Increasing specialization within the ASC care continuum.
By Pete Mercer
Outpatient care is booming – in fact, more than 80% of surgeries are now performed in outpatient settings, outsourcing these procedures to ambulatory surgery centers. ASCs are highly regulated care facilities that provide outpatient surgery and preventive care for their patients, performing a more focused scope of procedures compared to hospitals and other healthcare facilities. These facilities are creating unique opportunities for physicians to provide high-quality care in a high-value market.
One of the more interesting opportunities for patient care at an ambulatory facility is that the procedures are increasingly becoming specialized. Specialization in an ambulatory setting is when patients receive a specific kind of medical care or surgery at an ASC. As ASCs have recently grown to become the dominant provider of specific surgical procedures in the U.S., many have diversified their services to offer a wider range of surgical specialties and other services, including pain management, diagnostic imaging, and gastroenterology services.
ASCs continue to drive innovations that are transforming the world of outpatient surgery. In order to fully understand how the ambulatory care market is effectively streamlining patient care protocols, we need to look at why these facilities are trending towards specialization and what that specialization means for physicians and patients alike.
The influx of specialization
Part of what makes specializing work in the ambulatory space is the autonomy granted to these facilities by simply not being a hospital. In a hospital setting, there are so many different moving pieces that go into a patient stay that it becomes just about impossible to offer any level of specialized care.
Dr. Neal Badlani, an orthopedic surgeon who specializes in minimally invasive spine surgery, wrote in The Journal of Spine Surgery, “Compared to hospitals, ASCs have a much greater capacity to pick and choose what procedures they perform, who their patients are, and what processes both clinical and administrative are to be used in their centers. This autonomy results in, proportionately, far less overhead for the facility. Specifically, the lower overhead costs can be achieved by limiting the scope of procedures.”
This surge of ASC specialization is likely because physicians are pushing the drive to develop new ASCs. A report from the ASC Association says that by leveraging a focused model for specific procedures, ASCs can provide a more consistent and controlled environment that largely avoids the many challenges of delivering a multitude of different surgical and medical services.
Increased physician autonomy
Consistency in healthcare is critical. Physicians in an ASC environment have a significant amount of control over many components of the healthcare continuum; they can build more convenient procedure schedules, assemble a team of specially trained and highly skilled staff, obtain high-quality equipment that best fits the specific sets of procedures they offer, and even design their facilities to fit the specific needs of their patients and the procedures they provide.
ASCs allow a level of autonomy that is hard to come by in the healthcare industry, making them more attractive to physicians who would otherwise have to operate within the parameters and boundaries of a hospital.
Part of the autonomy that piques the interest of so many physicians is because approximately 52% of all ASCs are operated in a physician ownership model. In this scenario, doctors own 100% of the equity in the ASC, are responsible for all management decisions, and make all decisions related to the quality of care.
“There are great benefits to physician ownership such as autonomy and control,” Badlani writes. “This usually leads to a clinical environment with a high quality of care for patients and convenience for physician owners. There is a flatter hierarchy which can lead to better access for patients to physician operators who have direct knowledge of the patient’s clinical situation and control over the care environment. Physician entrepreneurs often stimulate innovation and progress.”
In this ownership model, physicians can also partner with a management company to handle all the contracting and administration tasks that come with owning an ASC. These partnerships allow physicians to maintain their focus on the care of the patient and the quality of the procedures, without sacrificing too much control or their equity in the facility.
The impact of specialization
There are many benefits of increased specialization within the ASC space. From the patient’s perspective, it’s a significant time saver. Patients undergoing procedures in ASCs are often in and out of the facility within the same day, spending whatever recovery time is necessary from the comfort of their own home. The increased convenience, flexibility, and accessibility of an ASC makes it a compelling option for outpatient care.
Patients in an ASC setting also see significant cost-savings by opting for outpatient procedures. The ASC Association reported that a Medicare beneficiary “could pay as much as $496 in coinsurance for a cataract extraction procedure performed in a hospital outpatient department, whereas the same beneficiary’s copayment in the ASC would be only $195.”
Another added benefit to operating a specialized ASC is they are often associated with lower facility costs. By providing a focused set of procedures, these facilities can significantly reduce overhead costs. A study conducted by UnitedHealth Group showed that conducting more joint replacement surgeries in ASCs could result in 500,000 fewer hospitalizations and $3 billion in annual savings across the board.
The study found that hospital-acquired infections have been a significant challenge for patient safety, with up to 3% to 4% of hospital patients contracting infections – this also includes infections in patients following 1% to 2.5% of joint replacement surgeries. Because of this, up to 26,000 joint replacement patients each year face additional treatment and a longer stay in the hospital.
Procedures like joint replacement don’t necessarily require a hospital stay. Patients who get an outpatient hip or knee replacement are often discharged the same day, with no increased likelihood of infection or readmission compared to inpatient procedures. In fact, an outpatient procedure might even decrease the likelihood of infections – hospital-acquired infections are a huge risk and safety challenge.
Looking toward the future
As ASCs continue to branch out and specialize in more procedures, it gives the patient a larger menu of options to choose from. ASC Data found that the specialties with the highest growth rate in 2023 were cardiology, musculoskeletal, and orthopedics, while the specialties with the most potential for growth in 2025 are orthopedics, cardiovascular, and gastroenterology.
With the increase of specialization in the ambulatory care space, it will be interesting to see how this affects the rest of the care continuum. ASC Data predicts that private insurance will continue to shift towards ambulatory, which will completely reshape the hospital environment.
Additionally, the consolidation of ASCs through mergers and acquisitions will continue to enhance efficiency for physicians and staff, while also enabling ASCs to negotiate better reimbursement rates with payors. Technology will also continue to evolve in the ambulatory space, allowing physicians to better streamline their workflow and patient care processes. Specialization will continue to advance across the board, allowing for more patients to tap into cost-effective, efficient, and high-quality outpatient care.