Ambulatory Surgical Centers (ASCs) are an emerging global trend in the delivery of health care

As health care facilities that provide same-day surgical care, Ambulatory Surgical Centers (ASCs) are an emerging global trend in the delivery of health care. With many states newly adopting the Delivery System Reform Incentive Payment (DSRIP) Program that calls for a 25% reduction in hospital visits over 5 years, this trend is positioned to continue as ASCs increasingly become key to achieving DSRIP goals.

ASCs save money, increase patient efficiency for insurers and patients and provide higher quality, more efficient care. As a result, they are a lower-cost alternative to hospitals and other outpatient surgical venues (Ambulatory Surgery Center Association)

Quality

Because ASCs have a smaller scope and operate a much smaller space, staff and physicians have greater ability to focus on patient care and respond quickly to needs as they arise. This increased clinical focus has a direct impact on quality of care, resulting in ASCs delivering higher quality of care and better outcomes. In addition to better outcomes, increased patient focus also leads to greater customer service. ASCs make customer service a priority and reap the benefits of this commitment.

ASCs are designed to be welcoming environments that evoke comfort. Rooms in these facilities often look similar to rooms one would find in a home. As a result of the more relaxed atmosphere, patients using ASCs are less fearful about procedures than those using hospital-based services. In a home-like environment, patients feel comforted that their minor procedure isn’t being handled within the same location as patients requiring critical care.

Forty years ago, virtually all surgeries were performed in a hospital. Waiting for weeks to get an appointment was not uncommon. Surgery involved a several-day hospital stay, exposing patients to infection and bacteria and resulted in several weeks of missed work. In many countries surgery is still performed this way, but technological advances have changed the face of surgery in the United States (Ambulatory Surgery Center Association).

ASC’s are highly regulated to ensure quality and safety. All ASCs serving Medicare beneficiaries must be certified by the Medicare program. In order to be certified, an ASC must comply with standards developed by the federal government for the specific purpose of ensuring the safety of the patient. The ASC must demonstrate compliance with these Medicare standards initially and on an ongoing basis. In addition to state and federal inspections, ASCs are required to obtain accreditation by an independent accrediting organization. Accrediting organizations for ASCs include the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Accreditation Association for Ambulatory Health Care (AAAHC), the American Association for the Accreditation of Ambulatory Surgery Facilities (AAAASF) and the American Osteopathic Association (AOA). Most hospitals are accredited by JCAHO while ASCs are accredited by AAAHC. These inspections are thorough and time consuming. Without initial accreditation, ASCs cannot see any Medicare patients.

ASCs consistently perform as well as, if not better than, Hospital Outpatient Departments (HOPDs)  in quality and safety. A recent study included an examination of the rates of inpatient hospital admission and death in elderly patients following common outpatient surgical procedures in HOPDs and ASCs. Rates of inpatient hospital admission and death were lower in freestanding ASCs as compared to HOPDs. Even after controlling for factors associated with higher-risk patients, ASCs had low adverse outcome rates.

Cost Savings

The cost savings provided by ASCs are tremendous. On average, the Medicare Program and its beneficiaries share more than $2.6B in savings each year because the program pays significantly less for procedures performed in ASCs compared to the rates paid to hospitals for the same procedure (Ambulatory Surgery Center Association). Medicare saves approximately 42% of costs on each procedure performed in an ASC setting. These savings are enabled by ASCs significantly lower overhead rate per visit.

Without ASCs as an option for care, health care expenditures would be increasing at an accelerated rate. Private insurance companies tend to save similarly, which translates to lower health care costs for employers when employees utilize ASC services. For this reason, both employers and insurers are exploring ways to incentivize patients to use ASCs.

Efficiency

ASC settings provide Physicians with greater control over scheduling. As a result, procedures are rarely delayed due to institutional demands that occur in hospitals, such as emergency room demands. Also, increased control over scheduling prevents compact scheduling that occurs in hospitals to avoid excessive staff downtime. Physicians are able to schedule a few of the same procedures in a row, which significantly reduces prep time for each procedure.

ASC’s have become innovators of practices in surgical care. For example, the industry has led to development of minimally invasive procedures and advancements of technology to replace the intraocular lens. This procedure is commonly used to restore vision (Ambulatory Surgery Center Association).

References

Ambulatory Surgery Center Association. (n.d.). ASCs: A Positive Trend in Health Care. Retrieved August 27, 2015, from ASC Association: http://www.ascassociation.org

Ambulatory Surgery Center Association. (n.d.). Innovative Practices. Retrieved August 27, 2015, from ASC Association: http://www.ascassociation.org

Ambulatory Surgery Center Association. (n.d.). Quality of Care in ASC’s. Retrieved August 27, 2015, from ASC Association: http://www.ascassociation.org

ASC Coalition. (n.d.). A Positive Trend in Health Care. Ambulatory Surgery Centers, 8.

New York State. (n.d.). Delivery System Reform Incentive Payment (DSRIP) Program:. Retrieved August 30, 2015, from Department of Health: https://www.health.ny.gov

Published in Develop Health Infrastructure

Comments

  1. Tejinder Singh

    A very positive trend towards cost reduction & quality of care.

    The patients must be undergoing diagnostics & lab test prior to coming for surgeries.
    The most important factor is that ASC’s are highly regulated to ensure quality and safety.

    We in India have centers run by doctors, mushrooming all over the country, but few are accredited. Nevertheless, some do provide quality healthcare. National Accreditation Board for Hospitals and Healthcare Providers (NABH ), a body that came into being in 2006, has developed Accreditation Programs for varied Healthcare Services. But NABH Accreditation so far is a voluntary process and therefore it is entirely up to the healthcare organisation whether to adopt it or not.
    However, with progressive reforms coming up, it may soon be mandatory to get NABH Accreditation, keeping in line with, “First Do No Harm.”

    1. Rose Rosenfeld Post author

      Its nice that India finally created the governing body.

      In addition, to ensuring quality and safety the accreditation also provides opportunity to the hospital to benchmark with the best in the industry. Benchmarks are vital part of total quality management. In a 2018 survey conducted by Health Catalyst, 72 percent of executives said to identify and prioritize improvement opportunities, benchmarks are important or extremely important. Additionally, 22 percent said that an organization’s performance against benchmarks is the most influential factor for determining which improvement initiatives to launch, after regulatory/reporting requirements (25 percent) and improvement team priorities (24 percent).

  2. Shubh Singh

    Do ASCs need to coordinate care with hospitals that a patient might be receiving treatment from, and will the UNHIN help in making that easier? The UNHIN would provide the patient a health wallet which consolidates all of the patient’s health information and allows them to authorize both the ASC and their hospital to review and manage their relevant health information.

  3. Rose Rosenfeld Post author

    Unfortunately, ASCs have no requirement of reporting to any caregiver of the patient about the procedure they received. That is exactly the problem in today’s healthcare environment. UNHIN will give the ability for all caregivers of the patient to see and have access to the full patient’s medical record. Surgery centers are not hospitals, they don’t have ICUs, NICU’s or PICU’s in case of an emergency thus need to be extra careful. Having access to the full patient’s medical record will avoid errors, emergencies and wrong treatment.