Ajay Mangal, MD, MBA, a board-certified otolaryngologist and president and CEO of Cincinnati-based Prexus Health, a physician-owned developer and manager of ASCs, imaging centers and surgical hospitals, has found that offering ENT in his company's facilities is a worthwhile venture. "We like ENT procedures because 90 percent of them can be performed quickly and safely in outpatient settings and most are very profitable," he says.
Here are four ENT procedures Dr. Mangal recommends ASCs should perform or add to improve profits.1. Myringotomy — This procedure involves the insertion of ventilation tubes, also known as pressure equalization tubes. "We schedule them every 15 minutes, but the actual procedure only takes five minutes and is typically done under anesthesia," Dr. Mangal explains. "I haven't ever seen a complication, but anytime anyone goes under general anesthesia, there's always that potential. From a safety standpoint, it's no more or less safer than doing it in a hospital." He says reimbursement ranges $1,000-$1,200 per procedure.
2. Tonsillectomy and adenoidectomy — While Dr. Mangal says this procedure is not performed as commonly as it was 40-50 years ago on young baby boomers, he says it is still frequently done for patients who meet criteria for strict indications, such as chronic tonsillitis or adenoiditis, and difficulty breathing. "It's done safely in ASC settings and is typically reimbursed at around $1,600," he says.
3. Septoplasty — Septoplasty is a corrective surgical procedure to straighten the nasal septum by removing nasal obstructions from patients having trouble breathing. Dr. Mangal says the procedure typically takes 15-30 minutes and insurers pay an average of $1,600.
4. Sinus endoscopy and debridement, and other functional sinus endoscopic surgeries — He says these endoscopic procedures can take from 30 minutes to two hours and are reimbursed from $1,200-$10,000.
"Some of the more complex endoscopic procedures were done more frequently in hospitals until recently," he says. "But with growing physician comfort in operating in an outpatient environment and realizing they can be safely done there, it's now becoming the industry standard. At many universities, doctors are now trained to do these in outpatient settings. The waiting time is less and the throughput is better. Unless a patient needs to be admitted after a surgery, I see no reason why these cases have to be done in a hospital at all."
Dr. Mangal (ajay.mangal@prexushealth.com) is an ENT specialist and president and CEO of Prexus Health. In 2000, Prexus opened its first ASC with 16 other physicians and the company now operates 13 ancillary services facilities, including physical therapy suites, imaging centers, surgical hospitals and two ASCs.