A wise man once said that the simplest choice is preferred when all else is equal. I thought about this principle of economy when I was faced with the choice of constructing a new ASC or an office-based surgical practice. Ultimately, I chose the latter because the office setting let me do just what I wanted to do - no more, no less. Despite the recent furor over office surgery safety, I stand by my decision.

Who needs an ASC?
Foremost, I wanted a single-specialty practice. Although I considered building a multi-specialty ASC, I felt this would dilute my focus. I wanted every nurse and every staff member to have expertise in plastic surgery and to understand my personal philosophy of practice. I didn't want nurses working for me doing plastic procedures one day and working for another surgeon doing cholecystectomies the next. In addition, cosmetic surgery patients want privacy and they're willing to pay for it.

Second, although I could have built a single-specialty ASC, my research showed that there was no need to go this extra step. Sure, I would have liked to do a mix of reconstructive and cosmetic procedures that a Medicare-certified, state-licensed ASC would have enabled. But the Medicare and private insurers' reimbursements for reconstructive procedures in my region are low, especially relative to cosmetic surgeries like $5,000 to $6,000 breast augmentations. I would have had to handle a very large volume of cases to make this case mix financially feasible and, frankly, I felt this would compromise patient care.

Third, I wanted to be in charge of my own destiny. I wanted control over the process - from the basic facility design down to the nitty-gritty details. To build an ASC, I would have had to follow the Medicare certification/AIA guidelines, which dictate everything from the separation of the waiting room to installation of staff-only toilets to the size of the OR and recovery rooms. By building an office-based surgical facility instead, I was able to control costs without sacrificing safety or those amenities that are important to my patients. I ended up with a facility that is functional and upscale yet not over-engineered.

Right choice for my patients and me
In my office-based surgical facility, which has a two-bed recovery room where we oversee some patients overnight, my patients receive one-on-one, private care in a comfortable and safe environment. Although it represents a significant investment in a time when the economic forecast is uncertain, I feel confident I made the right decision. My facility was by no means inexpensive to build, yet I avoided unnecessary costs. My new facility is exactly what my patients and I have been looking for.