Capital Expenditure BioVision by Faxitron

CAPITAL EXPENDITURE: BIOVISION BY FAXITRON 1

Capital Expenditure: BioVision by Faxitron

The Ambulatory Service Center has determined a proposal supporting a capital

expenditure for a Digital Imaging System is needed. The cost of the BioVison Digital Surgical

Biopsy Specimen Imaging System by Faxitron will be $99,875.00 total. This includes the 10cm

x 15cm digital detector, high resolution 2.3 MP flat-panel LCD monitor, Ergonomic Keyboard,

Transparent Imaging Door, 3 Hour Battery Backup Operation, Battery Life Indicator, Automatic

Exposure, Automatic Calibration, 2 times Magnification, and DICOM compliant. Additionally it

includes (1) One year warranty and (1) one day in-service training by a factory trained

representative. This proposal explains how the purchase of Faxitron’s BioVision is supported by

the management and organizational goals of need and improving the economic environment of

the ASC.

Executive Summary

The purpose of this report is to establish the need and costs to add Digital Radiology

(DR) to the Ambulatory Surgery Center (ASC). The ASC was built at a cost of $2.9 million

dollars. The report will disclose financials and operating costs. The Ambulatory Surgery Center

is a corporation that provides outpatient treatments to patients in its targeted area. At issue is that

85% to 90% of patients will have health insurance or a medical cost reimbursement program.

The lower cost of ASC will attract patients who are paying for their own procedures, for example

cosmetic surgery procedures.

The ASC offers outpatient services to adults and children in the targeted area. These

services include consultation and outpatient procedures. A source of secondary revenue for the

Ambulatory Service Center is MRI, CAT scan, ultrasound, and other diagnostic services

provided to patients through the ASC’s ultramodern facility. The ASC employs two radiologists

CAPITAL EXPENDITURE 2

who provide these services to outpatients using existing in equipment. The Ambulatory Service

Center’s mission is to provide outpatients with specialized and general high-tech care at

reasonable costs and with an eye toward compassion.

Ambulatory Surgery Centers (ASCs) provide same day surgery and medical care

including diagnostic care and preventative healthcare. ASCs area modern concept healthcare

locations where patients can have outpatient procedures and other procedures performed in a

professional and ultramodern facility without being admitted to a hospital. ASCs have were

introduced in the United States in the 1970s and have expanded in number and services so that

today they are looked to for their exceptional care capacity, high quality personnel and

equipment, and customer service attitude. Medical care costs have become prohibitive for much

of the population. In order to obtain health care services and benefit from high-end technology

most outpatients travel to large hospitals and medical centers. ASCs continue to change that by

providing millions of people with an alternative to in hospital outpatient procedures. The ASC

expanded faster than had been expected and was servicing a wider market than originally

planned within the first three years.

The main source of revenue for the Ambulatory Service Center is outpatient services

performed onsite. In ASCs, the standard assumption is that patients stay between 6 to 10 hours

onsite depending on the procedure. The ASC has three ultramodern operating rooms plus a

recovery room. The procedures currently offered include outpatient procedures, cosmetic

procedures, and emergency outpatient services. The ASC receives payments from co-pays,

Medicare, and insurance companies.

Approximately 85% of the ASC’s current patients use private insurance, Medicare, or

Medicaid. There is going to be huge growth in the ASC industry. The “Value Based Purchasing”


options available via The Affordable Care Act have already been established. This plan allows

for payments to ASCs similar to those that are already popular under the Medicare program. The

report to Congress referred to need to improve payment quality and speed for ASC services. The

intention is to reward ASCs for providing “better value, outcomes, and innovations, instead of

merely volume” (Centers for Medicare & Medicaid Services, 2013).

Because of the changes in the population that will enjoy medical care in the future, ASCs

are in position to service the demographic of outpatients who will be seeking disease

management, surgery, and other payer made decisions. The issues facing ASCs will be

complicated and ASC growth will need to be planned in order to meet the increasing demands

for ASC services.

ASC’s consistently operated at a profit. Even during periods of recession, outpatient

centers enjoy economic stability. People always need specialized diagnostic care and cancer

patients require radiation treatments continuously. Costs for providing outpatient care is paid by

insurance and healthcare systems, in the future this will include ACA payments. There are over

200,000 outpatient service facilities in the United States. These outpatient facilities produce

approximately $180 billion dollars in revenue annually and employ almost 2 million people. As

the population increases so does the demand for outpatient treatment. The predicted growth rate

of outpatient care in the next two decades is expected to grow rapidly as the baby-boomers

demand treatment.

Analysis reveals three factors that traditionally define the number of outpatient

procedures performed at ASCs. Firstly, there is an acknowledged need for increased healthcare

and medical procedures on an outpatient basis. The healthcare procedures performed relate to

the population served, the protocols for screening used by a given facility, and the advancement


and availability of technology (equipment). Secondly, a determination must be made as to

whether a give procedure requires the patient be admitted for a hospital stay or if the patient can

receive treatment as an outpatient. This is often a technologically driven decision based on the

services provided by the ASC as well as issues related to anesthesia and outpatient technology

and techniques available. Thirdly, there is a site-of-service decision to be made. This decision

takes into account the ambulatory setting, for example, the ASC, the physician’s office, or a

Hospital’s Outpatient Department.

The demand for ASCs increase based on the medical cause of the patient’s treatment. For

example, as the baby boomers age there is an increased demand for disease management, this

includes screening, diagnostics, and consultation. Cost becomes an issue and leads to the

necessity for analyzing not only the quantitative aspects of care but also the corresponding

quality of that care.

PubMed includes studies that address growth factors in ambulatory surgery, as well as

predicted changes in the ambulatory aspect of healthcare and private payment trends. A study of

the growth rate of ASCs reveals that between 2000 and 2007 Medicare-certified ASCs grew at an

average rate of 7.3% per year. The amount of payments from Medicare to ASCs over the same

period increased 11.4% per year (MedPAC). Of note is that Medicare payments to hospitals for

outpatient services during the same period increased 6.9% per year (MedPAC, 2008). Demand

for outpatient services has increased and the use of the Hospital Outpatient Department (HOPD)

at medical centers and ASCs will continue to increase in the future. ASCs provide advantages

over HOPDs such as location, shorter wait times, and flexible schedules (MedPAC). Co-

payments are lower at ASCs than they are at HOPDs. There are also reports that the focused

nature of care at ASCs as are Medicare program payments for services (Chukmaitov, et. al.,


2008). An important draw for patients is that ASCs provide them access to ultramodern

technology.

Based on Medicare data for the period 2000 to 2007 supplied by Medicare

Physician/Supplier Procedure Summary (PSPS) growth in outpatient services for all kinds will

continue to increase and this means updated technology will be required for ASCs, HOPDs, and

physician offices as well as other facilities that offer alternative sites for of outpatient procedures.

We conducted a comprehensive study of the growth factors for ASCs. The predicted growth in

ASCs will mirror the movement away from hospital inpatient surgeries to outpatient settings.

ASCs need to be prepared to use disease screening for common procedures, for example,

colorectal cancer. Because these patients will have a choice, they will be drawn to ASCs that can

provide them with improved technology, fast recovery times, pharmaceutical services, and

modern ex-ray procedures.

Productivity at the ASC

One of the goals of management at ASC is productivity. The ASC is committed to being

at the forefront when it comes to technology. This will be accomplished by Faxitron’s BioVison.

This system is not only useful for daily imagining procedures. ASC surgeons will be able to use

the BioVison in the operating room to reduce procedure times and advance patient care. The

cutting-edge digital imaging technology comes with user-friendly software that is designed to be

learned intuitively so that training time is short and the results are the finest images every time

thereby bettering the workflow at the ASC and in the surgical suite. Specimen radiographs are

ready for review immediately. This means that surgeons, technicians, and radiologists can view

the x-ray simultaneously. The BioVision consistently reduces procedure times and saves on per

procedure costs.


Efficiency in the ASC

The ASC is in need of updated radiology equipment. The film x-ray equipment currently

in use is outdated, requires frequent repairs, and uses a slow process by which the ex-ray results

take a long period to produce and read. This means long wait times for ASC patients and

multiple appointments. The addition of a BioVision Digital Surgical Biopsy Specimen Imaging

System would save ASC money because the image is a twenty second process and can be read

on site rather than sent out for reads. Cost savings would be realized because it uses far less

consumables. The BioVision does not use any film, it is 100% digital. Additional savings would

result from using less paper, less employee time transferring the film to courier service to the

read location, and less time trying to contact and reschedule patients to review their ex-rays.

The addition of new radiology equipment would eliminate the need for employees to wait

on ex-ray results, re-contact patients to explain the results or arrange for patients to make an

extra appointment at the ASC in order to review results. The BioVision uses the most recent and

best technology available. It is especially beneficial in practices such as ASC where the

diagnosis of breast cancer is a major concern. The BioVision would significantly improve the

standard of patient care. Additionally it would increase operational effectiveness. Working to

improve quality care for patients is the best done by offering them technically advanced

equipment.

Increased Revenue

Advanced customer service is one of the best ways to enhance the economic environment

of the ASC. Joel French, CEO of SCI Solutions, studies revenue management for healthcare

organizations. His recommendations include optimizing physician referrals and physician

orders. Because ASCs are in competition with hospitals and medical centers the good way to


attract business from physicians is by offering them the ability to refer patients and get results

back as fast and as conveniently as possible (French, 2011). The BioVision would definitely

attract the attention of local physicians who would send their patients to the ASC for ex-rays as

well as other tests and procedures. MRI and CAT scans constitute a steady revenue source.

Besides the cost of the MRI or CAT scan, the patient usually generates between $2,500 and

$3,000 in additional services.

Quality Assurance

The management goals of the ASC include making sure that the facilities are prepared to

enter into the next era of patient care, surgical treatments, and professional management by

means of planned design and regularization to ensure a dependable, consistent experience for

patients, providers, families, and staff. ASC seeks to maintain a high level of clinical quality. In

doing so the organization will be better able to evaluate, monitor, and increase the clinical

outcomes for its patients. By creating standardized procedures that capitalize on the use of

modern technology, ASC will be able to simplify employee workflow and increase employee

productivity. To establish better patient access the ASC was originally designed using standards

that enhance patient and family experiences. State-of-the-art clinical care was and is one of the

main goals.

An example of how the BioVison would enhance quality assurance is the application of

the equipment to core specimens. When the physician is about to release a patient from

the stereotactic core needle biopsy procedure, the physician needs to be sure that he or she wants

to be certain that the core specimens taken are representative of the micro-calcifications

recognized on the mammogram. The BioVison eliminates the need to move the specimen to a

different location because the unit is in the stereotactic suite. It sets up easily and provides a


superior digital image on the spot (Faxitron, 2013, p 6). This assures that the patient will be

inconvenienced or forced into an uncomfortable position for as short a time as possible. The

time saving element reduces the workload for employees thereby saving money on every

procedure.

Cleverley & Cameron (2007) mention quality assurance in relation to revenue, but

quality assurance in relation to patient care can be improved using the Digital Imaging System.

Data can easily be accessed from the system and reports generated for patients who have fallen,

have frequent pain, are currently experiencing a urinary tract infection or have shown a decline

in activities of daily living. These reports can be used to compare historical trends within the

facility, the state, and the industry. The reports also can be used by the clinical staff to improve

infection control procedures, increase fall prevention plans and address a patient’s pain more

efficiently. The reports generated from the Digital Imaging System can provide nursing

management an opportunity to review documentation for accuracy and follow through by the

registered nurse, licensed practical nurse, and the nursing assistants. This information can be

then forwarded to the appropriate person to ensure quality patient care.

Economic Environment

Most of the comments relate to Independent research and user experience suggest that

the use of Digital Imaging System systems can help organizations save money and can be used

as sources of new revenue” (Renner, 1996, para. 7). The economic environment of ASC will

certainly improve once the transition has taken place. The financial benefits to implement the

Digital Imaging System is a reduction in labor costs in the medical records department, for

personnel involved in coding, billing or manually retrieving lab results, the nursing department

in the transcription of hand-written physician orders and redundant documentation. The system


will be integrated with the business office and the billing and coding department. The automated

system will ensure that the process links clinical information to financial information and lost

charges can be reduced substantially with improved documentation. The length of time accounts

receivables are outstanding will decrease increasing revenue monthly or quarterly. Storage and

supply costs will decrease with the use of the Digital Imaging System. Storage costs can be

eliminated or decreased because of the amount of paper a health care facility must keep.

Supplies such as paper, folders, filing cabinets, dividers, and storage boxes will decrease.

Another factor to consider is the cost of an outside vendor to shred sensitive information. With

the use of the Digital Imaging System the paper, needing to be shred will decrease and so will the

cost.

A decrease in the amount of funds necessary for labor is a large benefit to the Center. An

improvement for the economic environment also can be seen in the reduction of repeated lab

tests, such as x-rays, ultrasounds, and blood draws because of a misplaced document. The

physician’s access to the complete clinical record will ensure medication orders are complete and

covered by the patients insurance. Many times the facility has been responsible to pay the

pharmacy charges for non-covered medication or medications ordered too soon. Having access

to pertinent data will decrease pharmacy charges. With the reduction in labor needed to perform

all the above duties the staff will spend time that is more productive with the patients.

Cost Containment

ASC has detected an inefficient practice related to the medical record. Areas of concern

are the location of needed documents, inadequate documentation, missing documentation,

inappropriate diagnosis codes, and failure to follow through on necessary patient care needs. All

of these concerns increase cost and unnecessary treatments or inefficient treatment of the patient.


The initial cost of the system will be large for the organization and the effects may not be seen

for quite some time. The organizations goal is to improve patient care by reducing the cost of

labor and increasing productivity. Decreasing the need for costly medications and unnecessary

medications will help in cost containment and better patient outcomes.

Leadership Role in the ASC Community

There are many testimonials available from reliable leaders and researchers in the field.

The following are just a few from notables. Dr. and Professor G.W. Eklund at the University of

Illinois College of Medicine states that "Faxitron's unit has opened a new era in specimen

radiography. The ultra-high resolution and 5 times magnification capability of needle core and

excisional biopsy tissue have enabled us to find micro-calcification that would otherwise escape

detection. The superior contrast achieved with very low kV enables discrimination of soft tissue

lesions that have similar density to normal glandular tissue. With Faxitron specimen radiography

we can predict the extent and location of disease more accurately.” Surgeon and Director Dr.

Christine B. Teal of George Washington University Hospital wrote “The BioVision system

allows us to see the specimen radiographs immediately which has improved our efficiency

substantially, benefitting us and our patients.” Dr. Michael N. Linver of the University of New

Mexico School of Medicine considers the BioVision "…one of the great breakthroughs in breast

cancer diagnosis in the past 10 years.” In his praise, Dr. Linver said of the BioVision “Through

its exquisitely detailed magnification images, the Faxitron has expanded our understanding of

breast pathophysiology, resulting in more accurate and complete diagnosis and better patient

outcomes." These leaders in the field point up many benefits to the BioVision. It assists the

institutes in guiding workflow, meets the needs of the whole clinical staff that includes

administration, nurses, assistants, and physicians. Using this imagining system will allow the


ASC to take and maintain its place as a leading ASC as well as take a leadership role in

educating its employees in the most modern technology.

Organizational Need

ASC’s goal to provide high-quality clinical care means that all processes at the

facility should not only be standardized but also should be state-of-the-art. This goal sets the

standard for all of the clinic specialties the staff offers to its patients and their families.

Standardization provisions regulatory compliance. In order to assure that an organized and

dependable patient approval process takes place the ASC must consistently maintain the best

possible inventory of equipment. The ASC must demonstrate that its goals include a coordinated

effort to accomplish constant enhancements to the patient experience. The BioVision improves

the ASCs ability to increase the standard of care to patients going through a surgical excision or a

biopsy.

Nurses will be able to bring patient care plans up to in real time because of the presence

of the BioVision results and the ease in transferring the information. Staff will spend less time

on the phones with other locations, handling film, arranging new appoint, or worse making the

patient come in to the facility for a re-shoot of the x-rays because of film development issues.

Repairs and the procurement of film, paper, transport packets and other consumables associated

with film x-rays will be eliminated. Because of the timesavings, the staff will not be required to

work over-time nor will they have cause to fall behind schedule. The auditing process will be

streamlined because the digital images with travel with the patient file. In this way the staff can

ensure that all of the patient’s records are complete, up-to-date, and accurate. Physician orders

will be contained in the file and available immediately upon the review of the record. This

comprehensive way of maintaining patient records, will all available information including x-ray


images in one place will assist the lab and other sectors in the ASC. This will allow the ASC

staff to make informed and speedy decisions about a patient’s healthcare needs.

The acquisition, simple delivery method and installation, along with the training provided

by Faxitron (and included in the quote price) correlates directly with the ASC goals of value-

added patient care, long-term revenue enhancement, community leadership, and ethical

responsibility. Comprehensive, precise, readable images will enhance the maintenance of

medical records, ensure a continuousness high standard of patient care, lessen the possibility of

error during transport of and development of film and above all guarantee that diagnosis and

treatment for patients occurs in a timely fashion.

The staff will require less time in performing clerical duties. This will increase cost

containment overall. The ASC budget apportioned to clerical and staff labor hours, technician,

nurse and physician labor hours, materials, consumable supplies and their storage, space used for

film x-ray storage, as well as medical records will be cut. This will reduce stress in the ASC as

the staff will not be burdened with non-patient care tasks and will feel confident that their

records are up-to-date and comprehensive. This should increase employee job satisfaction

thereby reducing the risk of staff resignation and discharge. Physicians, technicians, surgeons,

nurse, and nursing assistants, in fact all the clinical staff, will be gratified to be using the most

modern imaging equipment available.

Justification

This capital expenditure is justified because the BioVision Digital Imaging System

meets the administrative, business, and clinical needs of the ASC. The improvement in

information management will enhance employee job satisfaction and advance the quality of

patient care. The problems associated with film will be eliminated because here is no


development, transfer, and transport of physical film x-rays required. The elimination of film

problems will increase efficiency, productivity, quality, and profits. Cost containment with

regards to employees will be assured.

Acquiring the Digital Imaging System will allow ASC staff to focus on clinical issues

such as patient diagnosis and treatment. The capability of reviewing a patient’s medical records

comprehensively will reduce wait times as well as the very timely task of telephoning

laboratories, read services, and other external support sources. Patient histories and regularly

scheduled physicals will be conducted with the knowledge that the clinical staff is approaching

patient care in a holistic manner due to the completeness of the information contained in the

patient’s medical record. Redundancy will be eliminated, there will be no need for duplication

services, or multiple copies of an x-ray because clinicians can review x-rays digitally.

The Digital Imaging System will reduce the time required to file, warehouse, and

preserve the film and paper x-ray reports. Off site and on site storage space that has been

allocated to x-rays can be eliminated in the future. This will be an immediate hard cost savings

as will the reduction on supplies needed to maintain a film and paper records including storage

cabinets. The incorporation of the patient’s clinical record, insurance records, and payment

record will allow for more accurate and timely billing. It will streamline the procedure for

billing insurance companies because all the information will be in one comprehensive patient

file.

Conclusion

The BioVision cost of $99,875.00 total will be recouped in less than a year with a

minimum number of procedures benefitting from the new equipment. The attached Time & Cost

Savings calculations demonstrate that using a low estimate of four surgical procedures and


assuming patient screens of approximately 32 per day the immediate monthly savings compared

to film will be an estimated $20,800.00 per month. This equates to an estimated savings of

$249,600.00 in the first year. This more than meets the requirements established by Cleverley &

Cameron whose studies indicate that a capital expenditure should be based on the assumption

that it will not only deliver benefits for a decent time period ( two years being the established

minimum) but also that the expenditure will be recouped (Cleverley & Cameron, 2007, p. 397).

As has been demonstrated in this report the ASC will benefit in many aspects of

operation form the acquisition of a BioVison. The organization has long been aware of the need

to modernize radiology services and streamline the handling of patient information. The call for

this report and proposal is an acknowledgment that the ASC wants to advance patient care,

address employee productivity issues, increase overall efficiency and service, and ensure high

quality patient experiences. The decrease in duplication of documentation alone will allow for

increased organization when meeting patient needs and simultaneously increase employee job

satisfaction and therefore employee retention. New higher levels of productivity and precision

will cause revenues to increase because of cost containment and patient loyalty.

Section II: Establishing Acceptability

In Section I and in the attachments that comprise Section III the acceptability of

the purchase for revenue enhancement has been examined. Section I addresses the payers whose

focus is cost-effectiveness; and the ASC as an employer whose focus is cost constraints and

improved employee productivity.

This Section of the report addresses the acceptability of the BioVision for key

stakeholders at the ASC. The providers of direct care to patients, those being the clinicians

including physicians, radiologists, and nurses are key stakeholders. Clinicians focus on high


quality and advanced technology as well as providing an accurate diagnosis, selecting the correct

course of patient care and therapies, and finally the best result for the patient’s health outcome.

The patients themselves are key stakeholders as well and concerned with many of the same

things as are providers, additionally they look for compassion and communication (Duke

University, 2005).

Research from other organizations point to the valuable contributions that digital

imaging has made in the field of breast cancer diagnosis and treatment. Because mammograms

are so much in demand, it is important that the ASC offer the best possible service to these

patients. The speed of the digital mammogram recommends itself to the patient. Additionally

the capability of manipulating the digital image of a mammogram electronically is very useful

for radiologists, physicians, and surgeons. A digital mammogram is much better than the film

mammograms currently in use because the digital imaging system utilizes an exceptional

detector that captures and converts the x-ray energy into a digital image. There are obvious

advantages to offering digital mammography at the ASC, not the least of which is patient and

employee expediency. There is not film that needs to be developed. This means the radiologist

or technician doing the imaging can appraise the quality and usability of the image immediately.

The patient and the technician will not need as much time for the examination. Also, because the

technician can check the images as they are taken there will not be a need for repeating the

procedure at another time as happens so often when film images are over-exposed (URMC,

2013).

From a patient point-of-view, the fact that they will not need to twist themselves into

awkward and even painful positions for x-rays will appreciate how much faster the digital

imaging is compared to film. Once the mammogram is ready to view, the technician can change


the setting for brightness, contrast, or darkness as well as zoom in or magnify specific areas in

the image. This allows for a high quality and refined appraisal of the tissue under examination.

Experts praise the way in which they can manipulate the contrast feature of a digital image in

mammograms because this aspect of the image is vital to readings that reveal dense tissue. The

problem with film mammograms is that malignant cells and dense tissue both look white on a

film mammogram. Other advantages of digital imaging noted were that the images can be stored

and retrieved easily, they can be transmitted between doctors quickly and easily, and they can be

used with the latest advances in software to aid in the early detection of breast cancer (URMC,

2013). The BioVision delivers instantaneous confirmation of excised breast tissue margins.

A publication that points up the advantages of this digital radiology is Abdominal

Imaging experts discuss the benefits of digital imaging when doing examinations of the pelvis

and abdomen. In this book, the experts discuss a variety of organs and systems that benefit from

being examined using digital equipment. Suggestions for imaging methods and exam protocols

are explained. The book uses many excellent digital images to demonstrate how effectively a

physician can differentiate between a normal scan and a scan that reveals pathologic entities

(Hamm & Ros, 2013). This type of ability to render complete and accurate diagnosis in a timely

manner will reduce organizational risk and increase the ASC’s compliance record.

Because it is important that the ASC management make certain that the

organization stays in accordance with accreditation sources recommendations from such

agencies as The Joint Commission need to be examined. That organization has in place

guidelines whereby the ASC must provide modern diagnostic imaging services. Additionally

there are special requirements for ASCs that want to obtain an advanced diagnostic imaging

certification. The criteria regulates safety issues, in particular the issue of claustrophobia that


larger, older ex-ray equipment exacerbates. This problem can be avoided by using a digital

imagining system. Another issue for The Joint Commission is that either quality of the imaging

equipment. For ASCs that offer diagnostic computed tomography (CT) services, they consider it

necessary that a diagnostic medical physicist evaluate the imaging equipment. The following is a

list of what the evaluator would be looking for in terms of quality imaging results (The Joint

Commission, 2013):

● Image uniformity

● Slice thickness accuracy

● Slice position accuracy

● Alignment light accuracy

● Table travel accuracy

● Radiation beam width

● High-contrast resolution

● Low-contrast resolution

● Geometric or distance accuracy

● CT number accuracy and uniformity

● Artifact evaluation

Owning and operating a state-of-the art digital system would insure the ASC passes all of

the above requirements and achieves the very desirable advanced diagnostic imaging

certification.

Sensitivity Analysis

Healthcare businesses are immune from negative changes in the economy due to the

simple fact that people will continue to get sick and require outpatient treatments. Additionally,


these treatments are often paid for by private insurance companies and publicly funded health

systems. As such, the Ambulatory Service Center should have no issues generating top line

income or receiving payments from its patient base.

It is possible that ASCs are held to even higher standards that HOPD and physician

offices because of the newness of ASCs and the remarkable growth in their facilities as those of

choice for patients. Compliance with state and national standards means on-site surveys during

which the ASC is subject to evaluation. Licensures differ according to the state and ASCs need

to be prepared for on-going re-inspections. When Medicare patients are involved, the ASC must

meet federal facility standards. There are several accreditation organizations, the main one being

The Joint Commission and the Accreditation Association for Ambulatory Health Care (AAAHC).

The reason it is so important for an ASC to offer the best possible technology is that they are

expected to use innovations in all aspects of outpatient care including ex-ray, anesthesia, and

outpatient techniques. The development of minimally invasive techniques, including the

technology that replaced intraocular lens is now expected. Procedures such as this are used one

million times every year to treat Medicare patients for cataracts. These and other procedures that

used to take place in hospitals are now performed at ASCs with greater customer service and at

lower costs.

The ASC would benefit from the purchase of the BioVision because it would provide for

intra-operative use. This makes for less time-consuming procedures. The unit provides point-of-

care specimen radiography so that surgeons can immediately read breast biopsies and

lumpectomy specimens. The estimated timesaving using digital imaging is a minimum of twenty

minutes for patients under anesthesia. The surgeon and others do not need to send the specimens


to another department or location for imaging. The radiologist and the surgeon can view the

digital image instantaneously and make decisions accordingly.


References

Chukmaitov, Askar S, Menachemi, Nir, Brown, L Steven, Saunders, Charles, & Brooks, Robert

G.

(2008). A Comparative Study of Quality Outcomes in Freestanding Ambulatory Surgery

Centers and Hospital-Based Outpatient Departments: 1997–2004. Blackwell Science

Inc.

Cleverley, W. O., & Cameron, A. E. (2007). Essentials of health care finance (6th ed.).

Sudbury, MA: Jones and Bartlett.

French, Joel. (2011). “Four ways to improve hospital revenue.” Healthcare Finance News.

Retrieved from http://www.healthcarefinancenews.com/blog/four-ways-improve-

hospital-revenue.

Hamm, B., & Ros, P. R. (2013). Abdominal imaging. Berlin: Springer.

Renner, K. (1996). Cost-justifying electronic medical records. Healthcare Financial

Management: Journal of the Healthcare Financial Management Association, 50(10), 63.

Retrieved from MEDLINE with Full Text database.

Organization Publications

Duke University. (2005). “Patient Quality Improvement.” Department of Community and

Family Medicine, Duke University Medical Center. Retrieved from

http://patientsafetyed.duhs.duke.edu/module_a/introduction/stakeholders.html

Medicare Payment Advisory Commission (MedPAC). (n.d.). Medicare Payment Advisory

Commission (MedPAC).

Peer Reviews. (2013). “Ask the Experts.” Retrieved from

http://www.faxitron.com/medical/about/peer-reviews.html.


The Joint Commission. (2013). “Revised Requirements for the Ambulatory Health Care

Program.” The Joint Commission Perspectives. Retrieved from

http://www.jointcommission.org/assets/1/18/PREPUB-1-2-2014-PCMH_AHC.pdf.

URMC. (2013). “Advantages of Digital Mammography.” University of Rochester Medical

Center.

Retrieved from http://www.urmc.rochester.edu/highland/departments-centers/breast-

imaging/tests-procedures/advantages-digital-mammography.aspx.

Documents

Capital Expenditure BioVision by Faxitron