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Outpatient surgery new operation


Dispatch/Argus Photo By Chuck Thomas

More and more operations in the Quad-Cities area are being done in outpatient clinics and usually involve a stay of one day or less for the patient. Not only is it cheaper, it frees up hospital operating rooms for someone having serious heart surgery who needs a longer hospital stay, according to officials.

ROCK ISLAND -- Having surgery once meant a hospital stay -- the way air travel means an airplane ride -- but with the recent boom in outpatient surgery, doctors are operating on patients all over the Quad-Cities.

Outpatient surgery is here to stay, according to Peter Wundram, executive director of the Rock Island County and Scott County medical societies.

``We're seeing it all over, on a large scale like Trinity Medical Center's 7th Street operation, and on a smaller scale in physicians' offices,'' he said. ``More and more, surgery is being performed in a clinic or doctor's office.''

Surgery centers like Mississippi Valley Surgery Center and Spring Park Surgery Center, both in Davenport, are geared toward surgeries doctors perform during a one-day visit without a hospital stay. Trinity's new 7th Street Campus in Moline features an outpatient and short-recovery surgical center.

The trend makes financial and logistic sense, Mr. Wundram said.

``If you're just having your hernia repaired, why monopolize an expensive hospital surgical suite with all the bells and whistles?'' he asked. ``You can go to a `surgicenter' and free up that hospital, or for someone who's having a quadruple heart bypass and has to be in a hospital.''

Insurers don't want to pay for more medical overhead during surgery than they have to, Dr. John Dooley of Mississippi Valley Surgery Center said.

``There are cost pressures applied by managed-care companies to go to the most appropriate (level) of care,'' he said. ``That's not necessarily a hospital, but often a physician's office or freestanding surgery center.''

While financial and logistic reasons are driving the trend to outpatient surgery, advances in medical technology are making it possible, Mr. Wundram said.

``Diagnostic and treatment machinery has become more portable,'' he said. ``A piece of equipment that used to take up half the room might sit on a table now.''

Advanced technology also has changed surgical techniques, making most operations less invasive and less dangerous, with shorter recovery times.

``Even heart surgery is getting to that point,'' Mr. Wundram said. ``Instead of cracking open your chest with a rib spreader, they can make a small incision between your ribs and operate with the help of a tiny video camera.''

Some patients, especially the elderly, may be confused to learn their doctor is referring them somewhere other than to a hospital for surgery. But once they have tried a surgery center, Dr. Dooley said, many prefer it.

``It's a lot more convenient for the patient, in terms of not having to find their way around a hospital,'' he said. ``It's also more timely -- you don't have emergency procedures getting in the way and pushing back your elective surgery.''

Many hospitals reacted with alarm to the advent of freestanding surgicenters.

Four years ago, Mississippi Valley Surgery Center's founders faced opposition when they sought the state's permission to build the center. Genesis Medical Center, Davenport, argued the center would unnecessarily duplicate services already offered in the Quad-Cities.

The developers argued they would inject some healthy competition into the marketplace.

Although the Iowa Certificate of Need Board rejected the surgery center plans in 1993, it reversed its decision the following year.

Hospitals are starting to see some advantage to the outpatient surgery trend, Mr. Wundram said.

``Surgery `boutiques' and outpatient surgery in doctor's offices has carved a niche out of the hospital system,'' he said. ``That is freeing up hospitals to do what they do best -- acute care. They can concentrate now on the kind of surgery where they field a team of specialists.

``This allows hospitals to dedicate their surgical resources to becoming regional experts in a specialty -- heart surgery, for example,'' he said. ``It allows them to become better hospitals.''

Dr. Dooley agreed that, in general, hospitals are starting to accept the idea of surgery centers.

``That's not true in this community, though,'' he said. ``They look at outpatient surgery as a very profitable segment of their business. Their rates for it are quite a bit higher.''

Bob Travis, vice president of strategic planning at Genesis Medical Center, disagrees.

``We think our outpatient-surgery prices are not just competitive, but the best in the area,'' he said. ``But price is not really the issue. A more important consideration is that, when you have your outpatient surgery at Genesis, we've got the backup equipment and medical staff right here if something goes wrong.''

The biggest difference between hospitals and private surgicenters is in their sense of mission, Mr. Travis said.

``Genesis has a mission to serve the whole community,'' he said. ``We don't differentiate in the patient's ability to pay. We don't look at the difficulty of the case or whether the patient is financially solid -- we treat all comers.''

Mr. Wundram envisions the Quad-Cities soon trending toward even more specialized outpatient service centers.

``I think we'll see -- in the very near future -- multidisciplinary care centers focused on one chronic health problem that affects a large number of people,'' he said. ``For example, a diabetes center that will be a one-stop-shopping place for diabetics to receive treatment for their circulatory, eye, digestion, dietary, emotional and other problems.''

-- By John Kanthak (February 2, 1998)

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