Surgical Center Used by Rivers Part of Outpatient Push

The surgery center where comedian Joan Rivers suffered complications is among a class of medical facilities created by doctors that is attracting more patients and higher revenues from routine procedures and minor surgeries.

Yorkville Endoscopy Center, which opened last year in a luxury doorman building on New York’s Upper East Side, was started by four practicing doctors and an investor group to perform gastroenterology procedures. In documents filed in 2011 with the New York State Health Department, the group said it was seeking to open the center to perform procedures the doctors were doing in their private office-based practices.

After suffering complications at Yorkville, Rivers was transferred on Aug. 28 to nearby Mount Sinai Hospital, where she died Sept. 4 at age 81. Rivers’ cause of death hasn’t yet been determined. Medical examiners who performed an autopsy of Rivers were unable to determine why the comedian died after several days in a coma, a state spokeswoman said yesterday.

The Yorkville facility is now the subject of a state investigation to determine whether it violated any New York rules. The New York City Office of Chief Medical Examiner will continue studying the cause of Rivers’ death, according to a spokeswoman. The office reviews cases when it believes a death could be related to a medical therapy or procedure.

“Following an examination the cause and manner of death are pending additional studies,” Julie Bolcer, a spokeswoman for the medical examiner, said yesterday. “More investigation is needed.”

Yorkville’s offices were open and doing business yesterday, according to a newly added security guard stationed at the entrance to restrict access to patients. There was a local TV truck parked across the street. Officials with Yorkville couldn’t be reached for comment.

Greater Convenience

Ambulatory surgery centers have benefited as patients and insurers seek more convenient, less costly treatment outside of traditional hospitals. The centers tend to cost less because they have fewer overhead expenses and wait times are shorter, encouraging insurance companies and doctors to recommend them more frequently.

The centers also perform administrative functions for the doctors, such as negotiating more favorable reimbursement rates on an in-network basis with health insurers, according to a 2013 report by Moody’s Investors Service Inc. Larger centers can also provide their physicians with more time to see patients and are better able to accommodate physician schedules than a typical hospital, Moody’s said in the report.

Increasing Use

Revenue and patient numbers at outpatient surgery centers nationally are expected to continue to increase, even as hospitals see declines, Moody’s said. Most such centers are doctor-owned.

“While hospital inpatient surgery procedures will continue to contract, same-store volume growth in ASCs will continue to increase as more procedures can safely be done on an outpatient basis,” according to the report.

Critics of ambulatory centers say the facilities create a potential conflict of interest because 90 percent are owned by at least one of their practicing physicians, providing a financial incentive to recommend procedures.

“Recent research findings relating increased utilization to ownership are of concern and warrant further study,” said the American Academy of Orthopaedic Surgeons in a statement on its website.

Rivers’ health records are private. She experienced cardiac arrest during her treatment at the facility before being transferred to Mount Sinai, authorities have said. A spokeswoman for her daughter, Melissa Rivers, declined to answer questions on the comedian’s death.

Diagnostic Procedure

Among its procedures, Yorkville performs endoscopy, in which a doctor usually sedates a patient and guides a scope through the esophagus and into the stomach to diagnose or treat diseases in the upper and lower digestive tract.

Complications are rare and tend to be worse in older patients, according to the Society of Gastroenterology Nurses and Associates, a trade group. Elderly patients can be at a higher risk for cardiac events, the group said.

The state health department will review documents and a sample of records at Yorkville to determine on whether any state rules have been violated. The department has already visited the facility.

Bill Schwarz, a spokesman for the department, said 43 ambulatory surgery centers in New York State are monitored as strictly as hospitals. The centers follow different federal rules than hospitals because they operate differently, according to the Ambulatory Surgery Center Association, an Alexandria, Virginia-based trade group.

Revenue Estimates

In the 2011 Yorkville document laying out plans to open the facility, the group projected performing 5,500 procedures in the first year and 6,064 by the third year. It expected $3.87 million in revenue and a gain of about $1 million after expenses by the third year.

The center’s ownership was expanded in 2013 to 11 doctors and the investor group, Frontier Healthcare Management Services LLC. Its website currently lists the same 11 physicians practicing at the facility.

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