A Continuing Trend For Growth

By Laura Freeman

Not long ago, surgery was primarily done in hospital operating rooms. This began to change as an aging population developed more chronic conditions that needed attention at the same time that many community hospitals were having to close their doors, which funneled more patients into city hospitals. Administrators faced a challenge in trying to schedule procedures for patients who were in pain, but whose conditions were not life-threatening.

Fortunately, advances in treatment and technology have expanded the types of care that could be completed in a day with the patient likely to go home the same night. This made ambulatory surgery centers (ASC) a new option that has quickly become a thriving alternative. As of June 2023, there were 5,828 ambulatory surgery centers in the United States, which was an increase of five percent over the previous year. The outlook for growth continues to be strong.

“Advances in surgical techniques are dramatically expanding the types of procedures that can be safely done in an outpatient setting,” Kelly Fowler, Administrator of Surgical Institute of Alabama, said. “Medicare is shifting toward approving more acute conditions for treatment in ambulatory surgery centers, which is creating opportunities for continuing growth.

“We are already doing total joint replacement and spinal surgeries for patients who are happy that they don’t have to spend time in the hospital. They are up within a couple of hours, ready to start rehab, and they can go home the same day.

“Traditionally, most of the ASCs in our state have been multi-specialty, but we also have several that perform only eye surgery or gastroenterology procedures. As we see expansion into cardiology, urology and other specialties, I believe we will see more single-specialty surgery centers set up to handle these specific types of procedures.”

As technologies continue to evolve, ASCs can anticipate a growing demand from cardiology, bariatric surgery, colorectal surgery and higher acuity procedures from a wide range of specialties. ASCs that want to attract a following in a particular specialty may need to invest in specialized technologies. The revolution in robotics, imaging, optics and AI will likely affect future needs. There may also be regulatory requirements such as certificates of need that will have to be addressed.

A number of hospitals have also opened their own outpatient centers for same day surgery patients. ASCs can free up hospital-based operating rooms and patient beds to handle trauma and sudden illnesses that don’t allow predictable scheduling. This also gives hospitals the opportunity to concentrate on more complex procedures that require longer recovery time and to make major investments in more sophisticated technologies.

In turn, ASCs can provide access and help avoid frustrations for patients who might otherwise see their wait for a minor procedure repeatedly extended due to emergencies that take priority. At 3:30 pm, even the most understanding patient who hasn’t been able to eat or drink since midnight can become cranky with another delay. This could affect the review they give on care quality questionnaires that can affect reimbursement.

In contrast, ASCs doing the same types of procedures over and over are set up for efficiency. They can also shift staff early in the day to streamline admissions and handle routine paperwork and discharges later. This efficiency allows ASCs to offer cost advantages compared to hospital-based procedures, which is good for the coverage provider and the patient’s out of pocket costs.

An NIH study showed that 30-day outcomes in the sample reviewed were equal to or better than those for in-patient procedures. Patient satisfaction scores are also high.

The forecast for ASC growth is not without challenges. “One of the biggest difficulties we face is the fact that to secure anesthesia services we have to pay stipends in addition to what the payer and the patient pay the anesthesia group,” Fowler said. “In the past, the reimbursements they received were enough to cover the cost. Now we have to pay the difference despite the fact that what ASCs receive in reimbursement is significantly less than what hospitals are paid for the same service, despite our record for good outcomes. Anesthesia services are an essential part of the team, and we understand that they need to be reimbursed for the valuable work they do. The key is finding an anesthesia partner to walk this road with you, one who will get creative in how we operationally work together, maximizing throughput and efficiency while looking for new ways to lessen overall costs.

“We also don’t necessarily have the favorable vendor contracts that hospitals tend to have. Although ASCs are known for efficiency and the savings that are helping to keep costs to Medicare and private payers lower, the reality is that costs are growing beyond what we can offset with efficiency and cost containment efforts alone. We have to negotiate contracts and reimbursements with fairness and real-world numbers in mind.

“Overall, the future for ambulatory surgery centers is looking bright That should be good news for us, for patients and for everyone interested in providing access to efficient, affordable quality surgical care.”