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During the past thirty years outpatient surgery has become an increasingly important part of medical care in the United States. The number of outpatient procedures has risen dramatically since 1981, and the majority of surgeries performed in the United States now take place in outpatient settings. Using data on procedure length, we show that ambulatory surgery centers (ASCs) provide a lower-cost alternative to hospitals as venues for outpatient surgeries. On average, procedures performed in ASCs take 31.8 fewer minutes than those performed in hospitals-a 25 percent difference relative to the mean procedure time. Given the rapid growth in the number of surgeries performed in ASCs in recent years, our findings suggest that ASCs provide an efficient way to meet future growth in demand for outpatient surgeries and can help fulfill the Affordable Care Act's goals of reducing costs while improving the quality of health care delivery. [PUBLICATION ABSTRACT]

Background The healthcare industry is a leading contributor to climate change and resource depletion and its footprint is growing given efforts to improve healthcare access worldwide. Low- and middle-income countries (LMICs) are most vulnerable to this environmental degradation due to their relatively weaker infrastructure and lack of resources. This case study describes the infrastructure and procedures that drive environmental sustainability at Kyabirwa Surgical Center (KSC), an ambulatory surgery facility in rural Uganda that has cared for over 25,000 patients since its 2019 inception. Methods KSC was architecturally designed with the goal of zero carbon footprint, exemplifying how environmental sustainability can be achieved in low-resource settings. In collaboration with a New York-based institution, Ugandan stakeholders constructed the original 8500 ft 2 center with local materials, leveraging natural resources such as sunlight and natural ventilation to minimize energy required. The center also prioritized operational independence from the local power grid and water supply, nearly exclusively using solar power and rainwater. Specific treatment and storage protocols, like environmentally conscious anesthesia regimens, were also implemented to minimize environmental footprint. Results From 2021 to 2023, KSC obtained only 0.4% of its power and 25% of its water from the town. Excluding installation, this saves KSC an estimated $6,121 in annual operating costs—greater than annual maintenance costs estimated at $5,040. KSC also conserved 11% of solar power produced and 93% of rainwater collected from 2021 to 2023 for future use. Lastly, 71% of procedures were completed under environmentally friendly alternatives to general anesthesia. Conclusion Integrating sustainability into LMIC surgical care is essential for improving healthcare resilience and accessibility. KSC shows that sustainable surgical models are feasible with innovative design, renewable energy, and potentially cost-effective practices. Scaling these efforts requires global collaboration, particularly support from high-income countries (HICs), to build resilient health systems in the face of climate change and resource limitations.

Private negotiated facility fees at hospitals are on average double the ambulatory surgery center facility fees for common outpatient procedures.Private negotiated facility fees at hospitals are on average double the ambulatory surgery center facility fees for common outpatient procedures.

We studied the impact of the growth of ambulatory surgical centers (ASCs) on total Medicare procedure volume and ASC market share from 2000 to 2009 for four common outpatient procedures: cataract surgery, upper gastrointestinal procedures, colonoscopy, and arthroscopy. ASC growth was not significantly associated with Medicare volume, except for colonoscopy. An additional ASC operating room per 100,000 population results in a 1.8% increase in colonoscopies performed in all outpatient settings. Increases in the number of ASCs were associated with greater ASC market share with effects ranging from 4- to 6-percentage-point gains for each additional ASC operating room per 100,000. The study demonstrates that continued growth of ASCs could reduce Medicare spending, because ASCs are paid a fraction of the amount paid to hospital outpatient departments for the same services.

Increasing insurance deductibles have prompted some medical centers to initiate transparent pricing. However, the impact of price transparency (PT) on surgical volume, revenue, and patient satisfaction is unknown, along with the barriers to achieving PT. We identified ambulatory surgical centers in the Free Market Medical Association database that publicly list prices for surgical services online. Six of eight centers (75%) responded to our data collection inquiry. Among five centers that reported their patient volume and revenue after adopting PT, patient volume increased by a median of 50 per cent (range 10–200%) at one year. Four centers (80%) reported an increase in revenue by a median of 30 per cent (range 4–75%), whereas three centers (60%) experienced an increase in third-party administrator contracts with the average increase being seven new third-party administrator contracts (range = 2–12 contracts). Three centers (50%) reported a reduction in their administrative burden and five centers (83%) reported an increase in patient satisfaction and patient engagement after PT. The leading barrier reported to making prices transparent was discouragement from another practice, hospital, or insurance company. The findings of this preliminary study may help guide medical practices in designing and implementing PT strategies.

Background The Emergency Hospital in Battambang, Cambodia, is essentially a surgical center for victims of injuries. Methods Using methods previously described, operating costs were calculated, and effectiveness of treatment was estimated for 957 patients undergoing 895 surgical procedures over a 3 month period (October–December 2006). Results Results of the cost-effectiveness analysis are compared to the few existing ones in the literature. Conclusion At $77.4 per DALY averted, surgery for trauma in such a context is deemed very cost-effective and compares favorably to other non-surgical public health interventions.

These patients would have been bet- ter served in Europe \"where public and private systems operate alongside each other and improve each other through competition,\" says [Brian Day]. He cites Bel- gium, France, Denmark, Sweden, The Netherlands, Switzerland, Austria and Germany as examples of countries with two-tier systems where wait lists are \"essentially nonexistent.\" \"Likely we would have to institute some kind of a means test for people to access publicly subsidized services,\" [Colleen Fuller] notes. It will come as a rude awakening for everyone who has grown up under Medicare. \"We haven't had to pay for doctor's visits, we haven't had copays and a lot of other charges that exist in other countries for hospital care, and that will come to an end.\" \"That evidence will all be refuted at trial,\" he says. \"This is part of blaming and assigning evil intentions to doctors.\"

Second surgeries represent a significant detriment to breast cancer patients. We examined the impact an intraoperative pathology consultation service had on multiple facets of breast cancer surgery. We compared the 8 months before the establishment of a pathology laboratory, when intraoperative pathology consultation was not available, with the 8 months subsequent, when it was performed routinely. The average number of surgeries per patient decreased from 1.5 to 1.23, and the number of patients requiring one surgery increased from 59% to 80%. Re-excisions decreased from 26% to 9%. Frozen section allowed 93% of node-positive patients to avoid a second surgery for axillary lymph node dissection. A cost analysis showed savings between $400 and $600 per breast cancer patient, even when accounting for fewer axillary lymph node dissections based on the American College of Surgeons Oncology Group Z0011 data. Incorporation of routine intraoperative margin/sentinel lymph node assessment at an outpatient breast surgery center is feasible, and results in significant clinical benefit to the patient. Use of frozen section decreased both the time and cost required to treat patients.

Objective: To evaluate the relationship between ownership and use of ambulatory surgical centers (ASCs). Methods: From 1998 through 2002, ambulatory surgical discharges for procedures within the genitourinary system were abstracted from the Florida State Ambulatory Surgery Database. State-wide utilization rates for ambulatory surgery were calculated by physician-level ownership (using an empirically-derived, externally-validated method) and financial incentives. A surgeon-level Poisson regression model was fit to compare the rates of surgery by year, ownership, and their interaction. Results: Rates of ambulatory surgery increased from 607 per 100,000 in 1998 to 702 per 100,000 in 2002 (P < 0.01 for trend). Although rates at the hospital increased only slightly (0.9%), those at the ASC were up by 53% (P < 0.01). Physician ownership was associated with this greater utilization as new owners increased their use from 9 per 100,000 to 94 per 100,000 (P < 0.01) in the first full year as owners. In the first year of ownership, the proportion of a new owner's surgeries comprising of financially lucrative procedures increased to 61% compared with 50% in the year preceding ownership (P < 0.01). Conclusions: Physician ownership is associated with the increasing use of ASCs, although the extent to which this is attributable to previously unmet demand is unclear. However, new owners seem to alter their procedure mix after establishing ownership to include a greater share of financially lucrative procedures.

Background Ambulatory surgical centers (ASCs) provide outpatient surgical services more efficiently than hospital outpatient departments, benefiting patients through lower co-payments and other expenses. We studied the influence of socioeconomic status and race on use of ASCs. Methods From the 2005 State Ambulatory Surgery Database for Florida, a cohort of discharges for urologic, ophthalmologic, gastrointestinal, and orthopedic procedures was created. Socioeconomic status was established at the zip code level. Logistic regression models were fit to assess associations between socioeconomic status and ASC use. Results Compared to the lowest group, patients of higher socioeconomic status were more likely to have procedures performed in ASCs (OR 1.07 CI 1.05, 1.09). Overall, the middle socioeconomic status group was the most likely group to use the ASC (OR 1.23, CI 1.21 to 1.25). For whites and blacks, higher status is associated with increased ASC use, but for Hispanics this relationship was reversed (OR 0.84 CI 0.78, 0.91). Conclusion Patients of lower socioeconomic status treated with outpatient surgery are significantly less likely to have their procedures in ASCs, suggesting that less resourced patients are encountering higher cost burdens for care. Thus, the most economically vulnerable group is unnecessarily subject to higher charges for surgery.