FEBRUARY 9, 2024
Originally published by our sister publication OR Management News
For more than four decades, ambulatory surgery centers (ASCs) have demonstrated an exceptional ability to offer patients the convenience of having surgical procedures performed safely outside the hospital setting, while simultaneously improving quality and reducing costs.
Today’s ASCs are modern outpatient facilities offering same-day services, both diagnostic and preventive. Consequently,
Originally published by our sister publication OR Management News
For more than four decades, ambulatory surgery centers (ASCs) have demonstrated an exceptional ability to offer patients the convenience of having surgical procedures performed safely outside the hospital setting, while simultaneously improving quality and reducing costs.
Today’s ASCs are modern outpatient facilities offering same-day services, both diagnostic and preventive. Consequently, they are experiencing tremendous growth. To put this into perspective, from 1996 to 2006 more than 57 million procedures were performed, approximately a 300% increase; comparatively, hospital-based surgery volumes remained flat over that same period.1
The number of cases shifting from hospitals to ASCs continues to grow, particularly in orthopedics. In 2020, the year of the COVID-19 pandemic, it’s estimated that more than 30 million procedures were performed in over 5,800 ASCs across the country.2 Even though the pandemic negatively affected the surgical volumes in this space because of elective procedure cancellations or postponements, the U.S. ASC market is projected to grow from approximately $37 billion in 2021 to nearly $59 billion by 2028.3
Over the next 10 years, surgical procedures are projected to grow by at least 25% at ASCs and 18% at both hospital outpatient departments and physician offices. The reason for this increased growth in ASCs is cost. Common procedures performed in hospital outpatient departments cost significantly more than in an ASC. In fact, an ASC can perform the same procedures for 144% less.4 By shifting costs to the ambulatory market, commercial insures reduce their costs by nearly 60% and the consumer can save on average almost $700 per procedure.4
The Centers for Medicare & Medicaid Services has increased payments to the ambulatory market by 2.6%. This was done to promote site neutrality and encourage the migration of surgical procedures from the hospital setting to the lower cost ambulatory setting.5
How ASCs Can Outperform Hospitals
The emphasis is on efficiency. A well-designed ASC facility reduces its waste by reviewing every aspect of its daily routine and performance—for example, accommodating preoperative and postoperative areas, establishing efficient workflows, while keeping their patients and providers comfortable and secure. Through this process many are finding unexpected cost savings along the way. By co-locating patient registration areas and staff offices, administrative staff can assist during peak admitting times, reducing the number of full-time equivalents.
Anesthesia’s Role
For a surgical procedure to be successful in an ASC, it’s necessary that both the patient and the procedure are assessed and appropriate for ambulatory anesthesia. The advantages of ambulatory surgery evaporate when an emergency occurs, or an unplanned transfer and subsequent hospital admission is required.
With the growing prevalence of chronic conditions, it’s imperative that healthcare organizations, particularly the ambulatory market, make clinical and operational improvements to their patient preparation and selection process. Anesthesia is in the perfect position not only to ensure successful outcomes but also to maximize the benefits for risk assessment that identifies patient factors, which can significantly increase the risk for complications.6
When anesthesia proactively manages the surgical patient preoperatively, they help to reduce the costs of care, initiate postoperative teaching for more complicated patient cases, minimize cancellation rates and/or delays, and improve the patient experience in this setting.
Patients can present with significant medical histories and multiple comorbidities requiring additional planning before the actual surgical encounter. One way to minimize these challenges is to create or strengthen presurgical testing (PST) services, designed and led by anesthesia services. Patient preparation, scheduling and preregistration are all interconnected. Accurate scheduling is essential to optimize planning, and PST lends itself to a collaborative approach between anesthesia and the presurgical nursing teams.
By systematically completing the necessary level of PST services days or even weeks before the surgical encounter, an ACS can not only help to minimize complications but also ensure appropriate consultation occurs before surgery. Enhancing the patient preparedness and creating a more friendly and thorough experience will build confidence in the patients served and allow the ambulatory market to continue with its high patient satisfaction ratings. From a business perspective, organizations that better prepare patients for surgery can avoid costly delays, reduce or eliminate unexpected cancellations, and mitigate negative outcomes, which could unnecessarily require greater length of stay or transfer of care.
Enhancing the patient preparedness process not only creates a more friendly and inviting experience for the patient, but it also provides a thorough look into their health history, which can help the ambulatory market avoid unnecessary hospital readmissions and postsurgical procedures. The PST team, led by anesthesia, could be made up of registered nurses and support technicians (laboratory and radiology personnel), for example.
The anesthesia team establishes new criteria used to identify the level of PST needed for each patient, utilizing evidence-based practices. For example, creating a level I category that identifies patients scheduled for procedures such as:
In addition to the type of surgical procedure, identifying patients who have significant medical histories and comorbidities, such as:
A level II category patient who is not scheduled for one of the aforementioned procedures and does not present with one of the comorbidities would only require a telephone health screen with a PST registered nurse.8 This collaborative approach not only helps grow volumes but ensures safe surgical outcomes.
In addition to categorizing patients, a well-designed PST team could incorporate a standardized scheduling process that incorporates preoperative order sets used for all procedures to ensure adequate information is obtained for a safe patient experience. Lastly, the PST could develop a set of preanesthesia guidelines for laboratory testing by creating and using set criteria or protocols to identify what level of presurgical testing is needed for patients who require a face-to-face consultation with the healthcare team.
Presurgical testing is only part of the equation. Baby boomers turning 65 are reaching the age of eligibility at the rate of 10,000 per day. This group is exhibiting a growing prevalence of chronic conditions and risk factors for those conditions.8 As this generation ages, their healthcare usage will increase, which will drive procedure volumes for many specialties. As these sicker patients present to this segment of the market, ASCs will need to continuously evaluate the increasing need for more nursing care as required in this setting.9
Anesthesia that uses the PST process can optimize the patient’s condition before their planned procedure.10 The vigilant management of patient risk factors will allow the ambulatory market to leverage resources efficiently to improve performance and outcomes in the OR and postoperatively.
Conclusion
As the United States struggles to rein in the costs of healthcare, ASCs are successfully transforming surgical care while simultaneously reducing costs.
Reimbursement incentives, combined with greater consumer demand for an accessible and enhanced healthcare experience, will continue to contribute to the tremendous growth. Looking to the future, a robust ASC strategy can help hospitals become more resilient, promote value-based care, increase patient satisfaction, control costs and maintain a strong operating margin.
References
David L. Taylor III, MSN, RN, CNOR, is the principal of Resolute Advisory Group LLC, a healthcare consulting firm in San Antonio. Mr. Taylor is a board member of OR Management News.
