AMBULATORY SURGERY; SAME DAY SURGERY SAVES MONEY

A 4-year-old needs a tonsillectomy.

A middle-aged woman has been scheduled for a breast biopsy.

A businessman must have a cyst removed.

For each of the patients, Doctors' Park Surgery offers an option to a possible hospital stay.

Doctors' Park Surgery, a same-day surgery center in Cape Girardeau, is celebrating its 15th year.

The center was an idea ahead of its time, said Ron Wittmer, administrator of Doctors' Park Surgery, and has continued to offer healthy patients a surgical choice.

Doctors' Park Surgery is an outpatient surgery center, also referred to as an ambulatory, same-day or one-day surgery center.

"Outpatient surgery came into its own in the middle 1970s in this country," Wittmer said. "The Cape Girardeau medical community had the foresight to build a surgery center right at the leading edge of that trend."

Dr. Charles P. McGinty was instrumental in bringing the center to Cape Girardeau. In order to open the center, legislation had to be approved by the state.

"In order to get the Doctors' Park Surgery, I changed from a Republican to a Democrat," he said. "It was Senate Bill number one that year for ambulatory surgical licenses. We obtained license number one."

McGinty said: "When we discussed the Doctors' Park Surgery, it was like the Christians in the land of the Philistines. Nobody thought it would work."

In 1975, when the Doctors' Park Surgery was being planned and built, only 42 such centers operated in the United States. In 1989, there were 1,221 such facilities.

In 1985, 783,000 surgeries were performed in this type of facility. By 1989, the number had grown to over 2 million.

When the center opened, experts estimated that 40 percent of surgical procedures could be done on an outpatient basis. Now the estimate is that 65 percent of surgical procedures can be done on an outpatient basis.

McGinty said, "We felt we were really on the right track, and in those days, hospitals were not at all interested in outpatient procedures.

"David Berry (former Doctors' Park manager) and I helped write the first state regulations by which free-standing clinics were governed."

The first handbook had a picture of Cape Girardeau's Doctors' Park Surgery on the cover.

The center opened in 1976. Wittmer said, "One disadvantage at first is that we were not Medicare approved, and that was slow in coming."

Medicare approval for free-standing outpatient facilities didn't happen until the early 1980s, he said.

Wittmer said, "Today anything that is paid in a hospital is paid in an outpatient surgery center.

The average surgery lasts 30 minutes and recovery time is two hours or less.

"The big advantage we have here is that families can be with the patient up to the time they are taken to surgery and be with them as soon as they are awake in the recovery room."

For example, Wittmer said, the recovery rooms for pediatrics have rocking chairs. "Mothers are given their children right away. It gives a close-knit, warm feeling."

Wittmer said the surgery has a philosophy of personalized care.

"Our employees are people who for some reason don't want to work the shifts and hours at the hospitals. We have highly trained nurses, for example, who want to be with their children in the afternoons. We have cheerful, good employees who give our patients lots of personal attention."

Plus, Wittmer said, patients are much more interested in cost than they were just a few years ago.

"It's more private. It's convenient. There is a short recovery time, and the cost is one-third to one-half the cost of surgery in a hospital," said Wittmer. "With the rising health care costs, you can see why this is the type of facility for the future.

"Because of the rising costs of health care more and more people are asking their doctors for choices and we are getting more and more calls about the services we offer."

Since 1976, over 14,000 procedures have been completed. The most common surgeries are ear, nose and throat, general surgery, gynecological surgeries, plastic surgery and oral surgery

"We are fully accredited by the Division of Health and by Medicare," Wittmer said. Both groups regularly inspect the center

"In the United States, ambulatory surgical centers are among the most heavily regulated providers of health care," Wittmer said.

Forty-one states, including Missouri, require state licensing.

Wittmer said, "We just purchased three of the latest anesthesia machines. We are totally up to date with equipment and technology here.

"We have the same men and women operating here that operate at the hospitals."

In fact, before a surgeon earns credentials to operate at Doctors' Park Surgery, he or she must be on the staff of one or both local hospitals.

Dr. James Grable is the medical director at Doctors' Park Surgery. "He is here all times when patients are here. He does all the histories and physicals so the surgeon doesn't have to do that.

"Dr. Grable is the first person patients see here and the last person they see when they leave."

The center also employs a full-time anesthesiologist and two certified nurse anesthetists. Most employees are part time, though, Wittmer said.

The building was designed and constructed by a company called Med-Fac specifically as an outpatient surgery center. The center has five fully-equipped operating rooms, recovery rooms and emergency power generators.

"It was built strictly for surgery," Wittmer said.

The center has transfer agreements with both hospitals. If a patient needs extra attention or longer observation, he or she can be transferred to a hospital room.

"Our transfer rate has been extremely low, one maybe two patients a year," Wittmer said.

For doctors, Wittmer said, Doctors' Park Surgery offers advantages. "The doctors will find it easier to schedule time for operating rooms. In hospitals, they have emergency cases that come up and bump their cases."

Patients, he said, are generally pleased with their service.

"We send out patient questionnaires and get well over 75 percent of them back. People not only fill out the questions, but they often write notes or even letters about the care they have received."

Wittmer said the business of free-standing ambulatory surgery is growing.

"In the industry, they are studying recovery care centers. Patients would be allowed a 24-48 hour stay for recovery after surgery in a hotel-like facility.

"That kind of stay would not be as expensive as an in-hospital stay," Wittmer said.

McGinty believes eventually an overnight facility could be built at Doctors' Park.

Wittmer said, "I think the future in surgery is that sick people will be operated on in hospitals. Healthy people will be operated on on an outpatient basis. That also leaves hospital beds open for sick people."