OR Manager April 2022 - 25
AMBULATORY
SURGERY CENTERS
BY SHAWN SEFTON
Establishing service lines in ambulatory surgery centers
With the American Society of AnesT
AMBULATORY
SURGERY
ADVISORY
BOARD
* Claire Everson, RN, CNOR, CCAP, Clinical Educator
and Consultant, Bloomfield Hills, MI
* Diane Fecteau, MSA, RN, CASC, NE-BC, Executive
Director, Maine Medical Center Scarborough Surgery
Center, Scarborough, ME
* Cynthia Hess, MSN, RN, FNP-C, RT(R)(CT)(ARRT), Director
of Nursing, Northeast Missouri Ambulatory Surgery
Center, Hannibal, MO
* Tracy Hoeft-Hoffman, MBA, MSN, RN, CASC,
Administrator, Heartland Surgery Center, Kearney, NE
* Beverly Kirchner, BSN, RN, CNOR, CASC, Chief Compliance
Officer, SurgeryDirect, Highland Village, TX
thesiologists establishing anesthesia
guidelines in the 1970s and the Centers
for Medicare and Medicaid Services
(CMS) approving payments for
a limited number of procedures in the
early 1980s, ASCs were firmly established
as an option in the industry and
began a steady growth rate throughout
the remainder of the 20th century.
Today, surgical technology continues
to develop at a blistering pace, widening
the scope of procedures that can
be performed on an outpatient basis.
These advancements have taken surgical
procedures that previously required
hours in the OR, followed by a lengthy
recovery in PACU and an overnight or
multi-night stay in the hospital, into very
predictable timeframes and a greatly
reduced recovery period that allows patients
to head home before dinner.
These technological developments,
along with the continued corresponding
endorsement from CMS and multiple
medical organizations, mean the
breadth of procedures available at ASCs
will see continued growth, as we see in
the latest market forecasts. The market
size for ASCs exceeded $75 billion in
2020, and current projections anticipate
an annual 6.1% growth rate until
revenues reach $117 billion by 2027.
The convenience factor for patients
noted above is certainly influencing this
general shift, but the steady growth in
ASC procedures is really being driven
by surgeons and specialty physicians
who, like Drs Reed and Ford before
them, are leaping at the chance to put
their futures in their own hands. Likeminded
groups of medical professionals-whether
in the same service line
or not-are finding that ASCs give them
greater freedom and flexibility in managing
their caseloads and schedule while
their equity in the facility delivers financial
benefits above and beyond those
www.ormanager.com
he effects of the COVID-19 pandemic
on the healthcare industry
could fill an entire academic curriculum
at this point, let alone a single
article. But one potential silver lining
among the storms of bad news is the
increasing migration of elective procedures
from hospitals to ambulatory
surgery centers (ASCs). Although ASCs
were not immune to the effects of the
pandemic-with mandated shutdowns,
supply chain challenges, patient reluctance
or availability, and more-the industry-wide
trend of moving applicable
cases to dedicated facilities accelerated
in 2020 and 2021 and shows no
sign of slowing down so far this year.
The first ASC was opened by two
physicians in Phoenix, Arizona, in 1970.
Frustrated with hospital bureaucracy to
find OR time, have rooms turned over
in a timely fashion, and secure needed
equipment, Drs Wallace Reed and John
Ford began developing plans to open
their own surgical facility, giving themselves
control over scheduling, equipment,
facility upgrades, and one more
item of key significance-revenue.
seen by hospital-based surgeons. And
their success has certainly not gone
unnoticed by hospitals and health systems
that rely on surgeons to drive their
single largest revenue source, the OR.
Many hospitals initially tried to capture
the effects of the ASC trend by creating
Hospital Outpatient Departments
(HOPD) within their walls. This approach
had multiple benefits such as lower
capital costs compared to constructing
a new building, built-in staffing, and expedited
regulatory reviews and approvals.
However, with more patients becoming
comfortable with, or even preferring,
ASCs, hospitals are ready to take
the next step to standalone facilities.
Also increasing the push for hospitals
to take that next step is CMS-not
only are they increasing the range of
ASC procedures with approved reimbursements,
they are offering the same
reimbursement regardless of procedure
location, incentivizing hospitals to move
cases to lower-cost facilities.
In fact, an argument could be made
that ASCs have quickly gone from a
nice-to-have to a must-have for health
systems, particularly those in populated,
competitive markets.
Service lines inside the ASC
Total knee replacements, hip and joint
procedures, and hip arthroscopy have
been added from the orthopedic service
line. Spinal cases including microdiscectomies,
laminectomies, and anterior
cervical discectomies and fusions
are now on ASC menus. Interventional
cardiology, radiology, and vascular procedures
are now available, and other
cases such as peripheral artery disease
procedures, dialysis catheters, grafts,
and pain pumps are possible as well.
We are even seeing robotic procedures
make their way into ASCs.
Continued on page 26
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