ASCs have limited services but offer some advantages

Services provided at ASCs run the gamut from cosmetic, dermatologic, orthopedic, gynecologic and urologic surgeries, as well as some common cardiac procedures. ASCs' appeal is directly related to lower costs for everyone involved, more customized care and a more pleasant environment for patients.

"ASCs represent the objective of the future of healthcare in that they put the physician in the leadership role to create a more cost-effective, patient-centered, efficient, high quality and, in many respects, safer environment for surgery for patients that are appropriate for the ASC than the alternative: the hospital outpatient department," says Craig Jeffries, executive director, American Association of Ambulatory Surgery Centers (AAASC) in Johnson City, Tenn.

ASCs have been around for nearly 40 years and in the last five years have seen more than 10% growth annually, according to Michael Kulczycki, MBA, executive director of the Joint Commission's ambulatory accreditation program.

One of the greatest drivers for ASC growth, according to Kulczycki, is the physician/surgeon community desiring to practice outside the four walls of the hospital. In fact, more than 90% of all ASCs are physician-owned. Experts also say the limited-service model affords greater profitability.

"From the patient perspective, they prefer the convenience of ASCs. They can [access the facility] more easily than a hospital where parking can be difficult," Kulczycki says. "More importantly, ASCs run on time. When you enter their doors, you know the exact time you will have the procedure and can arrange a specific pick-up time. That's critical to many outpatients."

However, ASCs are not without their critics, according to Jeffries. Hospital associations and researchers that are funded by hospital interests want to protect their market dominance and will use their political strength to achieve their goal, he says. Luke Lambert, MBA, chief executive officer of Ambulatory Surgical Centers of America in Norwell, Mass., concurs that it is the hospitals that are often ASCs' biggest critics.

"We're cheaper, and we're better," Lambert says of ASCs. "Mortality rates in surgical centers versus hospitals-with the same population and controlled for risk factors-are much lower. In hospitals you have ongoing infection problems. We're not treating infectious disease, so we're not going to develop house infections.

"Surgery centers are very limited-focus facilities," he adds. "In the hospital, we may have one hour of a heart surgeon working in the operating room. The next hour is bowel resection, then eye surgery. Conversely, in the surgical center we may line up a whole day of eye surgery; the staff is specializing in the same procedure all day, so they become excellent at it and focused. It brings costs down."

Kulczycki views freestanding ASCs as "focused factories," a term coined by Regina Herzlinger, PhD, of Harvard Business School. It's based on the concept that healthcare organizations find one procedure or a grouping of procedures that they do extremely well and focus on that.

Kathy Bryant, president of the Alexandria, Va.-based Foundation for Ambulatory Surgery in America, says that hospitals and ASCs can't always be compared on an apples-to-apples basis.