Regulatory and legal aspects of outpatient surgery.

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.