Anyone do "inpatient" cases at a surgery center?

[Intubate]

Our orthos want to start doing some of their total joints ("select cases")at the surgery center, keep them overnight, and discharge them in the morning. They need an MD in house and they want that to be us. I don't believe we would be responsible for anything other than emergencies as their post op care is very protocolized. Are any of you guys involved in something like this? Any input would be helpful.

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[deleted126335]

Sounds like it could be a sweet gig or a prison sentence depending on how much they pay you to sleep.
Also, I would expect that your responsibilities would evolve from the initial "just for emergencies" to pain control, evaluation for things like confusion, belly pain, etc.

 

[Carbocation1]

Surgical Home???

 

[leaverus]

i dont get it. if theyre gonna keep em overnight anyway what's the point of doing them at the sc?

 

[deleted162650]

i dont get it. if theyre gonna keep em overnight anyway what's the point of doing them at the sc?

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

 

[pgg]

i dont get it. if theyre gonna keep em overnight anyway what's the point of doing them at the sc?

They probably own the surgicenter and collect the facility fee for everything they do there. They schedule the people with good insurance at the surgicenter and do the charity work at the hospital.

They'll push to do everything there, if the insurance meets criteria. Yesterday I was moonlighting at such a place, and they asked me to clear an old guy with CHF and an EF of 25%, and one of those Lifevest defibrillators he's been told to never ever take off. I said no. They turned around and put him on tge schedule anyway (a day I'm not there). I'm not sure why they even bothered to ask me.

 

[sleepallday]

Why do they need an MD in house? There's ortho here does that at a surgicenter without an MD in house.

At my own place, we've started to send most of our total hips and a few of the total knees home the same day.

 

[Psai]

So they want to keep them, earn money off your back and toss you some scraps for doing their bidding? Thanks, but no thanks. If you did the surgery and you want them to sit in your facility for no good reason, then it's your responsibility to follow up post-op

 

[Mman]

We do healthy TKAs at surgicenter and send them home POD #1, but there is no MD in house overnight with them. If the orthopod wants an MD 24 hours a day with the patient, I'd direct them to the location of a call room where they can get comfy.

 

[jwk]

No reason for anesthesia in-house. If they're worried about it, they can stay.

We're doing a ton of outpatient total joints at one of our hospitals - careful patient selection and good surgeons. Lots of happy folks all around so far.

 

[teeva]

$1000 per night minimum or $500 per pt is my babysitting fee. No one is hiring though.

 

[okayplayer]

$1000 per night minimum or $500 per pt is my babysitting fee. No one is hiring though.

Not worth it. Not even close.

 

[teeva]

I'm in California, gotta take what you can get!

 

[deleted162650]

Everyone has a price

 

[fakin' the funk]

$300/hr

 

[okayplayer]

$300/hr

Maybe $200 if you were NEVER called.

 

[deleted162650]

I'd rather do it in exchange for some ownership stake in the ASC.

 

[Planktonmd]

This is a very strange set up! Surgicenters are for out-patient surgery, a patient staying over night is not an out patient!
I have a feeling that there might be some legal issues here in changing the use an outpatient facility into an inpatient facility without proper licensing, unless this is the reason they are insisting on having a physician in house so they can change the classification of the facility.
If the money is good and you have guys who agree to sleep at the surgicenter for a good fee and your liability insurance carrier is OK with it then why not?

 

[deleted162650]

23 hour obs is not considered inpatient. That's how they skirt the rules

 

[Winged Scapula]

23 hour obs is not considered inpatient. That's how they skirt the rules

Yep, according to CMS anything less than "2 hospital midnights" can be considered as outpatient/observation.

 

[IlDestriero]

One place I looked at had this set up at one center. They called them 2359 patients. As in 23 hour 59 minute patients. You could sleep there overnight for $750 with 2 or 3 of them there. Supposedly you were rarely bothered as the surgeons managed most issues by phone at home. I was skeptical, but wasn't interested so I didn't follow up on that.

 

[Ignatius J]

Just hire a medicine doc to moonlight. Get a moonlighting resident and you're gravy.

 

[Gastrapathy]

The best are moonlighting fellows. They are IM boarded but still paid like residents. Doesn't matter the subspecialty (except for Allergy, those ****ers will never do it), they all need the cash.

 

[aneftp]

Just hire a medicine doc to moonlight. Get a moonlighting resident and you're gravy.

Great idea. Why not?

They do this all the time with "sub contractor" work.

We see it all the time in so many industries. The most notorious being big road construction projects.

Collect the cash punt the responsibility to someone else. Easy profit with no liability!........until the surgeons get wind of your plans.

Only if our taxpayer money were used wisely. Road projects would be completely faster without the subcontractors passing the buck.

 

[Ignatius J]

Great idea. Why not?

They do this all the time with "sub contractor" work.

We see it all the time in so many industries. The most notorious being big road construction projects.

Collect the cash punt the responsibility to someone else. Easy profit with no liability!........until the surgeons get wind of your plans.

Only if our taxpayer money were used wisely. Road projects would be completely faster without the subcontractors passing the buck.

Not sure where this is going. It doesn't take a board-certified anesthesiologist to sit on the floor overnight with total joint patients. Any resident is more than qualified to do this.

 

[Mman]

Not sure where this is going. It doesn't take a board-certified anesthesiologist to sit on the floor overnight with total joint patients. Any resident is more than qualified to do this.

Pretty sure there is no requirement for an in house physician except for perhaps a local policy of the facility. We have overnight observation patients at our outpatient facility and there is never a doctor in house overnight. The surgeon fields calls from home.

 

[aneftp]

Not sure where this is going. It doesn't take a board-certified anesthesiologist to sit on the floor overnight with total joint patients. Any resident is more than qualified to do this.

No. I am saying. Just say u will do it.

Than find some lower paying subcontractor (aka resident physician) and pay them $30-50/hr to baby sit patient while u collect the real fees (hopefully $150/hr).
That's how sub contracting work.

 

[Mman]

There was a physician owned orthopedic hospital that was permanently closed after a death. Maybe ten years ago. As I recall they had a cervical diskectomy, and what sounded like swelling/hematoma post op. No physician was in house. The nurses called 911 to transfer.

The question is probably whether it is a hospital or an outpatient facility. Inpatient admissions likely have different standards than 23 hour obs patients.

 

[Ignatius J]

No. I am saying. Just say u will do it.

Than find some lower paying subcontractor (aka resident physician) and pay them $30-50/hr to baby sit patient while u collect the real fees (hopefully $150/hr).
That's how sub contracting work.

Gotcha. We're in agreement then. I remember LTAC moonlighting opportunities when I was a resident. Seemed like good gigs.

I'm assuming the orthopods don't want to be bothered in the middle of the night with silly things.