72-Hour Recovery Center Greatly Expands the Scope of an ASC

An overnight recovery area opens a whole new world for ASCs looking to build volume with a wider array of procedures, says Joseph Banno, MD, a urologist and founder of the Peoria (Ill.) Day Surgery Center, a four-OR, multispecialty ASC.

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In Dr. Banno's opinion, when an ASC has no place for surgery patients to recover for up to a three nights, it cannot handle such cases as hysterectomies, sinus surgeries, many types of spine surgery, some gall bladder surgery, abdominoplasties and penile implants.

While Illinois and many other states generally don't allow ASCs to maintain three-night recovery areas, Peoria Day is an exception. It entered a state pilot program almost 14 years ago that allowed four ASCs in Illinois to build recovery care centers that can hold post-op patients for as long as 72 hours.

Dr. Banno says 93 percent of all surgeries can be done in an ASC when patients have a chance to recover for up to three nights. The recovery center made his ASC more attractive. When the surgery center opened in 1997, 10 more surgeons signed up. Today, 53 physicians, including 44 investors, use it and the ASC has an infection rate of less than 1 percent.

The state pilot never led to implementation of a full-blown program, but Peoria Day and the other original pilots remain in operation. Dr. Banno says the recovery center itself currently does not break even. The state limits the charge to $600 a night per patient and, under the current volume of patients, that doesn't pay for two nurses it has in each shift. However, the recovery center adds 38 percent more revenue to the ASC, representing cases that the ASC otherwise would not be able to accept.

Dr. Banno has petitioned the state to allow a higher charge and he expects the recovery center's volume to rise. He also says more insurers are interested in contracting with the ASC.

Similar recovery centers are permitted in California and several other western states. And in many states, some ASCs are converting into surgical hospitals to allow for longer recoveries. Dr. Banno says Illinois began allowing these conversions last year, but he is not planning to open such a facility at this time. Provisions to ban new surgical hospitals in the health reform bills in Congress have dampened enthusiasm. Also, new hospitals in Illinois are expensive due to state requirements to reinforce them with steel to withstand tornados.

Dr. Banno is pleased with his unusual recovery care center and owes a great deal of his business to it. He performs 100-150 penile implants a year at the ASC, knowing patients can always stay overnight in the center if necessary. Except when he is on call at the hospital, he almost never uses the hospital OR anymore.

Learn more about Peoria Day Surgery Center at www.peoria.com.