ASCs have several pros for both patients and physicians, including more buy-in opportunities, more physician autonomy and lower cost of care. As the popularity and prevalence of ASCs continues to expand year over year, the facilities hold the upper hand in some cases, while falling short in others.
Here are the specialties where ASCs may, or may not, have the upper hand over larger hospital systems:
Anesthesiology: Due to the rising cost of obtaining and retaining anesthesia providers, ASCs may fall short of large health systems. Unless affiliated with a major system, ASCs are often smaller and have less cash on hand to offer high, competitive wages. Anesthesiologist wages are continuing to rise as systems are forced to fight for providers. "Major medical institutions have had to scramble to divert funds from one or several other service lines to anesthesia. There is a major shortage of anesthesia providers in the U.S. Anesthesiologists are in a unique position to essentially state their salaries, or else walk to accept positions elsewhere or to do locum work for incredible hourly rates. Hospitals are scared to death and have been held hostage by the anesthesiologists who know that they can walk away at any moment for higher bidders. A bidding war has evolved and anesthesiologists are in the driver's seat," Kenneth Candido, MD, professor of clinical anesthesiology at the University of Illinois Chicago and CEO and president of Chicago Anesthesia Associates, told Becker's.
Cardiology: Major cardiology groups are taking an interest in cardiology ASCs now more than ever. CMS continues to approve more procedures in the ASC setting, and the American College of Cardiology recently launched a registry that offers data insights on cardiac procedures performed in the ASC setting. "Service lines like gastroenterology and ophthalmology have been highly successful veterans in the ASC world for years, but others, like cardiology, orthopedics and pain procedures, are becoming more and more prevalent. As the focus continues to migrate towards increased value in tandem with reduction of expenses, the sheer cost of care in an inpatient setting will continue to drive procedures into the ambulatory world," Angela Ross, director of surgical services at Charlotte (N.C.) Eye Ear Nose & Throat Associates, told Becker's.
Spine surgery: As more spine procedures are approved by CMS for the ASC setting, ASCs have secured an upper hand when it comes to specialist recruitment. "ASCs can attract spine surgeons by offering greater quality and case efficiency over a hospital. Surgery centers also provide a potential investment opportunity for a spine surgeon," Vladimir Sinkov, MD, surgeon at Sinkov Spine in Las Vegas, told Becker's.
Patient costs: CMS offers higher reimbursements for procedures performed in the ASC setting. The procedures also cost less for patients in most cases. Popular ASC offerings such as endoscopies and colonoscopies are cheaper in the outpatient setting. Hospital outpatient departments can be up to five times more expensive than ASCs for patients.
Increased autonomy: Since ASCs are smaller, and oftentimes physician owned, providers have more opportunities for buy-ins and to create their own schedules. At large hospital systems, physicians can be beholden to corporate policies. "Ambulatory surgery centers can potentially gain an edge in surgeon recruiting by offering a more streamlined and efficient work environment, increased autonomy for surgeons, opportunities for ownership or investment, and the ability to focus on specific surgical specialties. Additionally, ASCs may be able to provide more flexible scheduling and potentially higher reimbursement rates for surgeons. It is important for ASCs to highlight these advantages when recruiting surgeons and to tailor their recruitment strategies to attract top talent," Brian Fiani, DO, surgeon at Mendelson Kornblum Orthopedic & Spine Specialists in West Bloomfield, Mich., told Becker's.