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Surgery Center Deaths: Who Is To Blame, If Anyone?


A recent USA Today front page article, essentially did a hatchet job on surgery centers. In the opinion of this writer, the article is misleading, misplaced and inappropriate.

There has been a recent surge in the number of surgery centers - approximately 1,000 in 1988 to approximately 5,500 surgery centers in 2015. In all likelihood, the number will continue to grow.

The isolated cases that are reported to be the product of pouring over thousands upon thousands of Medicare records and postmortem records, which would seem to add legitimacy to the article, are anything but - as they represent a very small percentage of the number of patients that have been treated at Surgery Centers.

Furthermore, other than citing lawsuits brought against surgery centers, and the opinions of expert attorneys that were hired by the plaintiffs in those malpractice cases, there seem to be very few REAL stories or statistics that would answer the underlying question of how patients would have fared had they been in a hospital, as opposed to a surgery center.

The article ignores the fact that doctors are being squeezed in terms of reimbursement for the services they provide. The government is seeking ways in which to cut the cost of the provision of medical care, and like many other countries, has come to the realization that lowering the cost with the use of surgery centers makes a real impact on the cost of providing those very services.

It is inappropriate to take issue with the fact that doctors can own part of the surgery center and derive financial benefit from treating patients at those centers, when it is the very same cost saving initiatives that have driven doctors from the practice of medicine, to the business of medicine.

Let's be honest; would we rather that the profits to medical centers go to independent real estate investors, or would we rather that they go to doctors so that for the same procedure doctors can enhance their earnings based on rates carefully set by the government and the varied insurers. If we want to have enough doctors, it is pretty clear that we must allow doctors to earn amounts commensurate with the number of years they went to school and incurred significant debt and/or cleaned out their parent's savings accounts.

Without the benefit of any real independent comparison between how patients would fare at hospitals under the same circumstances, it is hard to really know the potential issues regarding surgery centers. It is true that they do not have the facility for comorbidities and very complicated or high-risk patients going through what would otherwise be more simple procedures. Surgery centers regularly assess medical history and general health regarding that very issue.

There may always be a judgment call, however, that turns out not to be accurate, just as there will occasionally be a patient that is less than candid about their medical history.

It is surprising that Bill Prentice, chief executive of the Ambulatory Surgery Center Association, dignified this article with any comment except that a failure to respond might sound like an admission of a problem.

It is logical that he declined to speak about individual cases as he may not be aware of the details, and even if he has any knowledge, his comments would have been inappropriate.

However, he did say that "he has seen no data proving surgery centers are less safe than hospitals."

"There is nothing distinct or different about the surgery center model that makes the provision of health care any more dangerous than anywhere else," Prentice said. "The human body is a mysterious thing, and a patient that has met every possible protocol can walk in that day and still have something unimaginable happen to them that has nothing to do with the care that's being provided."

Prentice said physician ownership of surgery centers is a good thing.

What I find possibly the most troubling of all is that ultimately, if we want to curtail the cost of medical care, we have to assign actual dollars to actual health risks. Let me be clear that at a very personal level, I believe in life at all cost. The question is, though, can society afford life at all cost?

In a simple example, how much would it cost for an airline ticket if there had to be an ironclad 100% guarantee that no flight was ever late. This may not be the perfect example and there are other industries of which that the same question can be asked.

In assessing cost, there is a trade-off between cost and perfection.

Many such considerations are readily made with respect to hospitals. Do we have enough hospital and/or trauma units to accommodate mass casualties in every locale?

Does every hospital have a trauma center, or do hospitals regularly divert or transfer patients?

With healthcare costs approaching 20% of GDP, it is abundantly clear that something must be done and it is apparent that surgery centers operate at lower costs than hospitals. It is also obvious that people die in hospitals.

Interestingly, this rather lengthy article did not compare surgery centers with the mortality rates at hospitals and/or the percentage of medical malpractice claims that were brought at hospitals.

The almost bizarre part of the article was the apparent skepticism that 911 had to be called in the cases where the facility could not provide the necessary level of emergent care. What did the writers of the article expect when an emergency transfer was needed - Uber?

In totality, I think it is unfair to cobble together a number of albeit tragic stories assign blame to the surgery care centers and somehow try to both impugn the integrity of all of the doctors in almost 5,500 centers, as well the efficacy and efficiency of those centers.

It is clear that we need major reform in lowering the cost of the provision of healthcare and it will not be accomplished by one-sided stories that give a recitation of a few stories primarily based on malpractice lawsuits, a few opinions of hired medical experts. It is not a real comparison, and makes it sound as though there are no issues or problems within the hospital system.

If we want to address the of the cost of provision of medical care and patient safety, let's do it in a real, accurate, even handed and comprehensive manner that gives the pros and cons of alternative methods, as well as the benefits and burdens thereof.

To the best of the writer's knowledge AXO BILL [] does not provide any billing or revenue cycle management services to any of the surgery centers referred to in the USA Today article.

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