Once upon a time in the not-too-distant past, all surgeries were conducted in hospitals. By the year 2008, more than half of all of surgical procedures were being performed in outpatient settings, including ASCs. Today, that number is even greater.
Why? What changed?
A growing trend
A recent study published in JAMA Ophthalmology found that most cataract surgeries are now conducted in ambulatory surgery centers.
This retrospective longitudinal cohort analysis looked at 369,320 patients who received cataract surgery between 2001 and 2014.
The researchers found that:
- 237,046 patients (64.2 percent) received cataract surgery at an ASC
- 136,261 patients (36.9 percent) received cataract procedure in a hospital outpatient department
- 3,987 patients (1.1 percent) received cataract surgery at both ASCs and hospital outpatient departments
Most interestingly, they found that the overall proportion of cataract surgeries conducted in ASCs has significantly increased over the last decade, from 43.6 percent in 2001 to 73.0 percent in 2014.
This study isn’t the only one that points towards a shifting trend in the ophthalmology world. According to the Medicare Provider/Supplier Procedure Summary, the number of cataract surgeries conducted in ASCs has gradually increased from 69 percent in 2012 to 72 percent in 2016.
Why?
This shift towards ASCs started in earnest in 2008 due to landmark regulations passed by the Centers for Medicare and Medicaid Services (CMS). With these regulations, ASCs could be reimbursed for the vast majority of ophthalmic surgical procedures once restricted to hospitals. Surgeons who were limited to hospital outpatient departments now had the opportunity perform procedures in physician-owned ASCs.
And they noticed some advantages.
Compared to hospitals, ASCs had:
- More flexible – and predictable – scheduling
- The ability to tailor the facility to the doctor’s specialties
- Freedom to use equipment and supplies that are best suited to the physician’s techniques, rather than those provided by the hospital
- Less risk of delays or rescheduling
- Reduced patient co-pays
- Increased control over patient flow
Several research studies have also uncovered the benefits in the ASC setting including:
Increased efficiency
In 2014, a pair of researchers from the University of Louisville and the University of Minnesota examined data from the National Survey of Ambulatory Surgery. They found that – on average, procedures performed in ASCs take 31.8 fewer minutes than procedures performed in hospitals, resulting in a 25 percent difference in mean procedure time.
ASCs are likely more efficient because they focus on a limited number of procedures and have specialized equipment, nursing and support staff. Since healthcare systems and providers are under pressure to provide care to more and more people, added efficiency can be vital.
More patients seek care.
Researchers found the presence of an ASC is associated with greater use of common outpatient procedures in older adults. Specifically, knee arthroscopy, cystoscopy, cataract removal, and colonoscopy were all performed more frequently in hospital service areas with ASCs.
In another study, researchers examined twenty percent of the national sample of Medicare beneficiaries. They found that when an ASC opened in a market for the first time, hospital-based outpatient surgery rates decreased by 7 percent.
Hospital-based outpatient surgery rates declined by 7 percent in markets where an ASC opened for the first time. This increase in procedure volume was greater than the decrease of procedures at hospital outpatient departments.
In other words, patients weren’t just moving from hospitals to ASCs – new patients were receiving care who might not have otherwise.
All of these benefits – and more – encouraged physicians to use ASCs more frequently.
Unfortunately, there is one major disadvantage for physicians in ASCs: reimbursement rates.
No matter where you practice; ASC or hospital, big or small, urban or rural, Sightpath Medical can bring you everything you need to perform your best cataract surgery.
Check out Part 2 of The Shift is On: Reimbursements.