Tessa Quinn
Ambulatory Surgery Centers (ASCs) and hospital outpatient departments (HOPDs) are two separate entities within the medical healthcare space. ASCs are standalone facilities that specialize in specific outpatient procedures for healthy patients who do not require overnight hospital stays. They are typically more efficient and cost-effective than HOPDs, offering advantages such as shorter wait times and lower chances of infection. HOPDs, on the other hand, are owned by and attached to hospitals, offering a wider range of services for less healthy patients who may need more complex procedures and longer post-operative monitoring. This article will explore the differences between ASCs and hospital outpatient surgery, specifically addressing whether the latter counts as an ASC.
| Characteristics | Values |
|---|---|
| Definition | Ambulatory Surgery Centers (ASCs) are medical entities that provide outpatient surgical care on a diagnostic and preventive procedures level without the headaches that often accompany receiving such procedures at an inpatient hospital. |
| Comparison with hospital outpatient departments | Hospital outpatient departments offer a wider range of services for less healthy patients who may need more complex procedures and longer postoperative monitoring. |
| Cost | The lower overall cost of care at an ASC is reflected in lower charges for insurance companies. |
| Patient experience | ASCs sometimes give a better patient experience because patients aren't having to go into the hospital, which can be daunting. |
| Safety | ASCs meet strict safety and quality standards and are subject to regular inspections by state and federal agencies. |
| California laws | California law prohibits physicians from performing some outpatient surgeries unless they are performed in an accredited, licensed, or certified setting. |
| Ownership | In some ASCs, the option for physician ownership leads to increased autonomy and incentivization, which can translate into increased quality of care. |
What You'll Learn
Ambulatory Surgery Centers (ASCs) are standalone facilities
ASCs are often more cost-effective than HOPDs. Medicare data show that out-of-pocket costs for patients are lower for some procedures at ASCs compared to HOPDs. For example, knee arthroscopy costs $251 at ASCs versus $524 at HOPDs, and ankle ORIF costs $713 versus $1,139, respectively. The cost differential is due to how payment rates are updated for inflation. HOPD payment rates are based on the hospital market basket, while ASC payment updates are subject to the Consumer Price Index for All Urban Consumers, which measures the rising costs of all goods.
ASCs also have operational advantages over HOPDs due to their ability to tailor technology and scheduling preferences to specific subspecialties. Additionally, the option for physician ownership in ASCs can lead to increased autonomy and incentivization, potentially resulting in higher-quality care. However, physician ownership also carries financial risks and the potential for conflicts of interest.
ASCs are fully equipped with the latest technology and are able to operate more efficiently than HOPDs. The streamlined nature of ASCs, focusing on minimally invasive procedures, allows them to require less space, equipment, staff, and time compared to more complex hospital procedures. This efficiency contributes to lower overall costs of care at ASCs, benefiting insurance companies and patients alike. The lower costs and convenience of ASCs have led to their growing popularity, particularly as they provide accessible, convenient, and affordable care that does not require hospitalization.
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Outpatient hospitals offer a wider range of services
Outpatient surgery, also known as ambulatory surgery, is a same-day procedure that does not require the patient to stay overnight in a hospital. This type of surgery is typically suitable for healthy patients without comorbidities or chronic health issues that increase the risk of infection. Outpatient procedures can range from minimally invasive to more complex operations, including colonoscopies, biopsies, cataract surgery, gallbladder removal, rotator cuff surgery, and hernia repair.
Ambulatory surgery centres (ASCs) and hospital outpatient departments (HOPDs) are the two main settings for outpatient surgery. While both provide surgical and diagnostic procedures, they differ in several ways. HOPDs offer a broader range of services catering to patients who may require more complex procedures and extended postoperative monitoring. HOPDs are owned by and attached to hospitals, whereas ASCs are standalone facilities.
ASCs specialize in streamlined, minimally invasive procedures, allowing them to operate more efficiently with lower costs. This efficiency translates into reduced costs for insurance companies and patients. The lower costs of ASCs compared to HOPDs are influenced by differences in payment rate updates, with HOPDs based on the hospital market basket and ASCs tied to the Consumer Price Index for All Urban Consumers.
ASCs, or day surgery centres, are equipped with advanced technology to perform same-day surgical and diagnostic care for outpatient procedures. The shift towards value-based care and the expansion of the ASC Covered Procedures List are expected to impact the ASC and HOPD markets.
Outpatient hospital services covered by Medicare Part B include emergency and observation services, laboratory tests, mental health care, radiology services, medical supplies, preventive and screening services, and certain drugs. Outpatient care costs are typically lower than inpatient care, and patients have more control over expenses, such as shopping around for radiology and imaging services.
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ASCs are more cost-effective than hospitals
Ambulatory Surgery Centers (ASCs) are healthcare facilities that provide outpatient surgical care. They are freestanding and specialize in minimally invasive procedures that do not require as much space, equipment, staff, or time as more complex procedures performed in a hospital.
Secondly, patients undergoing surgery at ASCs are typically discharged on the same day, allowing them to recover at home instead of incurring additional hospital stay costs. This also reduces the risk of acquiring infections or coming into contact with other sick patients in a hospital setting. The streamlined nature of ASCs, focusing on specific outpatient procedures for healthy patients, contributes to their cost-effectiveness.
Additionally, the selection of technology and scheduling preferences in ASCs can be tailored to subspecialties, giving them an operational advantage over hospitals. The potential for physician ownership in ASCs can also increase the quality of care due to direct accountability and alignment of goals, incentivizing physicians to implement cost-saving measures.
Furthermore, a study presented at the AAOS 2024 Annual Meeting found that ASCs demonstrated cost-effectiveness across various hand and upper-extremity procedures when compared to hospital outpatient departments (HOPDs). The study identified significant cost savings in total expenses, facility fees, Medicare reimbursements, and patient payments. For example, arthroscopy procedures at ASCs resulted in total cost savings of $1,886 versus $3,418 at HOPDs. Fracture procedures also showed significant cost savings in ASCs, with total costs of $3,886.58 compared to $5,975.92 in HOPDs.
Overall, ASCs offer a more cost-effective alternative to hospitals for outpatient procedures, providing efficient, high-quality care at a lower cost.
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Outpatient surgeries are same-day procedures
Outpatient surgeries, also known as ambulatory surgery, office surgery, or same-day surgery, are procedures where patients do not stay overnight in a hospital. Instead, patients return home on the same day as their surgery. Outpatient surgeries can take place in a hospital, a doctor's office, or an ambulatory surgery center (ASC). ASCs are freestanding centres that provide surgery, medical procedures, and diagnostics outside of a hospital.
Outpatient surgeries are becoming an increasingly popular option in many areas of medicine, including orthopaedics. They offer patients several benefits over traditional inpatient surgeries, including greater convenience, lower costs, and the ability to recover in the comfort of their own homes. Modern, short-acting anaesthetics also facilitate quicker recovery and discharge from the facility. However, not all patients or types of surgeries are suitable for the same-day procedure. The type of surgical procedure, type of anaesthesia, and the patient's medical history will determine their length of stay.
ASCs specialize in minimally invasive procedures that do not require as much space, equipment, staff, and time as more complex procedures performed in hospitals. As a result, ASCs operate more efficiently than hospital-based outpatient surgery departments. The lower overall cost of care at ASCs is reflected in lower charges for insurance companies. According to the ASCA, having procedures performed in ASCs instead of hospitals saves Medicare and its beneficiaries an annual average of $5.3 million. Additionally, patients undergoing surgery in ASCs face a lower risk of infection compared to hospitals.
Some common outpatient procedures include cataract surgery, ear/nose/throat surgery (including tonsillectomy and adenoidectomy), arthroscopic surgery, vertebroplasty and kyphoplasty, laparoscopy, and total joint replacement (arthroplasty). It is important to note that patients are not allowed to drive themselves home after outpatient surgery and must have a family member or friend stay with them for 24 hours if they have received general anaesthesia.
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ASCs are subject to strict safety and quality standards
Ambulatory Surgery Centers (ASCs) are subject to strict safety and quality standards. They are fully equipped with the latest technology and provide same-day surgical and diagnostic care for minimally invasive procedures. ASCs are freestanding outpatient facilities that specialize in specific outpatient procedures for healthy patients who do not require overnight hospital stays.
ASCs are considered standalone facilities, distinct from hospital-based outpatient departments (HOPDs). HOPDs are owned by and typically attached to a hospital, whereas ASCs are independent entities with their own Medicare agreements. This distinction is important because it allows ASCs to maintain greater control over their operations, including technology selection and scheduling preferences, which can enhance their operational efficiency and quality of care.
ASCs are subject to federal health care quality standards and Medicare Conditions of Participation, ensuring acceptable quality in their operations. State Survey Agencies (SAs), under agreements with the Secretary of the Department of Health and Human Services (HHS), carry out the Medicare certification process and enforce standards for CLIA and Medicaid. Additionally, ASCs must comply with specific requirements, such as those related to the use of antibiotics, water quality, and growth ratios for fish, which contribute to overall safety and sustainability standards.
The focus on quality and safety in ASCs is further emphasized by their ability to provide a good counterpoint to hospitals. ASCs offer efficient, customer-friendly, safe, and high-quality care at a lower cost. This is particularly beneficial for patients, resulting in lower copayments and commercial insurance rates. The shift towards value-based care and cost savings contributes to ASCs capturing a greater proportion of the market and making outpatient procedures more accessible, convenient, and affordable.
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Frequently asked questions
ASC stands for Ambulatory Surgery Center. These are freestanding outpatient facilities that specialize in specific outpatient procedures for healthy patients who do not require overnight hospital stays. They are often more efficient, cost-effective, and have lower chances of infection exposure than hospital outpatient departments.
Hospital outpatient departments offer a wider range of services for less healthy patients who may need more complex procedures and longer post-operative monitoring. ASCs, on the other hand, are tailored for surgeries that do not require an overnight stay, offering targeted services with specialized surgical teams.
ASCs offer several advantages, including shorter wait times, lower costs, and a reduced risk of exposure to infectious diseases. They are also more streamlined and efficient due to their focus on minimally invasive procedures.
ASCs typically handle less complex procedures such as cataract surgery, endoscopies, minor orthopedic operations, biopsies, and certain plastic surgeries. More complex procedures like total knee arthroplasty (TKA) and total hip arthroplasty (THA) have recently been added to the ASC Covered Procedures List.
