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Some Interesting Statistics about the Continuing Growth of Ambulatory Surgery

Posted Aug 07 2009 11:58am

I have concerns about the continuing migration of various diagnostic and surgical procedures to office, clinic, and ambulatory settings. My concerns are based on the fact that the majority of pathologists, and the clinical labs that they manage, are hospital-based. A large percentage of the small biopsy surgical pathology work is migrating to in-office histopathology labs where it is diagnosed by pathologists working for large clinical groups (see: Corrected Definition for a Pod Lab and a Look at In-Office Labs, More on Integrated Diagnostic Centers; Trend or Lukewarm Idea? ). Ambulatory surgery centers (ASCs) are also widely proliferating, many of them physician-owned (see: Outpatient Surgery Now Dominates the Inpatient Variety in the U.S. ). A recent article in the Wall Street Journal provides some current numbers to this ambulatory surgery trend (see: Seeking a Safer Surgery ), Below is an excerpt from it:

...[A] growing number of states are regulating [surgical] procedures in doctors’ offices, or weighing measures to do so, including California, Indiana, Florida, Arizona and Nevada. This month, a law took effect in New York that for the first time requires the state’s approximately 3,000 doctors’ offices that perform surgery under moderate or deep sedation to have their facilities inspected and accredited by independent review agencies.... Outpatient surgery, from simple skin growth removals to knee replacements, accounts for more than 65% of all surgeries, up from about 20% two decades ago. Thanks to advances in anesthesia and minimally invasive surgical techniques, outpatient surgery offers lower costs, more convenient scheduling, and faster recovery and healing times than do hospital inpatient procedures. About 45% of [outpatient surgery] take place in hospital outpatient departments, which are operated by highly regulated hospitals. An additional 38% of outpatient procedures are performed in more than 5,000 ambulatory surgery centers, which typically are certified by the federal Center for Medicare and Medicaid Services, are accredited by an independent agency, and may also have to be licensed by their state. To be accredited, facilities must meet strict standards for equipment, operating-room safety, personnel training and surgeon credentials. Doctor’s offices in states with no regulation may perform surgery solely under the medical license of the physician with no formal licensing or accreditation requirements. Some doctors choose to be voluntarily accredited by one of three agencies that perform the inspections, but the process can cost several thousand dollars.

I don't need to embellish the facts. The trend toward ambulatory surgery is obvious. In my opinion, hospital-based pathologists need to be more aggressive in pursuing collaborative ventures with the large clinical urology and gastroenterology groups and ASCs for their surgical pathology business. The momentum toward ambulatory surgery can only increase in volume in upcoming years. Given that most of oncology care is delivered on an outpatient basis, most inpatient stays will soon be confined to critical care patients, many of them trauma victims, and perhaps end-of-life care. However, many of these latter patients, hopefully, will be served in the future by hospices or by family members in a home setting.

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