Romansky M A, Millman D S
Urol Clin North Am. 1987 Feb;14(1):15-20.
This is a brief summary of the regulatory and other legal issues that may be raised by the provision of surgery outside of the hospital environment. Despite these potential problems, however, outpatient surgery embodies significant potential for hospitals, physicians, patients, and third-party payers. Outpatient surgical facilities embody the potential to achieve two of the government's primary goals: the provision of high-quality services and the reduction of health care costs. Third-party payers, similarly, are increasingly recognizing the benefits of outpatient surgery. Some are providing "facility" payments to cover the overhead costs of such facilities, or at least, providing an add-on to physicians' professional fees, for example, UCR (usual and customary rates) plus 20 per cent, if surgery is conducted in an office setting. Health maintenance organizations and other alternative delivery systems are actively seeking to enter into contracts with ambulatory surgical centers to provide outpatient surgical services to their enrollees because HMOs and other alternative delivery systems maximize profits by decreasing inpatient hospital utilization. In the years ahead, certificate of need and other regulatory barriers to the establishment of ambulatory surgical centers may fall as states increasingly begin to reassess the costs and benefits of certificate of need programs. In short, the trend toward outpatient surgical facilities and outpatient care generally is one that is here to stay.
这是对在医院环境之外提供手术可能引发的监管及其他法律问题的简要概述。然而，尽管存在这些潜在问题，但门诊手术对医院、医生、患者及第三方支付方而言都蕴含着巨大潜力。门诊手术设施有潜力实现政府的两个主要目标：提供高质量服务以及降低医疗成本。同样，第三方支付方也越来越认识到门诊手术的益处。一些支付方正在提供“设施”费用以支付此类设施的间接费用，或者至少在医生专业费用基础上增加费用，例如，如果手术在办公室环境中进行，按现行医疗收费标准（UCR）再加20%。健康维护组织及其他替代医疗服务体系正积极寻求与门诊手术中心签订合同，为其参保人提供门诊手术服务，因为健康维护组织及其他替代医疗服务体系通过降低住院医院利用率来实现利润最大化。在未来几年，随着各州越来越多地开始重新评估需求证明计划的成本和收益，建立门诊手术中心的需求证明及其他监管障碍可能会消除。简而言之，门诊手术设施及一般门诊护理的趋势将持续下去。
