He is also past chairman of the Ambulatory Surgery Center Association and a current executive committee member.