Position Statement

Ambulatory Surgical Centers

This Position Statement was developed as an educational tool based on the opinion of the authors. It is not a product of a systematic review. Readers are encouraged to consider the information presented and reach their own conclusions.

An Ambulatory Surgical Center (ASC) exclusively furnishes outpatient surgical services. There are currently more than 3700 Medicare-certified ASCs representing a doubling in the past decade. In 2001, ASCs supported 3 million surgical procedures and received about $1.6 billion in Medicare payments.¹ Notwithstanding this growth, ASCs accounted for less than 1 percent of total Medicare spending in 2001.²

The number of ASCs has grown because of rapid advances in technology and medicine. The American Association of Orthopaedic Surgeons (AAOS), as one of the leading advocates for patient safety, believes that many procedures that were previously performed only in the hospital inpatient setting can now be safely performed in ASCs. For example, many orthopaedic procedures can be performed in ASCs because of advancements in arthroscopic equipment and techniques. The improvement of short-acting, general anesthesia has reduced operative and recovery times and has made it possible to perform more procedures in ASCs.

ASCs have also grown because they offer numerous benefits to the patient and the orthopaedic surgeon. For musculoskeletal patients, ASCs can be convenient because of shorter wait times before and after surgery. Furthermore, coinsurance rates are often lower when compared to other outpatient healthcare settings.³

Many musculoskeletal procedures are highly technical and specialized. ASCs allow orthopaedic surgeons to design a site where they can perform these complex procedures more efficiently than in other outpatient settings. For example, the operating room in an ASC is often customized for a specific procedure, such as arthroscopy. Equipment and supplies are setup for specific procedures, and the same clinical staff often works together on a daily basis. This makes it easier to schedule and perform surgery in an ASC, which can translate into improved efficiency, cost-effective use of resources, and better outcomes for patients.

The decision to perform procedures in an ASC should largely rest with physicians because they can assess the best venue for optimizing care. The physician would consider the anesthetic risk, age, and general medical condition of the patient; the expected duration and complexity of the operation; the anticipated degree of postoperative pain and discomfort; and the probability of complications. An operation would not be performed in an ambulatory setting – irrespective of convenience or cost – if the risk to the patient is increased. Improving the patient’s quality of care and outcome should be the guiding principle in determining whether a procedure should be performed in an ASC.

Reimbursement for procedures performed in ASCs must adequately capture all labor, equipment, and supply costs required to operate an ASC. Furthermore, ASC payment systems should be designed so that they can react to changes in technology or prices. Medicare and private insurers must work closely with the ASC and physician community in order to ensure fair payment is received for services provided. Failure to do so can create problems. For example, although many implant procedures can be safely performed in ASCs, many payers do not reimburse for implant hardware. This is a serious problem because the implant device is often the costliest part of a procedure. The result is that physicians cannot perform certain implant procedures in ASCs because reimbursement rates do not account for necessary costs, which are reimbursed in more expensive inpatient facilities.

The AAOS believes that many surgical procedures can be safely performed in ASCs. ASCs provide a benefit to both patients and orthopaedic surgeons because many musculoskeletal surgical procedures can be provided in an efficient, cost-effective manner. ASCs can improve the quality of care received by the patient and delivered by the physician. The growth and development of ASCs must not be hampered by restrictive payment or coverage policies from either Medicare or other private payers.

References:

1. MedPAC Report to Congress, Medicare Payment Policy March 2003, p. 136.
2. MedPAC, p. 136
3. MedPAC, p. 140

© March 2004 American Academy of Orthopaedic Surgeons

This material may not be modified without the express written permission of the American Academy of Orthopaedic Surgeons®.

Position Statement 1161

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