OMFS Surgicenter

[Sup Dude]

Hey sdn,

I am curious to hear from some practicing OMFS that participate or have ownership in a surgicenter. It is my understanding that surgicenters are extremely costly to build/start, but in the long run they provide better reimbursement for procedures (overhead is lower than hospital fee's). I have heard of a group of OMFS, plastic surgeons, ENT all being co-owners of a surgicenter and being able to have more take home pay for larger outpatient procedures like mandible fx's, cosmetic procedure's, simple TMJ, single jaw orthog's. Does anyone have any experience with this? I have so many questions about it.

1. How is the anesthesia administered? Can cRNA's fly solo or does there have to be a full time anesthesiologist present (this probably varies by state)? Can OMFS act as the overseeing anesthesiologist?
2. Approximately how much more take home pay does it provide?
3. How much is start up price for let's say a 3 OR surgicenter?
4. What type of procedures are typically being done?
5. What type of providers are typically interested in this setup or are good to have as co-owners? Urologist, orthopedics, ENT, plastics?
6. In general what are the pro's and con's of surgicenters (safety, liability, convenience, etc)

Any insight would be much appreciated!

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[Sublimazing]

OMFS make most of their money from thirds and multi-implant cases. Neither of those “reimburse” more with a surgery center. Nothing else pays nearly as much as those 2 procedures. Trauma, ortho, path, etc are all fun and you should do them…but they don’t justify having a surgery center.

 

[Sup Dude]

Thank you for your response, but it offered little to no insight at all and answered none of my questions @Sublimazing . Obviously T&T is the bread and butter of OMFS, and I would never consider doing those procedures in a surgicenter unless ETT GA was the preferred surgical environment for the particular case. I am more referring to the situation of private practice OMFS working 3-4 days a week in their practice and taking a few mandibles, cosmetic procedures, path procedures etc. to a surgicenter 1-2 days a week rather than taking them to the local hospital.

A few benefits I can think of off hand would be:
1. fewer staffing issues (your scrub tech won't be pulled out of your room to go to an emergent spine case because he/she is the only person there that is trained and available to do it)
2. better compensation due to lack of hospital fee's
3. convenience for both patients and surgeons

Some downsides:
1. safety (fewer personnel available in emergent situations)
2. buy-in or start-up costs

Anyone out there with first hand experience that can drop some knowledge on me! Thanks!

 

[Sublimazing]

Thank you for your response, but it offered little to no insight at all and answered none of my questions @Sublimazing . Obviously T&T is the bread and butter of OMFS, and I would never consider doing those procedures in a surgicenter unless ETT GA was the preferred surgical environment for the particular case. I am more referring to the situation of private practice OMFS working 3-4 days a week in their practice and taking a few mandibles, cosmetic procedures, path procedures etc. to a surgicenter 1-2 days a week rather than taking them to the local hospital.

A few benefits I can think of off hand would be:
1. fewer staffing issues (your scrub tech won't be pulled out of your room to go to an emergent spine case because he/she is the only person there that is trained and available to do it)
2. better compensation due to lack of hospital fee's
3. convenience for both patients and surgeons

Some downsides:
1. safety (fewer personnel available in emergent situations)
2. buy-in or start-up costs

Anyone out there with first hand experience that can drop some knowledge on me! Thanks!

what i was trying to get across to you was that almost no one does this…surgeons who are doing path, trauma, and cosmetics big enough to do in an OR setting are faculty at a hospital. OMFS don’t use surgicenters because we mostly don’t need them. you’re talking about getting “reimbursed” more for a mandible…even if you get $3k for it you would’ve made 4 times that doing thirds.

there may be a handful of practices who use a surgicenter occasionally, but there is zero benefit to that over just having a sevo outlet in your office or hiring mobile anesthesia to come out. there’s nothing a surgery center has that you couldn’t put in an office. and my reimbursement on a mandible is the same in my office as in the OR.

please link the OMFS you know who own a surgicenter or use one “2 days a week” so i can provide more specifics for you. but the likelihood of a surgicenter offering any benefit is really small.

 

[NomadicMaxFac]

I’m not an attending like @Sublimazing, just a resident, but I’ll take my best shot at providing an answer to some of your questions.

Some of the surgeons at my program use an ASE that is on the campus of our hospital for some of our cases. I know some of our faculty are part-owners of the ASE and is not owned or operated by the hospital. Turnover is much faster at the ASE and I understand that patient billing is more favorable, but medically complex or lengthy surgeries are not performed there. I also notice that everyone that is treated there usually has either private insurance or pays cash, we never take Medicaid patients there. I have done dentoalveoler cases over there for really anxious patients my attendings don’t want to try to sedate in their offices. I have also done some submandibular gland excisions, implants, and other quick cases in the ASE.

There is a podcast episode of Everyday Oral Surgery that features Jeffery Carter, the founder of the Oral Surgery Institute in Nashville. In the podcast, he talks about how he built an ASE that was owned by the practice and used for orthognathics and TMJ. He negotiated what is called a “carve-out” with insurance companies to cover his full $9k surgeons fee for a double jaw case once the insurance companies realized that having the case done in an ASE would save them money by avoiding hospital up charges. He does note that he usually cycled through associates every few years due to burnout caused by high surgical volume.

Another place that I believe owns their own surgical centers is the Carolinas Centers for Oral, Facial, Cosmetic & Dental Implant Surgery. From what I have heard, they have operating rooms built into all their practices and do orthognathics and cosmetics there. They offer a fellowship as well.

 

[NomadicMaxFac]

Also, although I’m sure there are tons more, here are a couple of practices that have their own operating rooms on site:

Alaska Oral+Facial Surgery Center:

Alaska Center For Oral & Facial Surgery - Welcome to Alaska Center For - Alaska Center for Oral & Facial Surgery

At Alaska Center For Oral & Facial Surgery, we treat a myriad of teeth and jaw issues including bone grafting and TMJ treatments. Contact our office today for more information!

www.alaskaoralfacialsurgery.com

Canyon Point Oral Surgery:

https://www.canyonpointsurgery.com/our-office/office-tour/

 

[Sublimazing]

I’m not an attending like @Sublimazing, just a resident, but I’ll take my best shot at providing an answer to some of your questions.

Some of the surgeons at my program use an ASE that is on the campus of our hospital for some of our cases. I know some of our faculty are part-owners of the ASE and is not owned or operated by the hospital. Turnover is much faster at the ASE and I understand that patient billing is more favorable, but medically complex or lengthy surgeries are not performed there. I also notice that everyone that is treated there usually has either private insurance or pays cash, we never take Medicaid patients there. I have done dentoalveoler cases over there for really anxious patients my attendings don’t want to try to sedate in their offices. I have also done some submandibular gland excisions, implants, and other quick cases in the ASE.

There is a podcast episode of Everyday Oral Surgery that features Jeffery Carter, the founder of the Oral Surgery Institute in Nashville. In the podcast, he talks about how he built an ASE that was owned by the practice and used for orthognathics and TMJ. He negotiated what is called a “carve-out” with insurance companies to cover his full $9k surgeons fee for a double jaw case once the insurance companies realized that having the case done in an ASE would save them money by avoiding hospital up charges. He does note that he usually cycled through associates every few years due to burnout caused by high surgical volume.

Another place that I believe owns their own surgical centers is the Carolinas Centers for Oral, Facial, Cosmetic & Dental Implant Surgery. From what I have heard, they have operating rooms built into all their practices and do orthognathics and cosmetics there. They offer a fellowship as well.

Can you give us more details on higher reimbursement? Because cash patients don’t get reimbursements…they pay what you charge. And that’s going to be for implant and dental alveolar. You’re also not going to get paid for the anesthesia…so can you give an example of a procedure you did in the surgery center and what the difference in reimbursement was like?

I personally cannot think of a single advantage the surgery center has over hiring a CRNA or Mobile anesthesia for the office…the private practice that is truly busy enough with orthognathics is rare…and in terms of the “carve out” my hospital double jaws reimburse closer to $17k…but maybe i’m missing something?

 

[Sublimazing]

Also, although I’m sure there are tons more, here are a couple of practices that have their own operating rooms on site:

Alaska Oral+Facial Surgery Center:

Alaska Center For Oral & Facial Surgery - Welcome to Alaska Center For - Alaska Center for Oral & Facial Surgery

At Alaska Center For Oral & Facial Surgery, we treat a myriad of teeth and jaw issues including bone grafting and TMJ treatments. Contact our office today for more information!

www.alaskaoralfacialsurgery.com

Canyon Point Oral Surgery:

https://www.canyonpointsurgery.com/our-office/office-tour/

Where are you finding their ambulatory surgery certification? Is there a database somewhere? I searched the canyonpoint site and saw nothing.

Are there any in chicago?

 

[Sup Dude]

Thanks for the info! Here is another example I just found. I looks like they have ENT, OMFS, pediatric dentistry, urology, OB, podiatry, gen surg, ortho.

Southern Indiana Surgery Center Bloomington – A Partner with Southern Indiana University Health

A Partner with Southern Indiana University Health

southernindianasurgerycenter.com

I have heard building one costs roughly $1 million per OR, but that was word of mouth so I'm not confident in how accurate that number is. But with several surgical subspecialties involved the startup cost would be well distributed. Would love to hear from some OMFS that have experience with this setup.

 

[NomadicMaxFac]

I wish I could answer those questions in detail for you. Our attendings don’t tend to share much about the financial aspects of their practices with us. I also am not privy to the details about Canyon Point works or how the operating room is certified. As I’m progressing in my training, I am trying to learn more about the details of how and why different surgeons choose to practice the way they do.

 

[Sublimazing]

I wish I could answer those questions in detail for you. Our attendings don’t tend to share much about the financial aspects of their practices with us. I also am not privy to the details about Canyon Point works or how the operating room is certified. As I’m progressing in my training, I am trying to learn more about the details of how and why different surgeons choose to practice the way they do.

well my main question is…how do you know they are ambulatory surgery centers? my office has sevo and an anesthesia machine…we use a CRNA…but we’re not an ASC.

I just haven’t seen the practices you’ve listed show any signs of ASC certification. And that’s my whole point, that it just doesn’t usually make any sense for private practice OMFS to own an ASC.

And you mentioned higher reimbursement but then talked about cash procedures and procedures that accept dental insurance…neither of which would vary at all in an ASC.

 

[Sup Dude]

well my main question is…how do you know they are ambulatory surgery centers? my office has sevo and an anesthesia machine…we use a CRNA…but we’re not an ASC.

I just haven’t seen the practices you’ve listed show any signs of ASC certification. And that’s my whole point, that it just doesn’t usually make any sense for private practice OMFS to own an ASC.

And you mentioned higher reimbursement but then talked about cash procedures and procedures that accept dental insurance…neither of which would vary at all in an ASC.

Both the Indiana ASC and the Alaska ASC's website clearly state they are AAAHC certified. How can you repeatedly and confidently state that it doesn't make sense for an OMFS to own an ASC without having any basis for this statement? If you are asking for explanations on the in's and out's surgery centers you aren't qualified to deem them worthwhile. Why not sit back and wait for someone with first hand experience to chime in or do some research for yourself.

Okay, your office has sevo and a vent- that's common. So are you doing orthognathic surgery in your office or doing a transQ mandible in your office? If not, why not? There's more to an ASC than sevo and a vent.

 

[Sublimazing]

Both the Indiana ASC and the Alaska ASC's website clearly state they are AAAHC certified. How can you repeatedly and confidently state that it doesn't make sense for an OMFS to own an ASC without having any basis for this statement? If you are asking for explanations on the in's and out's surgery centers you aren't qualified to deem them worthwhile. Why not sit back and wait for someone with first hand experience to chime in or do some research for yourself.

Okay, your office has sevo and a vent- that's common. So are you doing orthognathic surgery in your office or doing a transQ mandible in your office? If not, why not? There's more to an ASC than sevo and a vent.

Alright friend, let's pump the brakes here. Let do some education because you are using terms incorrectly. An ASC is a very specific entity with specific certifications and licensing. It's through CMS. This AAAHC that you're talking about is a separate 3rd party certification started by private groups...it means just about nothing.

This is a list of ALL the ASC's in Alaska

https://dhss.alaska.gov/dhcs/Documents/hflc/PDF/HFLC_Facility_List_WebsiteList.pdf

Notice that your oral surgery practice is not listed. Did you click on their website? They have a very normal oral surgery office. So let’s stop acting so confident about using terminology incorrectly.

And I'm not asking for the ins and outs. @NomadicMaxFac wrote a great post, but there were some holes in the information he was sharing. Let's start by pointing out that the facility he is directly familiar with is partly owned by a major health organization and on a hospital campus...So right off the bat let's all admit it really doesn't apply to your question about owning a surgery center because modern healthcare conglomerates would NEVER allow this to happen. Next he mentioned that they were getting reimbursed more for cash patients and dental implants. That just doesn't make sense...there's no such thing as reimbursement for cash patients...implants are nearly all cash and the ones that aren't are dental insurance which isn't going to pay more in an ASC. He also referenced Jeffrey Carter in Nashville...Carter was running an actual ASC...he was a CMS provider...and that's why he was making so little...he was "maximizing his billing" because he was doing something that no surgeon does outside of academics...accepting medicaid...and who knows how many years this was.

So my questions were poignantly asked to show that what he was describing really didn't answer your question. He then started sharing practices, the ones I've clicked on were not ASC's...so again I asked him to show me if maybe I was missing something.

You also did not comprehend the entire point of my post, and interpreted the exact opposite of my message. My office has Sevo, has a machine, and has a CRNA but we are not an ASC...because as I've been saying...it DOESN'T MAKE SENSE to CERTIFY AS AN ASC.

No we don’t do orthognathic in the office…we go every Tuesday to the OR…because there’s no real reason for 99% of surgeons to do it in the office or certify as an ASC to do it there. And these "transQ mandibles" you talk about...those referrals come from the hospital when you're on call. It just doesn't make sense to get the patient discharged from the hospital you have privileges at...see them in your office for the consult...and then use an ASC that you own all for a profit of less than $1500. As you move along in your training you'll also see that you'll want to admit almost all orthognathic and "transQ mandibles" for at least a night...or at the very least have that option.

I'm sure there are a handful of surgeons across the country who have an ASC and it makes sense for them...but I bet all of them have some qualifier that makes them different than 99% of their colleagues...like having done a cosmetic fellowship...running their own fellowship...or something else.

So if you want to wait for all the private practice oral surgeons with “first hand experience” of owning an ASC to chime in we can wait. But this is basically akin to asking very specific questions about cooking hamburgers because you plan on opening a Five Guys in Mumbai.

 

[DavesNotHere]

@Sublimazing what about using an asc or similar facility (not necessarily certified) as opposed to a hospital?

 

[Sup Dude]

@Sublimazing an ASC certified by CMS is simply a medicare/medicaid certified ASC. Ambulatory Surgical Center is actually a very broad term..

But since we are talking about Medicare Certified ASC's..

Find an ASC

Use this interactive map to locate Medicare-certified ambulatory surgery centers (ASCs) in the United States.

www.advancingsurgicalcare.com

There you go. In just 10 minutes I was able to find an ASC in Chicago that offers dental/oral surgery. Along with ASC's in Anchorage, Charolette, Gainesville, Dallas.. pretty much every city that I clicked on has an ASC with dental/oral surgery offered. Actually, 8% of all ASC's offer dental/oral surgery. And 2% of all ASC are solely dental/oral surgery centers. In 2015, there were over 5,200 ASC's in the U.S. That's over 400 ASC's offering dental/oral surgery and over 100 ASC's that are solely dental/oral surgery centers. Also, I'll remind you these are only the medicare certified centers.. This doesn't include the third party certifications we talked about earlier.

Also, 64% of all ASC's are solely physician owned and another 29% are physician/corporate or physician/hospital owned. Only 1% are solely hospital owned.

The website also offers great resources on the benefits of ASC's. Total Texas Medicare savings in 2019 was almost $400 million. And you can find the specific savings amount for every state. So, obviously there are patient benefits. But the purpose of the thread was to see if there is anyone out there that can expand upon the physician/dentist benefits. It's a slim shot, as most SDN participants are students or residents, but worth a shot none the less.

Please continue to fall on your sword in this thread. When you do it in all caps its even better..

 

[Sup Dude]

@Sublimazing what about using an asc or similar facility (not necessarily certified) as opposed to a hospital?

Yes, this is my entire point and what I am interested in- taking surgeries to a surgicenter rather than a hospital

 

[DavesNotHere]

Yes, this is my entire point and what I am interested in- taking surgeries to a surgicenter rather than a hospital

Lol dude what? Most of your post was about owning them. And you’re being annoying about it.

 

[Sublimazing]

@Sublimazing an ASC certified by CMS is simply a medicare/medicaid certified ASC. Ambulatory Surgical Center is actually a very broad term..

But since we are talking about Medicare Certified ASC's..

Find an ASC

Use this interactive map to locate Medicare-certified ambulatory surgery centers (ASCs) in the United States.

www.advancingsurgicalcare.com

There you go. In just 10 minutes I was able to find an ASC in Chicago that offers dental/oral surgery. Along with ASC's in Anchorage, Charolette, Gainesville, Dallas.. pretty much every city that I clicked on has an ASC with dental/oral surgery offered. Actually, 8% of all ASC's offer dental/oral surgery. And 2% of all ASC are solely dental/oral surgery centers. In 2015, there were over 5,200 ASC's in the U.S. That's over 400 ASC's offering dental/oral surgery and over 100 ASC's that are solely dental/oral surgery centers. Also, I'll remind you these are only the medicare certified centers.. This doesn't include the third party certifications we talked about earlier.

Also, 64% of all ASC's are solely physician owned and another 29% are physician/corporate or physician/hospital owned. Only 1% are solely hospital owned.

The website also offers great resources on the benefits of ASC's. Total Texas Medicare savings in 2019 was almost $400 million. And you can find the specific savings amount for every state. So, obviously there are patient benefits. But the purpose of the thread was to see if there is anyone out there that can expand upon the physician/dentist benefits. It's a slim shot, as most SDN participants are students or residents, but worth a shot none the less.

Please continue to fall on your sword in this thread. When you do it in all caps its even better..

And that website is just ANOTHER private organization.

You're not going to get more reimbursement for oral surgery procedures because you're at some flim flam surgery center.

Anyways, you're super unpleasant. Good luck with your medicare surgery center. Sounds awesome.

 

[Sublimazing]

@Sublimazing what about using an asc or similar facility (not necessarily certified) as opposed to a hospital?

well again, I can't see a benefit to taking cases to a surgery center...as opposed to just having mobile anesthesia in your office.

my practice is rare because we go to the OR once every 1-2 weeks with an orthognathic or a TMJ TJR...and I take level 2 trauma call every 5-6 weeks but we still use the hospital for a couple reasons

1. Orthognathic and TJR (and nearly all OMFS hospital cases) are elective. So there's no problem booking a first start case on almost any day of the week when you're doing it 1-2 months in advance.

2. These are big cases and we only do 1 per day so turn over time (which isn't really slow at a private hospital anyway) is not an issue...nor is getting a case bumped.

3. These cases almost all get admitted for at least a night. And any big case I'd want the option to admit for post operative airway, bleeding, or even 24 hours of IV abx and steroids. We were aggressive about discharging at LSU...but when you're in private practice, patients don't want to go home and roll around in pain on Norco...they want to be in a hospital with nurses suctioning their vomit and giving them dilaudid.

4. 90% of our trauma cases come straight from the hospital when I'm on call. So like I said, discharging them to home...setting up a consult in your office...then going to a surgery center makes no sense. It also would be an absolute pain to get all the plating systems and have them stocked in an ASC unless you were super busy with trauma...which only academic surgeons are.

5. Oral Surgeons need hospital privileges to be board certified...so almost all of us doing hospital level cases are on staff as a hospital at least at the consulting level anyway.


And all the talk above about "higher reimbursement" is total BS.

So, i think using a surgicenter only makes sense if you don't have those capabilities in your office (like a poorly equipped surgical office...or for some reason you can't intubate or find a separate anesthetist)...and you used the surgery center for large dental alveolar. And in terms of taking orthognathic/TMJ/etc that would only make sense if your hospital sucked...or if you were doing that stuff at an incredible volume...like a cosmetic OMFS or a fellowship like i mentioned.

 

[DavesNotHere]

well again, I can't see a benefit to taking cases to a surgery center...as opposed to just having mobile anesthesia in your office.

my practice is rare because we go to the OR once every 1-2 weeks with an orthognathic or a TMJ TJR...and I take level 2 trauma call every 5-6 weeks but we still use the hospital for a couple reasons

1. Orthognathic and TJR (and nearly all OMFS hospital cases) are elective. So there's no problem booking a first start case on almost any day of the week when you're doing it 1-2 months in advance.

2. These are big cases and we only do 1 per day so turn over time (which isn't really slow at a private hospital anyway) is not an issue...nor is getting a case bumped.

3. These cases almost all get admitted for at least a night. And any big case I'd want the option to admit for post operative airway, bleeding, or even 24 hours of IV abx and steroids. We were aggressive about discharging at LSU...but when you're in private practice, patients don't want to go home and roll around in pain on Norco...they want to be in a hospital with nurses suctioning their vomit and giving them dilaudid.

4. 90% of our trauma cases come straight from the hospital when I'm on call. So like I said, discharging them to home...setting up a consult in your office...then going to a surgery center makes no sense. It also would be an absolute pain to get all the plating systems and have them stocked in an ASC unless you were super busy with trauma...which only academic surgeons are.

5. Oral Surgeons need hospital privileges to be board certified...so almost all of us doing hospital level cases are on staff as a hospital at least at the consulting level anyway.


And all the talk above about "higher reimbursement" is total BS.

So, i think using a surgicenter only makes sense if you don't have those capabilities in your office (like a poorly equipped surgical office...or for some reason you can't intubate or find a separate anesthetist)...and you used the surgery center for large dental alveolar. And in terms of taking orthognathic/TMJ/etc that would only make sense if your hospital sucked...or if you were doing that stuff at an incredible volume...like a cosmetic OMFS or a fellowship like i mentioned.

Yeah I get your points. I do know one surgeon personally who uses a private surgery center in texas. But he just takes extractions and dental alveolar there when he needs them intubated. He said he makes less on them because he’s paying someone else for the anesthesia. He also doesn’t do double jaws anymore because his hospital would constantly bump him or cancel his cases for “real surgeons” (his words)

 

[Sublimazing]

Yeah I get your points. I do know of one surgeon personally who uses a private surgery center in texas. But he just takes extractions and dental alveolar there when he needs them intubated. He said he makes less on them because he’s paying someone else for the anesthesia. He also doesn’t do double jaws anymore because his hospital would constantly bump him or cancel his cases for “real surgeons” (his words)

For him I agree that a surgery center works, but it would still be more ideal to be able to intubate cases like that in his office.

When it comes to treatment at the hospital, I think I am probably privileged there. My boss has been taking cases there regularly for over a decade and they treat him and my practice extremely well. We would never get a scheduled case bumped. He's a 4 year guy and they still treat him like a "real surgeon". Also coming from LSU where OMFS gets treated better than most hospitals, maybe I'm biased on that account.

 

[Sup Dude]

@DavesNotHere Yes owning and performing surgeries at them. Sorry for being annoying, it's hard to take what @Sublimazing is saying as absolute truth when it's known that people use them and see value in them. But whatever, it's not a big deal. Probably best to go out in the community and ask people that are directly involved anyway.

 

[RIPHarambe4]

There is a chapter in Oral and Maxillofacial Surgery by Fonseca Volume I titled, "Accreditation of Surgicenters."
It's an interesting read. It notes 4 primary benefits of surgicenters. These are paraphrased right from the text:
1. They make delivery of care better. There are numerous checks and balances for infection control, incident reporting, and adverse reactions that often go unnoticed in an ordinary OMS practice.
2. The general public views them as being state of the art. Patients believe their surgeon is practicing at the very highest level.
3. With support of anesthesiologist, more sophisticated cases are being done on an outpatient basis. Some of the cases performed are cosmetic surgery, orthognathic surgery, and cancer and reconstructive surgery.
4. Surgicenters can be viewed as a profit center. Patients are accustomed to paying hospitals a facility fee. This facility fee can be paid to the surgicenter, and in some cases, insurance companies will pay facility fees. It is always more economical to perform a case in a surgicenter than a traditional hospital setting.

Then the chapter goes on to explain the various accreditation methods for surgicenters. It seems as though these would only make sense if you are doing a good amount of cosmetics, orthognathics or reconstruction. Also, it seems that an OMS would only benefit from the facility fee if they owned the surgicenter. There is an interesting podcast on Every Day Oral Surgery episode 82 with an OMS at Kaiser that does loads of orthognathic surgery. They have been discharging their orthognathic cases same day since 2018. They are publishing an article with the data in JOMS soon. They worked with their anesthesia team to develop a orthognathic anesthetic protocol in which it is primarily TIVA and the gas is off early in the case. So the patients recover from anesthesia much faster. I know that since Covid, my program has been discharging all of our orthognathic patients same day as an effort to keep hospital admissions down. That being said, you would certainly still want to have admitting privileges at an hospital if your patient isn't doing well after surgery.

Just thought I would offer up that information. Unfortunately, I don't have any firsthand experience with these surgery centers. Hopefully, they can begin to bridge the income discrepancy for the doc that wants to do a little more than teeth and titanium. I think most OMS enjoy doing larger cases, but are deterred by the headaches of the hospital system.