Tuesday, June 4, 2013

In-Office Procedures

Understanding the benefits of in-office procedures

By: Eric Eberts, MD

There has been an interesting transition over the years from a surgery done originally in an inpatient setting, where the patient would stay in the hospital for several days, to an outpatient surgery setting.  We have essentially accomplished this with procedures up to the hysterectomy, which once was a 4-day hospital stay and included 8 weeks of recovery. Oftentimes, it can now be a same-day surgery, going home the same day; or an overnight stay with a return to work in one week, more often in the 3 to 4 week time period. That, of course, is for the big surgeries.  Twenty years ago we were doing operating room procedures for urinary incontinence and bleeding and it again started off as inpatient surgery, migrated to outpatient surgery and in the last 1 to 2 years has become essentially an office procedure.  

Many advantages of in-office procedures have become apparent, and this drive will continue in the future as it offers many excellent outcomes, opportunities and advantages for the patient as well as for the health care system from a delivery standpoint.   First, this transition is based upon the idea that these procedures are becoming less invasive.  When these procedures are done here in the office setting, as opposed to the hospital setting, they also offer more of a personal savings while delivering an equal or better outcome.  These issues in combination with an office setting save the health care system, insurance companies and oftentimes the patient a very significant amount of money. This is because the procedures become less intricate with fewer people involved, faster stays, fewer drugs and less equipment is required. 

Here at Women’s Care of Wisconsin we have transformed many surgeries over the past few years.  Traditionally, these procedures were urinary incontinence and LEEP procedure of the cervix, which have been done in the office setting successfully for 15 years or so.  We have now added several other office procedures that nationally and state-wide continue to be done in hospital settings. We at Women’s Care are now doing office Botox for incontinence of the bladder and frequency and urgency symptoms.  This procedure is very effective when other medication has not been successful.  There’s no incision, it typically takes about 20 minutes, it’s often covered by insurance, very durable and we have again had very excellent outcomes with this in the office-based setting. 

Likewise, hysteroscopy and ablation, which is the destroying of the lining of the uterus, has also migrated to the office setting and is often covered by insurance. This procedure is done to effectively eliminate or at least successfully diminish the amount of pain and bleeding encountered by a woman during her cycle. With this procedure, there are no incisions, it only takes a few minutes of time and offers the ability for the patient to return to work typically the next day.  This procedure is particularly helpful in an office setting as we are able to perform, this procedure, at a much lower cost to the insurance company and that is often reflected in what the patient has to pay. We are effectively delivering this procedure in a fashion that is if anything better, more pleasing to the patient, a fraction of the cost, and has an identical outcome. 

Lastly, about a year ago or so Women’s Care was able to perform the first office-based urinary sling procedure for incontinence.  This is done with anesthesia in the office using a physician anesthesiologist and full capabilities.  It typically takes about 15 minutes or so to perform the procedure, and it only takes 3 stitches.  It’s identical to, and in some ways superior to, what we have been doing in the outpatient or inpatient setting for 15 to 20 years.  Again, the advantage here is that the technology and procedures have gotten better and given the hundreds of cases that we have performed as surgeons at Women’s Care, we are able to deliver this with very minimal bleeding and excellent outcomes in an office setting. This enables the patient to be in and out in a much faster time period. The patient, typically, is able to go back to work within a day or two after the procedure is performed.  Excellent outcomes, well into the 90th percentile cure rate, very few, if any, complications have been encountered so far and overall patients have been extraordinarily pleased with this procedure.

While all of these office procedures have offered significant cost savings to patients, their insurance companies and the government that foots the bill some of the time, the goal has been to offer better service with the same outcomes in a more personal setting.  I think we have achieved this and we have been able to bring the cost down while delivering this perfect triad of advanced care.  By creating an environment where we can have less paperwork, fewer handoffs between strangers and essentially taking this into an office setting where the patient can oftentimes be functioning the next day. At Women’s Care we are continuously improving ourselves as we drive towards a better delivery system in general. In particular, Women’s Care strives to deliver to our patients and our communities a point of excellent care of which we can all be proud. I had an excellent opportunity to share this drive with my peers at Women’s Care of Wisconsin and of course, if you have any questions about this, feel free to contact us and see what services we can provide for you and I’m sure that you will be most pleased with the outcomes that we can deliver.

Dr. Eric Eberts is an Obstetrician/Gynecologist at the Appleton and Neenah locations of Women's Care of Wisconsin. Contact Dr. Eberts at 920-729-7105 or meet him here.

About Women’s Care of WisconsinThe providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at www.womenscareofwi.com.