Health Affairs Down And Ability To Meet Demand Up Procedures Take Less Time At Ambulatory Surgery Centers , Keeping Costs

During the past thirty years outpatient surgery has become an increasingly important part of medical care in the United States. The number of outpatient procedures has risen dramatically since 1981, and the majority of surgeries performed in the United States now take place in outpatient settings. Using data on procedure length, we show that ambulatory surgery centers (ASCs) provide a lower-cost alternative to hospitals as venues for outpatient surgeries. On average, procedures performed in ASCs take 31.8 fewer minutes than those performed in hospitals—a 25 percent difference relative to the mean procedure time. Given the rapid growth in the number of surgeries performed in ASCs in recent years, our findings suggest that ASCs provide an efficient way to meet future growth in demand for outpatient surgeries and can help fulfill the Affordable Care Act’s goals of reducing costs while improving the quality of health care delivery. T echnological developments inmedicine have dramatically changed the provision of surgical care in the United States during the past thirty years.Advances in anesthesia and the development of laparoscopic surgery in the 1980s and 1990smade it possible for patients to be discharged the same day as their surgery, whereas previously theywouldhavehad to spend several days in the hospital recovering. The introduction of the Medicare inpatient prospective payment system in 1983 created additional incentives for hospitals to shift patient care from inpatient to outpatient departments. Between 1981 and 2005 the number of outpatient surgeries nationwide—performed either in hospital outpatient departments or in freestanding ambulatory surgery centers (ASCs)— grew almost tenfold, from 3.7 million to over 32.0million.Outpatientprocedures represented over 60 percent of all surgeries in the United States in 2011, up from 19 percent in 1981. The expansion of health insurance coverage under the Affordable Care Act (ACA) presents opportunities to explore new ways to accommodate the increased demand for outpatient services. In addition, the ACA’s goals of reducing the cost and improving the quality of health care delivery makes it increasingly important to find alternatives to existing methods of care delivery that cost less and are in more flexible settings. ASCs are such an alternative to hospital outpatient departments. The number of ASCs has grown quickly to meet the rising demand for outpatient surgery services since the 1980s. Whereas outpatient departmentsprovide a range of complex services, including inpatient and emergency services, ASCs provide outpatient surgery exclusively. Since most ASCs focus on a limited number of services, they may provide higher-quality care at a lower cost than hospitals that offer a broad range of services. Similar to retail clinics that meet primary care needs, ASCs offer convenient, relatively low-cost access to health care services. This article addresses thepossibilities forASCs doi: 10.1377/hlthaff.2013.1281