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SAFETY IN NUMBERS

While it is true that most ASC’s do not have the capabilities of dealing withpost-operative emergencies, the potential
risks can be minimized by honest and open communication between doctor and patient. Discussing previous medical history is crucial when determining eligibility for out-patient procedures, and there are guidelines that physicians must follow in making these decisions. For the most part, older patients or those who have previous medical conditions could be
considered at higher risk for an out-patient surgery setting. If that is the case, a patient will be referred to a traditional
hospital. Overall, the younger and healthier you are, the better your candidacy for an ASC.

By law, ASCs cannot admit patients that they consider to be at risk for life threatening surgical complications, as well as those that involve the direct involvement of major blood vessels or extensive invasion of body cavities. In addition, there are special rules with regard to children, which include a ban on treating children less than six months old.

Furthermore, ASCs are highly regulated, and most states require these centers to be licensed and certified by Medicare.
Compliance with these standards is constantly monitored. Out-patient standards that apply to hospitals are the same for ASCs, and all are required to maintain accurate medical records, as well as infection control and anesthesia standards.

PRESCRIPTION FOR SUCCESS

According to a recent report by the American Academy of Orthopaedic Surgeons, a shift is taking place in the ASC market. The focus is on developing outpatient surgery centers that remind the patient that the facility is affiliated with a particular health care organization. In addition, the future lies in much larger facilities that can offer a variety of services, known as Multiple-Service Ambulatory Care Centers (MACCs). Many of these facilities are already in place, but as of today there are none in the Kansas City area.



Recent advances of note include expanding insurance coverages at ASCs to include an additional 790 procedures over the next four years, although some exclusionary provisions apply. Currently the Centers for Medicare and Medicaid Services cover more than 2,500 procedures that are preformed in out-patient surgery facilities, and as more are added, the need for additional centers will be created.

Forecasted growth for these centers in the next seven to ten years could be as much as 47 percent, according to a recent report. As of 2003, there were approximately 3,700 such centers in the United States; a major leap from 275 in 1980 and 1,450 in 1990.

Several factors comprise the increased demand for out-patient surgery centers. New and improved anesthesia techniques have made certain types of surgeries more routine, affording the patient less pain and less recovery time. With fewer anesthesia-related deaths, as well as reduced post-operative observation times, patients now have a viable alternative to former ‘hospital-only’ offering. A shift in the number of available practicing physicians and oversupply of hospital beds by early 2000 created a competition for surgical patients between surgeons and hospital facilities.

The continued commercialization of health care has led to the increase of investor- owned ambulatory centers. Some
conflict of interest concerns have arisen from the fact that more than 60 percent of doctors are investors or full owners in
the ASCs to which they refer their surgical patients. In an article by William J. Lynk and Carina S. Longley, the affect of physician-owned surgicenters is examined in detail, citing that “the complimentary relationship between the surgeon and hospital shifts, when the referring physicians acquire personal financial ownership interests in ASCs that compete with the hospital facilities at which the physicians continue to practice.” Although their research was specific to a narrow set of hospitals, their study raises an interesting question with regard to where a sur-geon’s alliance should ultimately rest. Thankfully, guidelines are in place to ensure decisions such as these are based on the best interests of the patients, and could spur hospitals to re-evaluate their own operating procedures.

As far as the future of ambulatory surgical centers in concerned, the prognosis is good that this trend will continue. Keith Chambers of HCA-Midwest agrees.

“As more and more healthcare is beginning to shift outside the walls of the hospital, we will continue to see better outcomes, less infection, as well as more efficiency,” states Chambers.

«March 2008 Edition