Office-Based Lab (OBL) Handbook

Publication Date: January 1, 2019

Society for Vascular Surgery Office-Based Lab (OBL) Handbook Introduction

Society for Vascular Surgery Office-Based Lab (OBL) Handbook Introduction

Foreward - Anil Hingorani, MD, DFSVS

In 2008, when CMS authorized peripheral vascular interventions to be performed in the office-based laboratory (OBL) setting, the OBL revolution commenced. This allowed many arterial and venous procedures that were being performed in the hospital setting to be performed in the office. Indeed, today the majority of lower extremity arterial interventions are performed in an outpatient setting, and projections suggest that this trend will continue.

Although these changes are ongoing, there is actually very little guidance available on how to start or maintain an OBL. The SVS Sub-Section on Outpatient and Office Vascular Care developed this handbook to assist with these issues. The authors are leaders in this field and have used a variety of techniques and styles to write short and direct-to-the-point chapters, each addressing a specific focus. This handbook is meant to be a live document that will be revised as needed. The SVS hopes you find the handbook useful.

Acknowledgements - Kenneth M Slaw, PhD

I would like to thank Anil Hingorani, the chair of the Section on Outpatient & Office Vascular Care (SOOVC) for leading this innovative effort and all the authors of this handbook for working together to write a tangible resource for SVS members. A special thank you to Reva Bhushan, Chantel Moore, Kristie Wise and Erin Browning-Paine for designing the handbook and Chris Wise from Guideline Central for editing and formatting the handbook. Thank you to W. L. Gore & Associates, Inc. for support that contributed to the printing and distribution of the first OBL Handbook.

Kenneth M Slaw, PhD
Executive Director, Society of Vascular Surgery

Table of Contents and Chapter Authors

  1. Chapter 1. Background and History
    • Robert G. Molnar, MD
  2. Chapter 2. ASC vs. OBL vs. Hybrid
    • Ruosu An, MD
  3. Chapter 3. Building A Business Plan and Why?
    • Bhagwan Satiani, MD
  4. Chapter 4. Creating the Team: Consultants and Checklists
    • R. Clement Darling III, MD and Jeffrey C. Hnath, MD
  5. Chapter 5. Protocols, Manuals and Certifications
    • Steven Curtiss, MD
  6. Chapter 6. OBL Design
    • Douglas Wilhite, MD
  7. Chapter 7. Equipment
    • Krishna Jain, MD
  8. Chapter 8. EMR and PACS
    • Gregory Kasper, MD
  9. Chapter 9. Accreditation, Certification, Permits and Regulations
    • Anil Hingorani, MD and Justin Robbins, MD
  10. Chapter 10. Revenue Cycle Management in the OBL
    • Kyle Diamond, MD, FSVS, RPVI
  11. Chapter 11. Documentation of Outpatient Vascular Procedures
    • Ravi Chandra, MD and Julia Pignanelli (OSM III)
  12. Chapter 12. Staffing and Training
    • Christopher Bulger, MD
  13. Chapter 13. Service Lines, Procedures to Perform and Appropriate Use Criteria
    • Neil Poulsen, MD and Clifford Sales, MD PROCEDURES TO PERFORM
  14. Chapter 14. Management and Business Development
    • Patrick Ryan, MD
  15. Chapter 15. Complications and Troubleshooting
    • Daniel Gorin, MD
  16. Chapter 16. Patient Registries and Quality Improvement Process
    • Robert Tahara, MD

Chapter 1. Background and History

...Chapter...

...ed laboratory (OBL) represents a site of...


...2008 CMS coverage decision was based upon...


...he following references provide ins...


Chapter 2. ASC vs. OBL vs. Hybrid

...Chapter 2....

There are three different types of outpatient sur...


...Ambulatory Su...


...Office-Based Labor...


...Hybrid Mod...


...Ambulatory Surgery Centers – Advan...


Chapter 3. Building A Business Plan and Why?

...Chapter 3....

...market size of U.S OBLs is estimated at about $9.6...


...What Is A Business Plan?Ha...


...Why Is A Busin...


...Financial Aspects O...


...Pitfalls Of A...


...ConclusionThe best...


...Table 1. Cruc...


...Figure...


...es Overview of the U.S OBL market. gra...


Chapter 4. Creating the Team: Consultants and Checklists

...Chapter 4....

...l of the OBL is to provide patient procedures...


...Regulations and Re...



...Pre-P...


...Peri-Procedu...


...Post-Procedure...


...ConclusionIn conclusion,...


...in PH, Chandra FA, Urman RD, Ahn S...


Chapter 5. Protocols, Manuals and Certifications

...Chapter 5....

...eveloping an outpatient vascular center pres...


...ProtocolsRegardless...


...ManualsManu...


...Table 2. AccreditationsHa...


...Ta...


...CertificationW...


...Medicare ASC Standards ecfr.gov/curr...


Chapter 6. OBL Design

...Chapter...

...hin your ambulatory office, the OBL can be de...


...Des...


...StorageStorage...


...Design SafetyThe OB...


Chapter 7. Equipment

...Chapter 7....

...early decisions that needs to be ma...


...Equipment Con...


...Supplies and Med...


...Tabl...


...Table 5. Su...


...Table 6. MedicationsHa...