In 1970, two physicians bucked tradition and opened a facility offering their patients a safe, convenient, and comfortable setting for relatively simple procedures that didn’t require an overnight stay. Eschewing the expensive rigmarole attached to performing procedures in hospital operating rooms, they transformed healthcare by creating the world’s first ambulatory surgery center, moving the surgical sites of service
It is a transformation that is still underway, as surgical sites of service continue to expand. Advances in medical education and professions, technology, and anesthesia continue to break new ground in how and where we receive surgical care. While hospital ORs and ASCs will always have a role in facilitating major surgeries, increasingly minimally invasive procedures are moving to in-office and clinic-based surgical suites.
“Traditionally, you’ve seen a hospital, you’ve seen an ASC, and those have been the two traditional sites of services for surgeries and procedures,” explains Mobile Anesthesiologists CEO Scott Mayer. “Now you’re seeing clinic/office-based surgical suites having the ability to do a growing variety of outpatient cases usually assumed to be done in these more traditional settings.”
Sites of service are moving
Ambulatory anesthesia providers and new surgical methods and technologies have fueled this shift. Physicians who have made the move to in-office and clinic-based surgical suites routinely see increased reimbursements, flexibility, and control over their practice. Their patients enjoy reduced overall costs and greater convenience leading to a better overall patient experience when treated at their provider’s own office.
So then, what is on the horizon for surgical settings as the growing percentage of procedures move to more cost-effective and alternative care models that prioritize the patient and physician experiences?
Payers are increasingly incentivizing the move from relatively expensive ORs and HOPDs to lower-cost ASCs and office-based surgical suites. Minimally invasive surgery techniques and technology, streamlined computer and cloud data storage systems, and the lower overhead of these facilities have served to further advance the affordability, capabilities, and quality of care of these sites of service.
As the associated benefits become ever more apparent, there has been speculation that there still may be more untapped sites of service that would help improve access to critical preventative care measures in underserved areas and communities. Primary care offices and pharmacies that offer health and wellness services, such as CVS’ MinuteClinics and Walgreens’ Healthcare Clinics, could potentially host more robust care options including smaller outpatient procedures and immediate care.
There likely also could be a rise in multi-use facilities that house a large number of medical services, including urgent care, imaging, testing, labs, physician offices, and surgical suites, all under one roof. And, just as doctors now may share the costs – and profits – by investing in an ASC, there could be significant growth in shared surgical suites located within medical office buildings that are used by a number of specialties as an alternative to the increased investment and time needed to build a surgery center.
But there has been significant push back from those healthcare institutions that stand to see clinic-based and in-office surgical suites attract their patient and physician base away from their hospitals. leaving them harder to fill and pay for their overhead.
“We need long-term thinking and approaches rather than shorter-sighted focus and goals,” says Mayer. “The powers in healthcare want to hold on to how they built their power and refuse to allow significant change that will disrupt their control. Too many large and financially dominating institutions realize that by allowing quick change and opportunities that they don’t have full understanding or control over, they are at risk of outside threats that could rock their boats and put their permanence at risk.”
This is a direct example of the Shirky Principle, which states that institutions tend to preserve the problem for which they are the solution. Institutional health systems depend on the fee-for-service model as critical for their survival, while either working counter to or ignoring the innovation that is arising at the margins.
What’s needed to counter this, he adds, is more full-throated support from those that can enact meaningful change within the healthcare system. Insurance carriers need to increase reimbursement incentives for physicians with governmental assistance while adding a payment system that can incentivize for higher quality. Further enacting supportive regulations and compliance standards across the nation will bolster public confidence and provide quality of care requirements that are specific to this setting. On the education front, continued promotion of data and evidence proving that the benefits and safety record are real is a crucial element to making this a bigger pillar of the future of the industry and value-based care.
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