by Adrienne Snavely
Ambulatory Surgical Centers (ASC) arrived on the scene in 1970. Physicians continue to own nearly 90% of such facilities. Physicians can conveniently schedule procedures, assemble their own teams of highly skilled staff, check over the equipment and supplies to ensure high quality, and design facilities best to suit their specialties. ASCs have demonstrated an exceptional ability to improve quality and customer service while reducing costs. They have all the same equipment, surgeons, and staff as a hospital operating room without all the restrictive bureaucratic procedures that burden hospitals. ASC procedures are 75% cheaper than hospitalization because of the greater efficiency of the surgery center.
ASCs are regulated by federal and state organizations, just like any other health care facility. The safety and quality of care is evaluated by state licensure, Medicare certification, and voluntary accreditation. Most states require ASCs to be licensed in order to operate. All which serve Medicare patients must be certified by the Medicare program, which means they comply with the federal standards ensuring safety of the patient and the quality of the facility, physicians, staff, services, and management. Many ASCs choose to go through voluntary accreditation by an independent organization.
ASCs provide services in facilities specifically designed for outpatient surgery. They consistently perform as well, if not better than, hospitals when quality and safety are examined. Rates of inpatient hospital admission and death were lower in ASCs than hospitals, even after considering high risk patients. The excellent outcomes reflect the commitment that the ASC industry has made to quality and safety, with a keen focus on ensuring the quality of the services provided. The ASC industry has shown itself to be ahead of the curve in finding promising ways to improve health care delivery at lower cost. Technology allows for a growing range of procedures to be performed on an outpatient basis. The advancement in medical innovations is driven by high levels of patient satisfaction, efficient physician practice, high quality, and cost savings that benefit all.
ASCs are required to maintain complete, comprehensive, and accurate medical records. A physician must examine the patient immediately before surgery to evaluate anesthesia risk and the procedure to be performed. Prior to discharge, each patient must be evaluated by a physician for proper anesthesia recovery. A registered nurse trained with emergency equipment must be available during a procedure. They also must have a way to transport patients to a hospital in case of an emergency.
Patients have a lower risk of hospital-acquired infections due to the specialized nature of the facilities. ASCs ensure patients to do not acquire infections during their care at these facilities. They must establish a program for identifying and preventing infections, maintaining a sanitary environment, and reporting outcomes to the proper authorities. The program must include specific procedures for prevention, early detection, control, and investigation of infectious and communicable diseases according to the CDC. ASCs have very low infection rates. Reliable data on the rate of infections after surgery is hard to find. Since patients return to their physician’s office for post-op, the surgery center may never know that an infection has occurred. Every year, surgery centers that belong to SOIX are surveyed for infection rates. Of the 35 surgery centers who participated in the survey, the surgical site infection rates results:
- Overall infection rate was 1 in 1000 (0.1 %)
- Ophthalmology – 0.01% infection rate
- Pain management – no infections
- Orthopedics – 0.3% infection rate
- Otolaryngology – 0.02% infection rate
- Gastrointestinal – no infections
- Urology – 0.2% infection rate
- No specialty with an infection rate over 0.7%
- Most centers reporting infections were multi-specialty
- More than half reported one or more infections for 2010
The aging population will be a major force in a growing demand for surgical services. Federal regulations limit the surgical procedures that Medicare will reimburse, services limited to elective procedures with short anesthesia. Medicare reimburses surgery centers at much lower rates (56%) than it reimburses hospitals, even when the procedures are identical. It is difficult to show data supporting ASC safety on Medicare patients since it refuses to reimburse ASCs for many procedures, and pays low rates for the rest. ASCs will become more appealing as an inexpensive and efficient way to provide care and meet increasing demand.
Not only do ASCs ensure the best surgical experience possible, it is also the most affordable. They offer valuable surgical services at a lower cost than hospitals for the same service. Patients also pay less co-insurance for procedures at an ASC than in a hospital setting. By having surgery at a surgery center, patients can save as much as 60% compared to the same procedure at a hospital. Employers incur lower health care costs by using ASC services because they see that ASCs deliver consistently high quality outcomes at a significant savings. ASCs make pricing information available to the patient in advance. They want to make price transparency a reality for all patients. This will empower patients as they evaluate and compare costs among various physicians.
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Callard, Abby. “10 Points on Post-Surgery Infection Rates by ASC Specialty.” Infection Control & Clinical Quality. Becker’s Healthcare, 20 Oct 2011. Web. 26 Aug 2014.