FREE-STANDING SURGICAL CENTERS SEEK TO OFFER ALTERNATIVES TO PATIENTS

Medical consumers are becoming increasingly savvy and cost-conscious, medical professionals are finding, and many of them shop around for the best deals when it comes to outpatient procedures, especially surgery.

When they do shop around, the lowest price for many outpatient surgeries can be found at free-standing ambulatory surgical centers, said registered nurse Ashley Lipke, nurse manager at HealthSouth Surgery Center, which does general, gynecologic, podiatric, orthopedic, ear, nose, throat, dental, plastic and hand surgery and pain management.

"Medical customers are shopping around these days," said Lipke. They want the best price because even with insurance, there is usually some out-of-pocket expense.

"We can often give them a better deal because we don't have the overhead that a hospital does," Lipke said.

Most surgical centers don't have blood banks, diagnostic labs or X-ray equipment that hospitals do, said Bob Bauer, staff anesthetist at Silver Springs Surgery Center, which does cosmetic surgery, pediatric dental restorations and ophthalmic procedures like cataract removal. Nor do they the food services, round-the-clock care costs and cost of specialized equipment of hospitals, he said.

A "Buyer's Guide to Outpatient Procedures" put out by the Missouri Department of Health in 1996, the most recent edition available, listed prices for outpatient procedures in Cape Girardeau. There were a few cases where cost at a hospital was lower. But for most procedures, prices at ambulatory surgery centers ranged from the same as to as much as 64 percent lower than those at hospitals.

Yet for outpatient surgery, surgical centers offer the same quality care of hospitals, Lipke said.

"We offer the same quality, same surgery, same insurance acceptance, same equipment as hospitals," said Ron Wittmer, president of Doctors' Park Surgery Inc. Doctors' Park Surgery Inc. is the area's largest ambulatory surgery center with five operating rooms and one procedure room and does ear, nose and throat, endoscopic, eye, general, general dental, gynecologic, orthopedic, plastic and reconstructive, podiatric and urologic surgeries.

Surgical centers are licensed by the state and must comply with the same stringent guidelines as hospitals, Bauer said.

So when a doctor recommends a patient have a surgical procedure and that patient checks out all the options, people often choose surgical centers, Wittmer said.

"We strive to give good, quality care at an affordable price," Wittmer said.

However, Bauer noted, not all procedures and not all patients are right for surgical centers.

"One of the keys to not having complications is picking the right patients," Bauer said. The patient needs to be healthy and the procedure is generally one that can be completed in less than two hours.

Wittmer said Doctors' Park Surgery's medical director is a doctor who screens all referrals before a surgery is scheduled.

"If the patient has other medical problems, they can be addressed before surgery," Wittmer said.

In addition to competitive prices, surgical centers also offer convenience, Lipke said.

Patients can park close to the entrance and have everything done in one place rather than having to go from one department in a hospital to another, Lipke said.

"We have everything in one small area, which we think patients find less intimidating than going to different departments," Bauer said.

Because surgeries are done in an efficient manner, there is less waiting time at surgery centers, which helps reduce stress, said Dave Anderson, administrator of Cape Girardeau Outpatient Surgery Center, which does mostly ophthalmic procedures, including LASIK refractive vision correction and cataract removal, and plastic surgery.

Surgical centers also allow a family member or friend to stay with the patient until they go in for the surgery and as soon as they have stabilized in the recovery room.

"This is especially important when children are patients," Bauer said. Parents don't want to let the children to be out of their sight any longer than necessary, he said.

Patients also like the privacy surgical centers offer, Lipke said.

"When you walk into a hospital, you see tons of people. Here chances are slim you will see anyone you know. Privacy is important for patients," Lipke said.

People also like more personal service a surgical center offers, Bauer said.

Lipke said HealthSouth offers 23-hour observation if a patients needs it. "They stay in a nice comfortable room with a big TV and have one-on-one care. They are not one in 50," Lipke said.

Anderson said at Cape Girardeau Outpatient Surgery Center, the staff is encouraged to get to know patients and help them feel comfortable.

"We try to keep stress levels down, which makes a big difference in a person's whole state," Wittmer said.

The satisfaction rates of patients of surgical centers is very high nationwide, Wittmer said. He noted that a U.S. Department of Health and Human Services survey found that 98 percent of people who come to ambulatory surgery center were satisfied with their treatment.

Surgical centers also offer some advantages to doctors, Wittmer said. They are convenient, less expensive and there's less pressure, he said.

At surgical centers doctors can schedule operating room times to suit their schedules, Lipke said. Also, turnaround time, the time it takes to ready an operating room for the next patient, is so quick, Lipke said.

The number of ambulatory surgery centers is growing nationwide, from less than 2 million in 1980 to more than 30 million this year, Wittmer said.

The rise in the number of surgical centers has correlated to the decrease in recovery times for many surgeries.

"Years ago, you might stay in a hospital for a week after surgery. Now you go home that day," Lipke said.

Part of this is due to changes in surgery. More surgeries are done these days with laproscopy, in which tiny cameras are inserted through tiny incisions to guide the surgery. Smaller incisions mean faster recovery times, Lipke said.

Bauer said new drugs and ways of dispensing them mean patients are not under anesthesia as long. "They have allowed patients to be more awake but still not have pain," he said.

"There's also a change of thinking. Physicians see that you can heal as quickly at home as in a hospital," Lipke said.

LOCAL SURGICAL CENTERS

Licenses ambulatory surgical centers in Cape Girardeau are:

*Cape Girardeau Surgery Center

*Doctors' Park Surgery Inc.

*HealthSouth Surgery Center

*Physicians Alliance Surgery Center

*Silver Springs Surgery Center