About 25% of surgeries are expected to be performed outside hospitals within three years, in part because of financial incentives, Moss and others say. Surgeons are removing tonsils and implanting tubes in the ears of children, performing arthroscopic fixes on knees and shoulders of adults, and more. Doctors who perform operations in their own facilities rather than in a hospital get extra insurance money to cover facility costs. The hospital, on the other hand, may charge more for a surgery as it struggles to recoup costs from emergency rooms and other money-losing departments.
The result has been a rise in surgical centers in office buildings and strip malls across the nation.
"They're like 7-Elevens," Moss says.
Some doctors go to the trouble and expense of duplicating the safety standards in a hospital operating room; many do not. And only a few states even try to force doctors to meet office surgery safety standards. The result is a dramatic difference among operating environments.
In a hospital, a surgeon must pass a peer review to be allowed to perform a specific surgical procedure. The federal government requires state-of-the-art equipment to be on hand in case complications threaten the patient's life. And somebody who specializes in anesthesia puts the patient to sleep and watches over the patient as the surgeon works.
In the doctor's office, the physician can perform any procedure in complete secrecy without peer review.
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