Ambulatory surgery centers struggle to balance profits with patient safety

Hospital Review hosted an Orthopedics + Ambulatory Surgery Center (ASC) Virtual Forum this week, which had some interesting take-aways on the significant changes in how orthopedic surgeries are performed.

Orthopedic surgeons are physicians with specialized training in diagnosing and treating medical conditions affecting the bones, joints, tendons, ligaments, and muscles. Some orthopedic surgeons limit their practice to specific areas of the body, such as the knees, ankles, or hands, while others have a more general practice.

Historically, orthopedic surgeons performed surgeries in hospital settings. However, with changes in Medicare and health insurance company reimbursement rates, orthopedic and other surgeons begin to feel a cash crunch on their bottom-line profitability. Some surgeons began looking for other ways to make money. That’s when their attention turned to the hefty payments that hospitals were receiving from Medicare and insurers for operating room and ancillary service fees.

Then some surgeon—probably someone with an undergraduate degree in business or accounting—had an idea: What if we surgeons could own our own operating rooms and collect those lucrative facility fee profits? This is essentially how the concept of ambulatory surgery centers was born.

What are ambulatory surgery centers?

Ambulatory surgery centers aren’t hospitals. They’re facilities that are often owned by physicians and surgeons where they or outpatient surgeries are performed. Some ambulatory surgery centers are rather large, while others are merely a separate room in the doctor’s office.

Outpatient joint replacement surgery

According to Becker’s, ambulatory surgery centers have moved into the total joint replacement arena. In my view, this is really pushing the envelope because total joint replacement surgeries aren’t simple procedures. They include extensive surgeries such as shoulder, knee, and hip replacements.

One of the big selling points that six orthopedic surgeons used to convince patients to use ambulatory surgery centers over hospitals is affordability. According to one study, the average outpatient surgery costs is $11,677 and the average inpatient surgery costs is $19,361.

As surgeons start to enjoy the profitability from their ambulatory surgery centers, and Medicare and private health insurance companies realize their cost savings with this option, we expect that there will be increased pressure on patients to consent to having these complex surgeries outside hospital settings.

There’s already an upward trend in total joint replacement surgeries. In 2017, 15% of these procedures were done on an outpatient basis (with no post-operative hospital admission), and experts believe that that number will rise to 32% in 2020 and jump to a whopping 51% by 2026.

But there is another side to ambulatory surgery centers other than cost. It comes down to the preschool concept taught by Sesame Street: Things that are different are not the same.

Ambulatory surgery center safety concerns

Medical malpractice cases are like the canary in a coal mine, they spot problems, in this case it’s new health care trends. We’ve certainly seen an uptick in medical negligence and wrongful death claims involving outpatient surgery centers.

Let’s cut to the chase. Ambulatory surgery centers are generally set up to run as many patients through the operating room and out the front door as possible in one day. Many of them lack meaningful enforced policies and procedures that focus on patient safety, including useful pre-operative evaluation of whether it’s even safe to proceed with surgery in an outpatient setting.

Perhaps most importantly, though, is the fact that most ambulatory surgery centers aren’t set up to handle patient emergencies. That’s why Texas law requires them to have contracts with nearby acute care general hospitals who will accept emergency transfer of ambulatory surgery patients or when something goes wrong.

Outpatient surgery centers don’t have the same capability of hospitals in terms of equipment, anesthesia personnel, and emergency providers as hospitals. In medical malpractice wrongful death cases that we’ve handled, the delay in getting appropriate treatment while patients in respiratory or cardiac crisis are transferred from an ambulatory surgery center to the hospital lead to patient deaths. In other words, our medical experts believe that if the underlying surgeries had taken place at a hospital, rather than an outpatient setting, the patients would have survived.

Check out these interesting quotes that were tweeted from this week’s virtual forum hosted by Becker’s:

• “Outpatient total joints are here to stay. If you pay attention to medical conditions, emotional factors, and the support system, you will be successful.”

• “Even though you likely have an inpatient hospital as a backup, you don’t want to have too many patients go there. Be careful of medical conditions.”

These quotes suggest that at least some orthopedic leaders are critically thinking about the need to balance ambulatory surgery profitability and patient risk. The second quote, though, reminds me of something that an anesthesiology expert told me in a surgery center case. Most of them are hesitant to call 911 for help because they don’t want people in the lobby seeing what really happens in an emergency—it’s bad for business!

If you’ve been seriously injured because of ambulatory surgery center or other health care in Texas, then contact an experienced, top-rated Houston, Texas medical malpractice lawyer to discuss your potential case.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.