Does competition from ambulatory surgical centers affect hospital surgical output?

Courtemanche, Charles; Plotzke, Michael

doi:10.1016/j.jhealeco.2010.07.003

Cited by 42 publications

(32 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1,16 Compared to hospitals, ASCs have several advantages, most of which are derived from their efficiency. 4,17 Previous work has demonstrated that these facilities lead to modest decreases in hospital utilization 18-20 without negatively impacting outcomes. 21-23 Perhaps most importantly, ASCs perform the same procedure at a lower cost per episode, largely due to lower facility reimbursement.…”

Section: Discussionmentioning

confidence: 99%

Ambulatory Surgery Centers and Outpatient Procedure Use Among Medicare Beneficiaries

Hollenbeck¹,

Dunn²,

Suskind³

et al. 2014

Medical Care

View full text Add to dashboard Cite

Background There has been a strong push to move outpatient surgery from hospital settings to ambulatory surgery centers (ASCs). Despite the efficiency advantages of ASCs, many are concerned that these facilities could increase overall utilization. Objective To assess the impact of ASC opening on rates of outpatient surgery. Design A retrospective cohort study of Medicare beneficiaries undergoing outpatient surgery between 2001 and 2010. We compared population-based rates of outpatient surgery in Hospital Service Areas (HSAs) with freestanding ASCs to those without. After adjusting for differences using multiple propensity score methods, we assessed the impact of ASC opening in a HSA previously without one on rates of outpatient surgery. Subjects Medicare beneficiaries with Part B eligibility. Main outcome measure Adjusted HSA-level rates of outpatient surgery. Results Adjusted outpatient surgery rates increased from 2,806 to 3,940 per 10,000 and the number of ASC operating rooms grew from 7,036 to 11,223 (both p < 0.001 for trend). By the 4th year after opening, rates of outpatient surgery increased by 10.9% (from 3,338 to 3,701 per 10,000) in HSAs adding an ASC for the first time. In contrast, outpatient surgery rates grew by only 2.4% and 0.6% in HSAs where an ASC was always or never present, respectively (p < 0.001 for test between 3 slopes). Conclusion Rather than redistributing patients from one setting to another, the opening of ASCs increases outpatient surgery use. However, the 10.9% increase is more modest than previously suggested by state-level data.

show abstract

Section: Discussionmentioning

confidence: 99%

Ambulatory Surgery Centers and Outpatient Procedure Use Among Medicare Beneficiaries

Hollenbeck¹,

Dunn²,

Suskind³

et al. 2014

Medical Care

View full text Add to dashboard Cite

show abstract

“…[33] In 2006, there were 4,700 ASCs in the United States up from 2,462 in 1997. [34] One unique aspect of our study was the incorporation of location and surgeon information into the outcomes data as it related to cryopreservation. This has not been previously reported, and it is of interest as many IVF practitioners utilize an offsite urologist for the TESE.…”

Section: Discussionmentioning

confidence: 99%

Sperm Recovery and IVF after Testicular Sperm Extraction (TESE): Effect of Male Diagnosis and Use of Off-Site Surgical Centers on Sperm Recovery and IVF

et al. 2013

View full text Add to dashboard Cite

ObjectiveDetermine whether testicular sperm extractions and pregnancy outcomes are influenced by male and female infertility diagnoses, location of surgical center and time to cryopreservation.PatientsOne hundred and thirty men undergoing testicular sperm extraction and 76 couples undergoing 123 in vitro fertilization cycles with testicular sperm.Outcome MeasuresSuccessful sperm recovery defined as 1–2 sperm/0.5 mL by diagnosis including obstructive azoospermia (n = 60), non-obstructive azoospermia (n = 39), cancer (n = 14), paralysis (n = 7) and other (n = 10). Obstructive azoospermia was analyzed as congenital absence of the vas deferens (n = 22), vasectomy or failed vasectomy reversal (n = 37) and “other”(n = 1). Sperm recovery was also evaluated by surgical site including infertility clinic (n = 54), hospital operating room (n = 67) and physician’s office (n = 11). Treatment cycles were evaluated for number of oocytes, fertilization, embryo quality, implantation rate and clinical/ongoing pregnancies as related to male diagnosis, female diagnosis, and use of fresh or cryopreserved testicular sperm.ResultsTesticular sperm recovery from azoospermic males with all diagnoses was high (70 to 100%) except non-obstructive azoospermia (31%) and was not influenced by distance from surgical center to laboratory. Following in vitro fertilization, rate of fertilization was significantly lower with non-obstructive azoospermia (43%, p = <0.0001) compared to other male diagnoses (66%, p = <0.0001, 59% p = 0.015). No differences were noted in clinical pregnancy rate by male diagnosis; however, the delivery rate per cycle was significantly higher with obstructive azoospermia (38% p = 0.0371) compared to diagnoses of cancer, paralysis or other (16.7%). Women diagnosed with diminished ovarian reserve had a reduced clinical pregnancy rate (7.4% p = 0.007) compared to those with other diagnoses (44%).ConclusionTesticular sperm extraction is a safe and effective option regardless of the etiology of the azoospermia. The type of surgical center and/or its distance from the laboratory was not related to success. Men with non-obstructive azoospermia have a lower chance of successful sperm retrieval and fertilization.

show abstract

“…b Major joint replacement or reattachment of lower extremity without complications or comorbidities. (Courtemanche & Plotzke, 2010;Mitchell, 2007). To date, the case that specialty providers are a meaningful force in promoting improved performance in full-service competitors has not been made.…”

Section: Discussionmentioning

confidence: 99%

Ambulatory Surgery Centers and Prices in Hospital Outpatient Departments

Carey

2016

Med Care Res Rev

View full text Add to dashboard Cite

Specialty providers claim to offer a new competitive benchmark for efficient delivery of health care. This article explores this view by examining evidence for price competition between ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). I studied the impact of ASC market presence on actual prices paid to HOPDs during 2007-2010 for four common surgical procedures that were performed in both provider types. For the procedures examined, HOPDs received payments from commercial insurers in the range of 3.25% to 5.15% lower for each additional ASC per 100,000 persons in a market. HOPDs may have less negotiating leverage with commercial insurers on price in markets with high ASC market penetration, resulting in relatively lower prices.

show abstract

Does competition from ambulatory surgical centers affect hospital surgical output?

Cited by 42 publications

References 16 publications

Ambulatory Surgery Centers and Outpatient Procedure Use Among Medicare Beneficiaries

Ambulatory Surgery Centers and Outpatient Procedure Use Among Medicare Beneficiaries

Sperm Recovery and IVF after Testicular Sperm Extraction (TESE): Effect of Male Diagnosis and Use of Off-Site Surgical Centers on Sperm Recovery and IVF

Ambulatory Surgery Centers and Prices in Hospital Outpatient Departments

Contact Info

Product

Resources

About