Come-and-Go Surgery

Major savings for minor operations

They are usually open only nine hours a day, provide patients with nothing more to eat than a little orange juice and crackers, and shuttle them in and out of the operating room so fast they hardly realize that they have been under the knife. Surgical factories? Not quite. In the past few years, more than 70 such private, one-day surgical centers have opened in the U.S. Undertaking minor surgery of all kinds--from face lifts to vasectomies to repair of hernias--the clinics discharge patients almost as soon as they shake off their postoperative grogginess. The only radical surgery performed is on medical bills. By never keeping anyone overnight, they are able to undercut typical hospital costs for operations by as much as 50%.

The first such independent outpatient surgical clinic was opened seven years ago in Phoenix by two anesthesiologists, Drs. Wallace A. Reed and John L. Ford. Since then, some 46,000 patients have passed through the six operating rooms of their Surgicenter. While the establishment has only recently begun to show a profit, it has spawned three satellite Surgicenters --in Sacramento and Palo Alto, Calif., and in Louisville--and inspired dozens of unaffiliated imitators in other cities. Says Ford: "Up to 40% of all surgery can be done on a come-and-go basis. Our objective is to keep people from being hospitalized who don't really need to be."

Typical of the Surgicenter's cases is that of Andrew Dunham, a blond, 23-year-old Phoenix truck driver whose severely injured finger became badly infected and required surgery. Had his doctor chosen to operate in a hospital, Dunham would probably have been kept at least one night, perhaps longer. Instead, the surgeon--one of more than 300 doctors in the Phoenix area who occasionally use the Surgicenter--directed him to the facility at 10:45 one morning last week. Half an hour later, he was wheeled into an operating room and given a general anesthetic. In just 20 minutes, the surgeon had made an incision, cleaned out the infection and sutured and splinted the finger. After about an hour in the recovery room, Dunham got up and was taken home. Total elapsed time: 2 1/2 hours. His bill for using the facility: $170.

Most people are delighted not only by the low costs and quick exits but by the cheerful, comfortable informality of the small clinics, including friendly follow-up phone calls that nurses make to the patients' homes. If unexpected trouble does occur, the patient can be quickly taken to a nearby hospital. But because patients are carefully screened and examined beforehand by the surgeon, there are rarely any complications, and according to the clinics, there has not been a single fatality in more than 80,000 operations.

The medical Establishment's reaction to the clinics has been mixed. Concerned that the private centers would skim off patients and dollars at a time when they are hard pressed to keep their facilities in full use, many hospitals have established their own one-day surgery units. Some doctors are wary of recommending the private clinics, none of which have yet received the approval of the Joint Commission on Accreditation of Hospitals. By contrast, the American Medical Association has backed the idea for several years. The American College of Surgeons is reconsidering its initial opposition to the independent clinics, as opposed to hospital-affiliated ones. And while some insurance companies and Blue Cross plans originally suspected that the centers were merely a dodge to collect insurance payments for unreimbursable doctors' office surgery, many have become convinced that they are an excellent remedy for the nation's burgeoning surgical bill.

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