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Surgery ban at outpatient centers lifted

| Friday, March 11, 2005

The state Department of Health has lifted a short-term ban it had imposed on certain surgical procedures at outpatient surgery centers.

More than 170 centers were told in December to stop performing surgeries the state considered too invasive to be done outside hospitals, said Richard McGarvey, department spokesman.

"We found some facilities going in and taking out gallbladders, and that concerned us," McGarvey. "We didn't find any mistakes, but they were invasive."

Most outpatient surgery centers are independent of hospitals. They offer a number of the same outpatient surgical procedures as hospitals, but at a lower cost.

Health department regulations prohibit outpatient centers from performing prolonged surgeries within body cavities, primarily the chest area, in case complications arise. Other surgeries performed at the centers were unaffected.

"There were still many things they could do, like knee or shoulder surgery, or the throat," McGarvey said. "But with the chest cavity area, it's much easier to nick something in there, to make a mistake. Not that operating on an elbow can't be hard, but if something happens there, it's probably not going to be life-threatening."

The surgery centers lobbied for changes, McGarvey said, primarily seeking to be allowed to perform those outpatient procedures that are reimbursed by Medicare.

"Their biggest concern had to do with the (procedures) Medicare will pay for as outpatient surgeries," McGarvey said. "We looked at that and said, yes, maybe we were too strict, so we said if it's on the list, you can do it."

In a letter sent to outpatient surgery centers last week, the health department said it reversed the ban on Medicare-approved procedures because the federal government already has found they can be safely performed in an outpatient facility.

Centers still must seek prior approval from the state, but the requests will be expedited. Approvals will be granted only if the centers comply with Medicare regulations limiting the surgeries to 90 minutes of operating time, 90 minutes under general anesthesia and four hours in recovery.

If the centers want to perform other procedures that do not appear on the Medicare list, McGarvey said they must apply for a regular exception.

"They'll need to present a case to us to get an exception," McGarvey said. "They'll have to show us why it's safe in their facility."

McGarvey said the eased restrictions are a short-term remedy to the outpatient surgery centers' concerns. In light of advances in safety and technology, McGarvey said the state has agreed to review its regulations governing outpatient surgeries.

The review process could take as long as two years, McGarvey said, and will involve public hearings.

Dr. Greg Lauro, an orthopedic surgeon who performs outpatient surgeries at Laurel Surgical Center in Hempfield Township, welcomed the eased restrictions. He said the ruling doesn't affect the types of surgeries he performs but will apply to other surgeons who also use the center.

Lauro said surgeries that were affected by the ban have been performed safely at outpatient centers in other states, usually at a cost savings to patients.

"We've done how many thousands of these across the country; complications are low, with tremendous cost savings," Lauro said. "It's great for the outpatient centers, for the doctor and the patient; from that perspective it's a win. Hospitals may look at it differently."

Outpatient surgery centers compete with hospitals for patients.

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