- The Washington Times - Sunday, August 7, 2005

Chevy Chase resident Gerald Donaldson was set last month to have his rotator-cuff surgery performed at Sibley Memorial Hospital in Northwest.

But just before his surgery, his doctor switched the location to the Massachusetts Avenue Surgery Center in Bethesda, inside an office building near the District.

“I didn’t know anything about the place at all, just that it was a surgical center,” Mr. Donaldson said.

Now three weeks later, he said he prefers the surgical center to a hospital. “I hope I don’t have anymore surgeries, but, yeah, it would be marvelous there,” he said.

Mr. Donaldson’s mind-set is what the ambulatory surgery centers are trying to cultivate. The outpatient centers started springing up in the 1970s and have posted strong growth in the last decade.

Industry officials estimate there are more than 4,200 centers nationwide that perform operations for specialties like ophthalmology, pain management, gastroenterology, urology and orthopedics.

Maryland has the second-most surgical centers in the nation with 347, behind only California, according the Federated Ambulatory Surgery Association.

Part of the reason has to do with the Maryland’s regulations, said Pam Barclay, spokeswoman for the Maryland Health Care Commission.

Most centers in the state have one operating room, which exempts them from certain rules, Ms. Barclay said. “They are considered in effect to not be health care facilities, but part of the physicians’ offices,” she said.

Nationwide, 68 percent of the surgery centers are entirely owned by doctors, 18 percent are owned by doctors and hospitals, and 12 percent are owned by doctors and private companies, according to a 2004 report by the Alexandria trade association.

The remaining 2 percent are owned by doctors, hospitals and corporations, the report said.

The surgery centers offer a lucrative opportunity for doctors because they can perform more operations on a given day than at a hospital, where emergencies take precedence over minor operations.

“A patient in for an elective surgery wants to get in and get out,” said Dr. Michael Theodoulou, a podiatrist and surgeon at the Massachusetts Avenue center.

Operations often cost less than at hospitals because the centers are not required to provide an emergency department, he said.

The Massachusetts Avenue center, with its modern, brightly colored interior, opened in January and already is expected to break even this year, Dr. Theodoulou said. He would not give financial estimates.

Kensington resident Andrew Shea said he liked having his knee surgery at the Massachusetts Avenue center because he was able to go home to recover.

“I didn’t feel rushed at all,” Mr. Shea said after his Wednesday operation, even though he was at the center for less than three hours.

Time efficiency between surgeries has helped cut down on overhead costs, said Jerry Henderson, executive director of the SurgiCenter of Baltimore LLP, an Owings Mills, Md., surgery center.

The center, with 112 physicians on staff, grossed about $13 million to $14 million in revenue last year and is on track to make the same amount this year.

“The time in between cases in hospitals is what the physicians lose. We’re turning over rooms within minutes,” Mrs. Henderson said.

But hospitals worry the roughly $20 billion U.S. surgery center industry may lower the quality of care while being efficient.

They are concerned federal health care programs like Medicare will increasingly pay for services at centers instead of hospital facilities, said Carmela Coyle, spokeswoman for the American Hospital Association.

Federal and state laws have limited the scope of surgeries, use of anesthesia and age of patients the centers can admit.

The centers cannot perform any emergency procedures or long operations that have a high chance for blood loss.

Hospitals also noted their profit margins have deteriorated in the past few years because more of their healthier, insured patients are choosing the centers for elective surgeries, Mrs. Coyle said.

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