The role ASCs may play in primary care

While ASCs are designed to be hyper-focused on providing outpatient surgical procedures for patients, sometimes they are forced to deal with patient care encounters beyond their intended scope. 

Especially in rural or underserved parts of the country, ASCs can routinely encounter patients who do not regularly see a primary care physician and may be living with undiagnosed chronic conditions that can interfere with surgical procedures. 

In these cases, ASCs can play a role in primary patient care through preoperative treatment, patient referrals and more. 

Mark Mayo, founder and owner of Chicago-based Mark Mayo Healthcare Consultants, spoke with Becker's about the role that some ASCs and their staff have to play in providing care far beyond their job descriptions. 

Mark Mayo: Many ASCs are located in larger communities and may even be clustered in larger cities and suburban neighborhoods. While there may be several ASCs within a relatively short driving time from each other, they may actually not be competing as they may cover different surgical specialties (such as an ophthalmic surgery center and a nearby orthopedic surgery center) and have different medical staff rosters.

However, in some communities, there may be only one ASC and the town may have only one or sometimes two area hospitals.

When patients are scheduled by their surgeon, the ASC may find that the patient has no primary care physician on record. The surgeon may have performed a general assessment or may have focused only on the presenting condition and not have access to the patient's health history supported by a medical record as opposed just to the patient's verbal health information. In communities where PCPs may not be readily available or where they do not accept Medicare or Medicaid coverage, the ASC should be aware that some patients may not have access to or routinely seek primary care.

Even at an ASC associated with or in a community with a large regional medical center, the ASC should consider the possibility that a patient may not receive or seek routine primary care. The pre-admission health information call may be an opportunity to ask more about a patient's health status and history of routine PCP visits. Consider that a patient with limited health record may present with undiagnosed diabetes, previous MI or respiratory disease, or, if diagnosed, no longer takes prescribed medications or follows a healthy lifestyle.

It may help to be able to refer suspect patients for a cardiac or other clinic assessment and to have a more comprehensive history and physical on file in advance of the scheduled date of surgery so as to avoid a day-of-surgery cancellation and also help the patient obtain primary or other specialty care. In some cases this can be a source of cross-referral between different medical/surgical specialties represented on staff at the ASC. Both anesthesia and pre-op registered nurses can play a role in helping patients be better prepared for surgery by improved medical management.

Even in cases where surgery does not have to be postponed, the ASC can and should be prepared to serve as a referral resource to recommend to the patient during discharge that they should follow up with a PCP or other specialist in addition to following the normal discharge instructions from their surgeon.

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