1. Good alternative in CON states. APMR is located in Upstate New York, Northern Virginia and the District of Columbia, where CON laws strictly limit ASC construction. "I do pain procedures in the office because I am in a CON state," Dr. Haider says. "If it were easier to obtain a CON for an ASC, I would probably do the procedures in an ASC." ASCs can offer economies of scale not available in the office. But Dr. Haider says he has become comfortable with office-based procedures.
2. Cases shifting from hospitals. Dr. Haider says he was one of the first pain physicians to install fluoroscopy in the office and now he does more pain procedures in his office than in the hospital. "Office-based pain is a well-recognized trend," he says. Because there is no facility fee, the physician's reimbursement is higher in the office than in the hospital.
3. Regulations to comply with. Offices often have to get special state designation for procedures, depending on levels of anesthesia and complexity of procedures. Some states, such as New York, require accreditation by the Joint Commission or AAAHC for offices that use conscious sedation.
4. Cost of office conversions. Converting an office for pain procedures can cost as much as $500,000 per room, Dr. Haider says. That price covers equipment, application processes and special requirements such as having a back-up generator that can run for a minimum of 30 minutes, he says.
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