Ambulatory Surgery Centers (ASCs) on Direct Pay Edge

A little knowledge is a dangerous thing;

Drink deep , or taste not the Perian spring;

There shallow draughts intoxicate the brain,

And drinking largely sobers us again.

Alexander Pope (1688-1744), An Essay on Criticism

Other than having 4 procedures performed on myself and a family member at ambulatory care centers and writing a E-book on Direct Pay Medicine and Surgery, I have no deep knowledge of Ambulatory Surgery Centers.

I am aware that technological advances and positive results have caused the number of procedures done in ASCs to multiply, that growing numbers of surgeons are operating in ASC facilities, and that ASCs sometimes threaten profit margins of hospitals. I am aware, based on an interview with Keith Smith, MD, founder and director of the Okahoma Surgery Center in Oklahoma City, that demands for ASC procedures can upset a hospital-dominated surgical market’s apple cart.

As I dig deeper into the direct pay movement, the potential benefits of direct pay become clearer.

These benefits include:

• Immediate access to routine surgeries that can be performed safely on an outpatient, one-day basis.

• Transparent pricing, usually bundled and including anesthesiologists, nursing, and brief rehab stay.

• Fewer complications, such a facility acquired infections, which are more prevalent in hospitals.

• More operating room efficiencies, secondary to specialization and focus on efficiencies of scheduling.

• Quality care with superior outcomes, as performed by board-certified surgeons in the community.

• Certification by Medicare and other regulatory agencies.

Most Ambulatory Surgery Centers (ASCs) are members of the Ambulatory Surgical Care Association, located in Alexandria, Virginia. More than 5400 ASCs exist in all 50 states, the majority are certified by Medicare, and 20 or more are joining each year. Those ASCs run by hospitals in outpatient settings charge higher facility fees than free-standing ASCs.

In general, ASCs tend to perform cataract surgeries, colonoscopies, laporoscopic procedures, endoscopic extractions, such as gallbladder or parathyroid adenoma removals, cystoscopic procedures, arthroscopic and minimally invasive joint or back procedures, and a growing list of other procedures that can be performed safely on ambulatory patients.

To my limited knowledge, only a handful of ASCs charge direct cash without intervening third party arrangements, though I suspect the list is much longer.

Nine ASCs known to charge direct cash include:

• Daytime Outpatient Surgery Center (Fort Worth, Texas).

• Manitowoc (Wisconsin) Surgery Center,

• MEDARVA at Stony Poinht Surgery Center (Richmond, Virginia.

• Monticello Community Surgery Center (Charlottsville, Virginia).

• Northwest ENT Surgery Center (Woodstock, Georgia).

• Ocean Surgery Center (Torrance, California).

• Regency Healthcare (New York City)).

• Surgery Center of Oklahoma (Oklahoma City).

I suspect these 9 centers are just the tip of the direct pay surgery iceberg. The number of these direct pay ambulatory care will grow as consumers and self-funded corporations learn of dramatic lowering of costs due to lower overheads, quicker access, less bureaucratic bungling, and superior outcomes. Surgeons will welcome the scheduling and specialized efficiencies outside hospital settings.

The direct pay movement will never become more than marginal if it does not include both primary care physicians and specialists. Ambulatory care centers are a good place to start to recruit specialists.