Deep sleep now comes in small packages. Anesthetic-induced slumber, that is.
Engineers have put anesthesia equipment on a diet. Bulky patient monitors, once weighing 60 pounds, have become portable featherweights, slimmed down to the size of a lunch box.
State-of-the-art anesthetics work faster and wear off quickly with fewer side effects.
Add breakthrough equipment, such as the BIS Monitor by Aspect Medical Systems, Natick, Mass., which measures patient consciousness, and the result is unparalleled precision in controlling anesthetic doses, some doctors say.
Improved technology and smaller equipment have helped anesthesiologists usher many surgeries straight into doctors' offices from hospital operating rooms, bypassing even freestanding surgery centers.
"In the last few years, and for the first time ever, we have the pharmacology and the technology to offer a patient the same quality of care . . . and safety in the doctor's office that exists in hospitals and outpatient surgery centers," declares David Barinholtz, M.D., president and chief executive officer of Mobile Anesthesiologists, Chicago.
Barinholtz' staff of six anesthesiologists and their nurses provides surgery support services within a 60-mile radius of Chicago. Soon he expects the company will expand to Minneapolis and Milwaukee.
Barinholtz, whose firm is accredited, expects a healthy appetite for his services. The number of surgeries performed in doctors' offices is expected to surpass those done as inpatient hospital procedures by 2002, according to projections from SMG Marketing Group, Chicago. This year 8.3 million surgeries will be done in doctors' offices, SMG says, compared with 9.6 million inpatient surgeries at hospitals (See chart).
When many people think about office-based surgery, they picture plastic surgery.
But in-office surgery goes beyond tummy tucks, face lifts and nose jobs. Advanced anesthesia care means many physicians are also repairing hernias, performing tubal ligations and fixing even complex urological conditions in day surgery at their offices. Despite some safety concerns, some doctors are even implanting pacemakers in offices.
Technology may have blazed the way, but lower costs have bolstered doctors' desire to move surgeries outside hospitals.
Even with the costs of buying equipment and renovating, the office-based approach is cheaper than any surgery center or hospital, proponents say.
Of course, not all office-based anesthesiology services are equal in quality. And some skeptics question the safety of the practice altogether. Lawmakers and regulators in several states are scrutinizing this clinical development, considering restrictions or tough professional standards.
Nevertheless, the migration of more surgery out of hospitals and into doctors' offices seems unstoppable.
Marc Koch, M.D., president and CEO of Resource Anesthesiology, a six-doctor mobile anesthesiology practice, explains why. "By shifting procedures to their offices, doctors can use their time generating revenue. They don't waste their time waiting around an operating room."
What's more, the surgeons don't have to pay tribute to hospitals or surgery centers for using the facilities and services, such as pharmacy, pathology and radiology, he says.
Koch's group, based in New Rochelle, N.Y., provides accredited anesthesiology services to doctors' offices from southern New Jersey to the Connecticut shoreline. And business is booming. "We offer the safety of a hospital in the convenience of your office," he says, adding that in more than 5,000 cases his team hasn't had a single death.
Recently, Koch's firm helped HIP Health Plans, a New York-based HMO, bring some surgery cases into a physician office complex in Valley Stream, N.Y. The procedures include hernia repair, breast biopsies and hemorrhoid removal.
"The insourcing of surgery by third-party payers and HMOs will become one of the major drivers behind continued growth," Koch predicts. He estimates that payers can trim about 50% to 75% from peri-operative expenses, excluding professional fees, by moving surgery to doctors' offices.
To Koch, the fact that hospitals and hospital-based physicians' groups increasingly oppose office surgery strongly indicates that the time for the approach has finally come.
"Hospital organizations have a natural inclination to thwart growth of this venue, (because) it results in lost revenue for every division of the hospital," Koch says. "But surgeons are fed up with the rigmarole, the hubbub, the inefficiencies and fees of hospitals."