Ambulatory Surgery Centers (ASCs) are facilities where surgeries that do not require hospital admission are performed. They provide a cost-effective and convenient environment that is less stressful than what many hospitals offer. ASCs may perform surgeries in a variety of specialties or dedicate their services to one specialty, such as eye care. Each year, nearly six million surgeries are performed in more than 3,300 ASCs across the United States. Procedures performed in these centers include ophthalmology, gastroenterology, orthopedic, ENT (ear, nose & throat), gynecology, and plastic surgery.
Patient satisfaction is a hallmark of the ASC industry. The U.S. Department of Health and Human Services Office of the Inspector General surveyed Medicare beneficiaries who had one of four procedures in an ASC. He found that 98% of the people were satisfied with their experience.
One reason for high patient satisfaction is convenient scheduling. According to FASA’s Outcomes Monitoring Project, 75% of ASCs started more than 80% of their cases on time. Another reason patients like ASCs is value. A 1977 study conducted by Blue Cross/Blue Shield revealed that, on average, procedures performed in ASCs cost 47% less than the same procedures at hospitals. Furthermore, every study ever done has shown that the quality of care delivered at ASCs is equal to or better than comparable hospital care.
MOST COMMON OUTPATIENT PROCEDURES
The majority of surgery performed in ambulatory surgery centers includes:
ASCS ARE A KEY TO HEALTH CARE COST CONTAINMENT
ASCs perform high quality health care at lower costs compared to hospitals because they maintain low overhead costs and because they can focus on one thing: treating ambulatory patients efficiently. On average, procedures at ambulatory surgery centers cost 47% less than those same procedures at hospitals, according to a 1977 study conducted by Blue Cross/Blue Shield of North Carolina. This study showed that facility fees for removal of tonsils, for example, costs an average of $464 in an ASC, compared with $998 if the procedure is performed in a hospital. Other examples include cataract surgery which costs an average $835 in an ASC, compared with $2,012 in a hospital; repair of inguinal hernia $601 in a surgery center, compared to facility fees of $1,271 if this were performed in a hospital.
FEDERAL, STATE AND PROFESSIONAL REGULATION OF ASCS
ASCs are some of the most highly regulated health care providers in the country. Medicare has certified 85% of the centers, and 43 states require ASCs to be licensed. These states also specify the criteria that ASCs must meet for licensure. Both states and Medicare survey ASCs regularly to verify that the established standards are being met.
In addition to state and federal inspections, many surgery centers choose to go through voluntary accreditation process conducted by their peers. ASCs that want to demonstrate a commitment to quality can seek accreditation from one of four accrediting bodies. All four are recognized by Medicare for their rigorous adherence to the highest standards of quality care. All accredited ASCs must meet specific standards that are evaluated during on-site inspections. As a result, patients visiting accredited ASCs can be assured that the centers provide the highest quality care.
Since 1982, when Medicare agreed to pay for surgeries performed in ASCs, the program has saved a significant amount of money. The Office of Inspector General recently commented in their 1999 final rule regarding safe harbor provisions that ASCs can significantly reduce costs for Federal health care programs, while simultaneously benefiting patients. HCFA has promoted the use of ASCs as cost-effective alternatives to higher cost settings, such as hospital inpatient surgery. ASCs that receive Medicare payments must meet the program’s certification criteria and receive payments only for those procedures that have been approved by Medicare. Today, more 2,400 ASC procedures have been granted that approval.
Medicare beneficiaries prefer ASCs to hospitals for outpatient surgical and diagnostic procedures, according to a study by the U.S. Department of Health and Human Services Office of the Inspector General (OIG). The OIG surveyed 837 Medicare beneficiaries who had cataract extraction with intraocular lens implant, upper gastrointestinal endoscopy, colonoscopy or bunionectomy procedures.