Procedures that are being moved into the physician's office and the savings that this will bring

Article Conference CoverageFrom American Association of Gynecological LaparoscopistsLas Vegas, Nevada, November, 1999


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Dr. Roosevelt McCorvey: "I'm Dr. Roosevelt McCorvey. We're here at the AAGL in Las Vegas, Nevada, and I'm sitting here with Dr. Jaswant Chaddha and Dr. Beverly Ray Love. We're going to have a little discussion today on office-based procedures in the new millennium. As you may or may not know, we have always had a special predilection toward doing procedures that are accessible to the patient and that can be done in the office. After twenty years of exposure and experience, we're bringing all of our knowledge to the floor, and we're using instrumentation that was never available to us in the past. Companies have used the Internet and the software industry to make things more precise and have brought them to us in such a way that it makes office-based procedures natural. When you look at the cost of medicine, now escalating extraordinarily, you will need to have use of all of the things that are available to you. So we're really excited about the practice of gynecology, and particularly the practice of office-based gynecology, as we move forward in the new millenium. Dr. Jaswant Chaddha works with us. He works in Atlanta, Georgia, but has a wealth of information on office-based procedures, starting with outpatient office laparoscopy and progressing from there. As you may or may not know, Dr. Love and I practice together down in Montgomery, Alabama, and the name of our practice is the Women's Wellness Center. As I stated earlier, we have a special predilection toward office-based procedures. Now, with that as an introduction, Dr. Chaddha, do you want to say something about the things that you're doing, what you plan to do, and what you think we ought to be able to do as we move forward into the new millenium?"

Dr. Jaswant Chaddha: "I want to second everything you've said. I think in the new millenium they'll be more office-based procedures, and they will be replacing a lot of hospital procedures so that patients can have same-day surgeries and go home, walking and driving themselves rather than having to be dependant on other people. Apart from everything else, as you said earlier, the cost factor is going to be a much better profile than what it has been, even through today. So I think with your insight into office-based procedures, it's excellent that these things will take off in the next millenium. We should be able to do much better office-based procedures with the instruments that you've mentioned, which are available now. I think both you and Dr. Love, who have developed the OLULA procedure-it is office-based under local anesthesia-should take off very well. And pioneers like you have done great. Dr. Love...?"

Dr. Roosevelt McCorvey: "Thank you."

Dr. Beverly Ray Love: "We have to repeat his compliment because we actually did develop a technique, and we use it in our office. We call it OLULA, which stands for Office Laparoscopy Under Local Anesthesia. If you look on the Internet, you will find that a lot of places are using it. In fact, we helped start the Yale office laparoscopy program because they came down to Alabama, Montgomery, so we taught them how to do office-based laparoscopy. The fact is, Dr. Chaddha did 10,000 tubal ligations laparoscopically under local anesthesia in India before he came to this country. So he has a wealth of experience doing laparoscopic procedures outside of a hospital, out of a surgery-center-type environment where patients can have procedures done safely, they can recover, and they can go on about their business and go home. But now, I guess the thing that got Dr. McCorvey and I is that we started doing these procedures at a time when people were saying, 'no, you shouldn't be doing that' and 'that's not good' and 'that's not right... patients won't tolerate having procedures done.' But the fact is, we've shown within the last twelve years that people do tolerate these procedures. In fact, patients go and tell other patients that they can have a procedure done in the office, and that they don't have to be put to sleep. We have good local anesthesia, we have some minimal IV sedation, and you can accomplish a procedure with minimal discomfort for the patient and they can have it done like that. What this did for us is open up a whole other arena of office-based research because we have a lot of companies that have started to develop devices and procedures that you can use in the office. I guess one of the first ones we got started with was a company called Gynecare. They developed the balloon endometrial ablation device, which we actually used as part of a clinical trial. We did the procedures in the office using that balloon device under local anesthesia. What they did was open the door for us to be affiliated with other companies, and some of the companies we became affiliated with were for endometrial ablation to treat women with heavy bleeding. One was a company called BEI, and they have a procedure called 'hydro-thermal ablation,' which we did in the office. We used hot salt water. You can ablate the endometrium or destroy the lining of the uterus and treat a woman for heavy bleeding, and then hardly have any more heavy bleeding. The third company we got with was a company called CryoGen. They use cryoablation, a cold technique that you can use in the office. It's almost as if there's no pain, or minimal pain-painless endometrial ablation-and this is all done in the office. As we go forward... it's like Dr. McCorvey said: hopefully we can convince the politics to change because what has happened in the past is insurance companies and the hospitals are connected so well with each other that, until we come up with new devices and procedures that can be done in the office setting, they don't allow them to happen because they don't allow you to get adequate reimbursement to buy the equipment and do these procedures in the office. But hopefully we can overcome this and go directly to the payers and tell them that not only can we do safe, efficient procedures, we can do procedures that they ought to be able to compensate us for. The patients will benefit because they don't have to be put to sleep, and they'll have fewer complications. As a matter of fact, at this meeting there were some other companies that we connected with-one of them was a company called Microsulis. They have a microwave endometrial ablation technique, and they're doing these under local anesthesia in an office in England. We're going to bring this device to Montgomery, Alabama for endometrial ablations. We should start up probably sometime in January of the year 2000 doing microwave endometrial ablations in the office. We have to wave at people while we're on TV because we see people every week. We're on-real doctors-and we're talking."

Dr. Roosevelt McCorvey: "I think the other salient point that we want the world to know and we want this country to know is that it's not just heresy. The fact of the matter is instrumentation has come to fruition that will allow us to do a tremendous number of procedures in the office. As a gynecologist, I am thinking 70%-75% of all of my procedures can be done very well in the office and in a cost-effective manner, such that you can save money for the whole industry. If you think about it, if you have 35,000 to 40,000 gynecologists doing inpatient sterilizations, that's generating a bill to the national health arena of two billion dollars. If you could cut it down to half a billion dollars... think about it! Also, if you look at the procedures that are being performed in the hospital on a gynecological standpoint, 20% of hysterectomies are done for aberrant or abnormal bleeding. If you could use some of this technology for those who are suitable and cut the costs from $8,000 or $9,000 to $2,000, you could save that arena some 1.5 billion dollars. We're talking about big money, we're talking about money that has an impact on the whole system, and we're saying if you take a look at the technology that's available, we can give efficient and effective health care to all of the American people for what's in the system already. What we have here now is a system that has run aground. It is too big, and it is consuming too much of our natural resources. We need to look at the system and find a way to adjust that system such that everybody can reap the benefit from it. As long as the people that are in charge stay in charge, we have little or no chance of changing or turning that system around. The technology is available... all we need to do is use it."

Dr. Beverly Ray Love: "I think that's right. Do you have any other remarks for us, Dr. Chaddha?"

Dr. Jaswant Chaddha: "I think that a lot of procedures that we're doing through laparoscopes and hysteroscopes in the hospital can definitely be brought to an office-based environment. It is not as if we're reinventing the wheel. It has already been done, and it should only be done in a proper perspective manner. It should be done in a very safe manner so women get better care in a safe environment, plus at the same time the money could be diverted into more research, doing better things for women in the future and helping these women with better women's health care."

Dr. Roosevelt McCorvey: "I want to broaden it out. I know I'm not a cardiologist, a general surgeon, or a perinatologist, but I'm saying to the world, with the technology that is available in terms of the progress that we've made in instrumentation, there is a need for us to rethink the way we're doing health care in this country and look at an office-based procedure, a model that will help us to supply health care to all our folks in a cost-effective manner. I think it's available, and I think it's not too far away. I think it's just a matter of when we will come to look at it from a national standpoint, we don't have a platform to get this out to everybody. There's somebody out there listening, and they ought to pay attention and take what we're saying and move it to the next level such that we could use all the technology in all of medicine so we can all get what we need. Then you'll see that only about 25% to 30% of us really need a hospital and the other 70% to 75% can be treated adequately, amply, and appropriately on an out-patient and office basis."


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