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A Better Partnership


May 2006
May 01, 2006

Asking the Right Questions Before Elective Surgeries

As medicine advances, more and more people are choosing to have elective surgeries to enhance their lives, from laser eye correction to surgical sculpting of other parts of the anatomy.

For many reasons, these elective surgeries are taking place not in hospitals, but rather in a physician's own private surgical suite, usually attached to the physician's private office. There are heightened medical risks associated with being a hospital patient. Some people find a busy hospital environment needlessly stressful. Many outpatient surgical facilities have been inspected and certified for quality and safety. There's certainly something positive to be said for having care rendered by a support team that is highly practiced at caring for patients having a single type of surgical procedure.

Another very important reason behind this preference for small private outpatient surgery is the matter of cost. Since they are not saddled with the same level of free-care burdens as community hospitals, private surgical facilities can be less expensive.

There are several key issues patients should review before signing up to have elective surgery performed at a doctor's private surgical facility.

Are There Hidden Fees? Will the fee paid to the surgeon cover all aspects of the procedure? Or will there be a facility charge that is separate from the fee for the surgeon's own services? If the procedure will be done in a facility licensed as an ambulatory surgical center (as opposed to a procedure room in the physician's office), the answer will almost always be that there is a separate charge for use of that facility.

What about fees for other professionals who may be involved in the procedure, like an anesthetist? What about clinical laboratory fees? Are these covered in a global fee paid to the surgeon, or will they be charged separately? If there are to be separate charges, will insurance cover any part of those charges?

Consent Documents. Patients should also carefully review the "informed consent" documents they sign before an outpatient surgery. The planned surgery should be carefully described. Generalities allowing a physician to do whatever additional procedures the physician deems "necessary or appropriate" should be avoided. If there are unexpected complications during a surgery, the consent documents should be clear as to what steps (other than resolving clinical emergencies) the surgeon may take without asking the patient for further permission.

Follow-Up Procedures. Not every elective surgery goes as planned the first time. The patient's written agreement with the surgeon should make clear what the patient's rights will be if the patient is ultimately dissatisfied with the outcome of the surgery. Will the surgeon perform a second "touch-up" procedure at no additional cost? (In many cases, the answer is "yes.") What about ancillary facility costs for the touch-up procedure? Who will be responsible for those?

There are many reasons for patients to prefer having elective procedures done in private physician facilities. By asking the right questions up front, patients can minimize their risk of an unhappy surprise later.

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Richard L. Bouma is a partner with Warner Norcross & Judd LLP and has represented health care providers for twenty years on health law issues. He regularly advises clients concerning billing compliance, Medicare and Medicaid reimbursement, HIPAA privacy regulation, as well as transactional and contract issues. Rich is the former Chair of the Firm's Health Law Practice Group and a member of the Firm's HIPAA Task Force. Rich may be reached in the Grand Rapids office at 616.752.2159. Warner Norcross & Judd is a full-service law firm with offices in Grand Rapids, Metro Detroit, Holland and Muskegon. Because each business situation is different, this information is intended for general information purposes only and is not intended to provide legal advice.

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