OUTPATIENT SURGERIES SKYROCKET

To many people, outpatient surgery amounts to dollars and sense. And, at a time when the nation is talking about controlling health-care costs, the popularity of outpatient surgery has grown dramatically.

Cape Girardeau has three outpatient surgery centers, two of which have opened in the last nine months. At the same time, the two local hospitals have seen a surge in outpatient or same-day surgeries.

In 1975, the nation had 42 outpatient centers. Today, there are more than 1,600.

St. Francis Medical Center has seen its outpatient surgeries climb 341 percent. At Southeast Missouri Hospital, there has been a 642 percent increase.

About 65 percent of surgeries at both hospitals today is done on an outpatient basis.

A variety of surgical procedures are done at the centers, Doctors' Park Surgery Inc. and Missouri Surgery Center Inc. A third outpatient center is used exclusively by Dr. Richard Kies for eye surgery.

Kies said he does some surgeries at the hospitals, in large part because of government policies. Medicaid and Medicare will only pay for some surgical procedures if they are performed in hospitals. "This is not an effort to dump patients that don't pay on the hospitals," Kies said.

For most patients, the big advantage of outpatient surgery is the cost. National studies indicate that patients can save 30 percent on average by having surgery done at outpatient centers, said Dr. Gregory Tobin, who opened the Missouri Surgery Center last October.

Tobin said outpatient surgery centers have a lot to offer, including quality care. "It's a win-win deal: The insurance companies like it because there is less money that has to be paid out for a given procedure; quite frankly, the owners like it because there is profit involved."

For the patients, the bottom line is price, said Tobin.

"There is no magic with surgery centers over hospitals," he said. "It is an overhead issue."

Ron Wittmer is president and managing partner of Doctors' Park Surgery. The outpatient center was established 18 years ago when such facilities were in their infancy. It has expanded its operations since, coming under new ownership in 1992.

Wittmer said Doctors' Park Surgery provides patients with a more personable approach to surgery at a lower cost than if it were done in a hospital. Doctors, who perform surgery at the two hospitals, also do the same procedures at Doctors' Park.

"We have the same guys operating with the same equipment and the same safety features, but at a lower charge," said Wittmer.

In 1992, a hernia repair cost $1,455 at Doctors' Park Surgery, or more than $1,000 less than it cost at the two Cape Girardeau hospitals.

Dr. Paul Thompson, a Cape Girardeau urologist and one of the owners of Doctors' Park Surgery, said many procedures cost 30 to 50 percent less there than in the hospital.

Dr. Michael Jessup, a gynecologist, said his fee is the same whether he does surgery at the hospital or in an outpatient facility. But he said the total cost to the patient is less when the surgery is done in an outpatient setting.

In Missouri, surgery centers can keep patients for up to 23 hours. Any procedure requiring a longer stay must be done in a hospital.

Wittmer said state law used to prohibit outpatient surgery centers from keeping patients for longer than 12 hours. As a result, some of the more complicated cases couldn't be done at those centers.

But the law was changed in 1992. Last October Doctors' Park Surgery began offering surgeries that required patients to remain at the facility for overnight observation. However, most of its patients undergo surgery in the morning and go home in the afternoon.

Hospital officials say advanced technology is largely responsible for the growth in outpatient surgery. Tonsillectomies are a case in point, said Dottie Worley, director of surgery at St. Francis. "Those kids used to come in and be hospitalized." Today, the procedure is done on an outpatient basis.

Jim Wente, administrator of Southeast Missouri Hospital, said, "The technology has advanced to such a stage now that the surgeons feel more comfortable in providing these services in an outpatient way."

Wente said patients should consider more than cost in deciding on where to have outpatient surgery. "Risk factors are less in the hospital," he said. Hospitals have more staff and more equipment, and are better prepared to handle surgery complications, he said.

Wente said hospitals provide a lot of uncompensated care. "The hospitals essentially don't turn anyone down. We are doing a lot more uncompensated care for the Medicare and Medicaid population." As a result, St. Francis and Southeast must charge their paying customers more to recover their costs, said Wente.

Jessup said the local surgery centers compete with the two hospitals. That competition benefits consumers, he said. "The bottom line is competition keeps down the cost."