OBL: Keys to success in the outpatient setting

Brian DeRubertis

The ability to pivot in the face of changes to reimbursement while still meeting the needs of patients is a key facet of success in the office-based lab (OBL). That was among the key messages delivered by Brian DeRubertis, MD, professor of surgery at UCLA School of Medicine in Los Angeles, in a talk delivered at the Pacific Northwest Endovascular Conference (PNEC) in Seattle (May 27–28) focused on reimbursement issues in the context of OBLs—and whether or not this mode of outpatient setting can weather the challenges.

To demonstrate his point, DeRubertis used the example of arteriovenous (AV) access procedures for dialysis patients. “Reimbursement issues are always key to the OBL setting,” he explained. “Just like any hospital setting, you need to make sure your reimbursements are enough to sustain the model.

“Reimbursements have been decreasing in recent years. There is often discussion of large decreases in reimbursement or large changes, but there have not been significant changes over the last few years in my opinion. We have seen a decrease by a few percentage points in various procedures each year. Now, that does change—there are some procedures, such as AV access procedures for dialysis, which undertook somewhat major changes a couple of years back. I think as physicians we need to be aware of what these changes are to make sure the reimbursement is still sufficient enough that we’re providing care for patients in a way that we think is the right way to care for them.”

DeRubertis said it was important to highlight some of the benefits of providing care in the office-based outpatient setting. He referenced physician flexibility, autonomy and independence in care provision; the speed at which patients can be transported into the procedural suite; a nimble nature that enables adaptability to community needs; and increased safety.

Reimbursement challenges often rest on an ability to react to change, he noted, returning to the example of decreased payments for AV access procedures in the the OBL arena. “But they increased in the ASC [ambulatory surgery center] setting,” DeRubertis pointed out. “So some physicians have converted and gone through the process of converting their OBL to ambulatory surgery centers, which has a different set of requirements and regulations but in some ways that’s maybe a good trend going forward for some centers.

“So I think the real key is being aware of reimbursements, and being able to pivot to make sure that it is in concordance with a model that allows us to treat our patients the right way.”

DeRubertis also touched on the ways in which COVID-19 demonstrated other OBL benefits. While a patient attending a hospital for a procedure such as a lower-extremity angiogram might interact with as many as 30 different staff members, he said, the equivalent number in an OBL or ASC might be just five to seven. “So during such an unusual time like the pandemic, having that real simplicity and pared-down support staff really helped protect both patients and staff from COVID transmission.”


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