A modified version of this article appeared in Becker’s ASC Review
When Joyce Deno Thomas, now senior vice president for Regent Surgical Health, was administrator at Loveland Surgery Center, she helped develop a convalescence center that allowed surgeons to perform higher acuity cases at the ASC. After their procedures, patients were discharged to the convalescence center connected to the ASC. Now, Administrator Sonia Foote continues to grow and develop the center to take care of patients.
“The attraction for convalescence centers is that quite often surgical patients simply need a place to regain some strength and have pain controlled,” says Ms. Foote. “This doesn’t necessarily require full hospital services. A convalescence center allows patients to stay for 72 hours [or more] in a separately-licensed facility until they are ready to return home.”
Developing the convalescence center
The convalescence center needed separate licensing from the ambulatory surgery center according to Colorado state regulations. Each facility has its own narcotics, drugs and resuscitative equipment. Patients are discharged fully from the ASC and reassessed with new paperwork before admittance into the convalescence center.
Security is an important issue for patients and nurses staying after hours. The building is kept on lockdown and people are unable to see the nurse’s desk from the outside door. Staff is not allowed to enter or exit the building at night — not even to smoke — and a security guard drives by the center several times per night.
An anesthesiologist and a surgeon are on call at night,” says Ms. Thomas. Although there isn’t a surgeon onsite they are typically within five miles of the facility if an emergency occurs.”
Philosophy of care
Additional considerations are necessary for accommodating patients who are staying overnight, especially if they will be spending multiple nights. “When I initially sat down with our director of nursing, we realized that we weren’t just creating more recovery rooms; the center is like a mini-hospital,” says Ms. Thomas. “If you are going to keep patients overnight or up to 72 hours, you have to understand what the patient needs.”
Ms. Thomas and her team decided to staff the convalescence center with one nurse for every two patients at all times, and included a nursing assistant, even overnight. The center has four beds and often operated at 80 percent capacity Monday through Friday while Ms. Thomas was with the center.
“You want to have a strong nurse-to-patient ratio for safety,” she says. “Don’t scrimp on staffing. Our patients who were undergoing one- or two-level lumbar fusion with an average stay of a day-and-a-half experienced no complications or transfers because the nurses were dedicated to providing good care.”
A surgery center and convalescence center outside of the hospital has additional benefits for recovery. “The physicians appreciate their patients receiving more personalized care and attention,” said Ms. Foote. “There is also less risk of infection than in the hospital setting.”
A trend of the future?
State regulations prevent convalescence centers attached to ASCs in all but a handful of states currently; however, with more focus on saving healthcare dollars, more states may come onboard in the future.
“Having the convalescence center opens up the possibilities for cases such as simple thyroidectomies that may need more than an overnight stay,” says Ms. Foote. “We do spine cases now that require a longer stay. Additional gynecology cases such as vaginal hysterectomy would also be ideal for a facility like this.”
Convalescence centers such as the one connected to Loveland Surgery Center have the potential to provide higher quality care at a lower cost than hospitals. However, it remains a challenge to receive coverage from payers. Depending on the region of the country, some payers may be more amicable than others. “You need to work with payers to carve out CPT codes,” says Ms. Foote. “Codes that previously required procedures to be done in the hospital are now transitioning to the ASC. You also need coverage for the overnight stays. It hasn’t been hard for us to make the argument for coverage with the payer because the procedures cost so much more in the hospital.”
“I think the convalescence center is the wave of the future to keep patients out of the hospital where there is a higher risk of complications and the nurse-to-patient ratio is much less favorable,” says Ms. Thomas. “If you really measure the outcomes from the convalescence centers that currently exist — and leave politics out of it — you will find that the quality of care is there and costs are low.”