Ambulatory Surgery Centers and Prices in Hospital Outpatient Departments

Carey, Kathleen

doi:10.1177/1077558716633010

Cited by 23 publications

(14 citation statements)

References 25 publications

(33 reference statements)

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“…Approximately seventy percent of all surgical procedures are currently performed in the ambulatory setting [ 6 , 7 ]. Several ambulatory surgical centers and state regulations utilize the ASA PS classification to select patients for ambulatory procedures.…”

Section: Introductionmentioning

confidence: 99%

American Society of Anesthesiologists Physical Status Classification as a reliable predictor of postoperative medical complications and mortality following ambulatory surgery: an analysis of 2,089,830 ACS-NSQIP outpatient cases

et al. 2021

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Background Seventy percent of surgical procedures are currently performed in the outpatient setting. Although the American Society of Anesthesiologists (ASA) Physical Classification ability to predict risk has been evaluated for in-patient surgeries, an evaluation in outpatient surgeries has yet to be performed. The major goal of the current study is to determine if the ASA classification is an independent predictor for morbidity and mortality for outpatient surgeries. Methods The 2005 through 2016 NSQIP Participant Use Data Files were queried to extract all patients scheduled for outpatient surgery. ASA PS class was the primary independent variable of interest. The primary outcome was 30-day medical complications, defined as having one or more of the following postoperative outcomes: (1) deep vein thrombosis, (2) pulmonary embolism, (3) reintubation, (4) failure to wean from ventilator, (5) renal insufficiency, (6) renal failure, (7) stroke, (8) cardiac arrest, (9) myocardial infarction, (10) pneumonia, (11) urinary tract infection, (12) systemic sepsis or septic shock. Mortality was also evaluated as a separate outcome. Results A total of 2,089,830 cases were included in the study. 24,777 (1.19%) patients had medical complications and 1,701 (0.08%) died within 30 days. ASA PS IV patients had a much greater chance of dying when compared to healthy patients, OR (95%CI) of 89 (55 to 143), P < 0.001. Nonetheless, over 30,000 ASA PS IV patients had surgery in the outpatient setting. Multivariable analysis demonstrated a stepwise independent association between ASA PS class and medical complications (C statistic = 0.70), mortality (C statistic = 0.74) and readmissions (C statistic = 0.67). Risk stratifying ability was maintained across surgical procedures and anesthesia techniques. Conclusions ASA PS class is a simple risk stratification tool for surgeries in the outpatient setting. Patients with higher ASA PS classes subsequently developed medical complications or mortality at a greater frequency than patients with lower ASA PS class after outpatient surgery. Our results suggest that the ambulatory setting may not be able to match the needs of high-risk patients.

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Section: Introductionmentioning

confidence: 99%

American Society of Anesthesiologists Physical Status Classification as a reliable predictor of postoperative medical complications and mortality following ambulatory surgery: an analysis of 2,089,830 ACS-NSQIP outpatient cases

et al. 2021

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“…Absent a regulatory constraint, ASCs directly compete with hospitals for a variety of outpatient procedures (Bian and Morrisey 2007;Courtemanche and Plotzke 2010;Carey, Burgess, and Young 2011;Carey 2017;Whaley and Brown 2018;Baker, Bundorf, and Kessler 2019). Hospitals are medically appropriate for higher risk patients and procedures, but physicians may prefer using ASCs for at least some patients and procedures.…”

Section: A Physicians and Outpatient Surgery Carementioning

confidence: 99%

Trading Spaces: Medicare’s Regulatory Spillovers on Treatment Setting for Non-Medicare Patients

Geruso

Richards

2020

SSRN Journal

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“…Complication rates are similar between hospital‐outpatient centers and ASCs. Procedures appear to cost payers more at hospital‐outpatient centers than ASCs or office‐based laboratories …”

Section: Economics Of Outpatient Facilitiesmentioning

confidence: 99%

SCAI/ACVP expert consensus statement on cardiovascular catheterization laboratory economics: If the cath lab is your home you should understand its finances

Blankenship

Choi

Das

et al. 2019

Cathet Cardio Intervent

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This article is intended for any physician, administrator, or cardiovascular catheterization laboratory (CCL) staff member who desires a fundamental understanding of finances and economics of CCLs in the United States. The authors' goal is to illuminate general economic principles of CCL operations and provide details that can be used immediately by CCL leaders. Any article on economics in medicine should start by acknowledging the primacy of the principles of medical ethics. While physicians have been trained to act in the best interests of their patients and avoid actions that would harm patients it is vitally important that all professionals in the CCL focus on patients' needs. Caregivers both at the bedside and in the office must consider how their actions will affect not only the patient they are treating at the time, but others as well. If the best interests of a patient were to conflict with any recommendation in this article, the former should prevail. Key Points To be successful and financially viable under current payment systems, CCL physicians, and managers must optimize the outcomes and efficiency of care by aligning CCL leadership, strategy, organization, processes, personnel, and culture. Optimizing a CCL's operating margin (profitability) requires maximizing revenues and minimizing expenses. CCL managers often focus on expense reduction; they should also pay attention to revenue generation. Expense reduction depends on efficiency (on‐time starts, short turn‐over time, smooth day‐to‐day schedules), identifying cost‐effective materials, and negotiating their price downward. Revenue optimization requires accurate documentation and coding of procedures, comorbidities, and complications. In fee‐for‐service and bundled payment reimbursement systems, higher volumes of procedures yield higher revenues. New procedures that improve patient care but are expensive can usually be justified by negotiating with vendors for lower prices and including the “halo effect” of collateral services that accompany the new procedure. Fiscal considerations should never eclipse quality concerns. High quality CCL care that prevents complications, increases efficiency, reduces waste, and eliminates unnecessary procedures represents a win for patients, physicians, and CCL administrators.

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Ambulatory Surgery Centers and Prices in Hospital Outpatient Departments

Cited by 23 publications

References 25 publications

American Society of Anesthesiologists Physical Status Classification as a reliable predictor of postoperative medical complications and mortality following ambulatory surgery: an analysis of 2,089,830 ACS-NSQIP outpatient cases

American Society of Anesthesiologists Physical Status Classification as a reliable predictor of postoperative medical complications and mortality following ambulatory surgery: an analysis of 2,089,830 ACS-NSQIP outpatient cases

Trading Spaces: Medicare’s Regulatory Spillovers on Treatment Setting for Non-Medicare Patients

SCAI/ACVP expert consensus statement on cardiovascular catheterization laboratory economics: If the cath lab is your home you should understand its finances

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