Blog

by Beth Derby

My very first surgery center was 1978, when nobody knew what an ambulatory surgery center was, including me. I was brought in long after the design had been completed. The construction had already begun, and I was asked to outfit the place, to go buy things. I suppose if that facility had failed, I would have gone back to running the Yale Recovery Room and would’ve never had a career in ASCs.

It was Temple Surgical Center in New Haven, CT. We started with 4 ORs and eventually grew to 6. The flow was awkward and the rooms were small, but even then, space was used to maximize patient flow. People walked into the OR. Actually walked in!

What we didn’t know in 1978 could’ve filled 500 books. We learned with each project and then applied the experience to each of our future centers. That original company in Connecticut went on to build 6 more centers in every major city in Connecticut. The model for the facility grew over time. And since then, the model has become even more sophisticated. 

Insights from an ASC Expert, by Scott Bacon

What are the benefits and what unforeseen hurdles should it be aware of before proceeding?
This month’s ‘Insights from an ASC Expert’ column is focused on health systems considering the conversion of a hospital outpatient department (HOPD) to an ambulatory surgery center (ASC). Reimbursements for cases performed in an HOPD are greater than those same cases being performed in an ASC setting. For this reason, the conversion of these outpatient facilities to licensed, free-standing ambulatory surgery centers has been slow to occur over time. However, the pace of conversion is increasing.

Why Would Health Systems Convert HOPDs to ASCs?
Among many reasons, a few stand out:

1. Physician Demand. Employed, affiliated, or aligned independent physicians are pushing health systems to provide ASCs in which surgeons have more control, greater efficiency, less bureaucracy, and financial upside.
2. Hospital Protection. By creating alignment with surgeons in an ASC, those relationships become much stickier. In particular, it’s a tool to prevent employed surgeons from leaving or aligning with competitive systems or practices.
3. High-acuity Case Migration. CMS continues to approve higher-acuity cases to be performed within the ASC setting, meaning the majority of outpatient appropriate surgery can now be performed and billed in a licensed ASC.
4. Commercial Payer Requirements. Pre-authorization requirements from commercial payers. These payers are requiring certain case types to be performed in the lower-cost ASC setting.