Ambulatory surgery center
An ambulatory surgery center (ASC) is health care facility where surgical procedures not requiring hospitalization are performed, with an expected duration of services less than 24 hours following admission.[1] Such surgery is commonly less complicated than that requiring hospitalization. Avoiding hospitalization can result in cost savings to the party responsible for paying for the patient's health care.[2]
The ASC may also be known as an outpatient surgery center, same day surgery center, or surgicenter.
History
The first ASC opened in the United States on February 12, 1970, led by doctors Wallace Reed and John Ford in an attempt to provide more affordable and accessible outpatient surgery alternatives. By the end of 1976, 67 ASCs were running, buoyed by resolutions and standards from several medical associations. In 1982 the Centers for Medicare and Medicaid Services (CMS) began approving payments to ASCs for nearly 200 procedures. As of 2011[update] more than 5,300 ASCs in the United States performed 23 million surgeries annually, using more than 3,500 Medicare-approved procedures.[3]
Activities and management
An ASC specializes in providing surgical procedures, including certain pain management and diagnostic (e.g., colonoscopy) services in an outpatient setting. In simple terms, ASC-qualified procedures can be considered procedures that are more intensive than those done in the average doctor's office but not so intensive as to require a hospital stay. ASCs do not routinely provide emergency services to patients who have not been admitted to the ASC for another procedure. However, while complications are very rare, ASCs are still required by CMS and other accreditation organizations to have a backup plan for transfer of patients to a hospital if the need arises.
Procedures performed in ASCs are broad in scope. According to 2009 claim data from CMS, the most common procedures performed at an ASC that year were[4]
- Procedure (Percent of volume)
- Cataract surgery w/ IOL insert, 1 stage (18.1%)
- Upper GI endoscopy, biopsy (8.0%)
- Colonoscopy and biopsy (5.5%)
- Diagnostic colonoscopy (4.6%)
- After cataract laser surgery (4.4%)
- Lesion removal colonoscopy (4.4%)
- Injection spine: lumbar, sacral (caudal) (3.6%)
- Inject foramen epidural: lumbar, sacral (3.6%)
- Inject paravertebral: lumbar, sacral add on (2.8%)
- Inject foramen epidural add on (2.0%)
- Inject paravertebral: lumbar, sacral (1.9%)
- Colorectal screen, high-risk individual (1.6%)
- Destruction paravertebral nerve, add on (1.4%)
- Upper GI endoscopy, diagnosis (1.3%)
- Lesion remove colonoscopy (1.3%)
- Colon cancer screen, not high-risk individual (1.3%)
- Cystoscopy (1.2%)
- Cataract surgery, complex (1.2%)
- Revision of upper eyelid (1.0%)
ASCs rarely have a single owner. Physicians partners who perform surgeries in the center will often own at least some part of the facility. Ownership percentages vary considerably, but most ASCs involve physician owners. Occasionally, an ASC is entirely physician-owned. However, it is most common for development/management companies to own a percentage of the center.
Accreditation
Accreditation organizations are separate from the general trade organizations. Accreditation organizations for ASCs provide standards of medical care, record keeping, and auditing for ASCs. Some of the goals of these organizations include continuous improvement of medical care in surgery centers and providing an external organization where the public can get information on many aspects of ASCs. These accreditation organizations require members to receive periodic audits. These audits will come every one to three years, depending on the accreditation organization and the circumstances of the surgery center. In an audit, a team of auditors visits the facility and examines the ASC's medical records, written policies, and compliance with industry standards.
In 1996, California was the first state to require accreditation for all outpatient facilities that administer sedation or general anesthesia. Many other states have followed and require accreditation.
The three main accreditors of ASCs are American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), Accreditation Association for Ambulatory Health Care (Accreditation Association or AAAHC) and The Joint Commission.
References
- ↑ "Ambulatory Surgery Centers". CMS.gov. Centers for Medicare and Medicaid Services. 10 April 2013. http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/ASCs.html. Retrieved 29 March 2014.
- ↑ "Surgicenter". Baylor College of Dentistry. Archived from the original on 28 May 2010. https://web.archive.org/web/20100528150320/http://www.tambcd.edu/oralsurgery/surgicenter/surgicenter.html. Retrieved 29 March 2014.
- ↑ "History". Ambulatory Surgery Center Association. http://www.ascaconnect.org/ASCA/AboutUs/WhatisanASC/History/. Retrieved 29 March 2014.
- ↑ "Chapter 5: Ambulatory Surgical Centers" (PDF). Report to the Congress: Medicare Payment Policy. Medicare Payment Advisory Commission. March 2011. http://medpac.gov/documents/Mar11_EntireReport.pdf. Retrieved 29 March 2014.
