What Is an Ambulatory Surgery Center, ASC?

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As you age, chances are you’ll likely need to have an outpatient surgery or procedure to address a health problem or to screen for a disease or condition. These types of same-day surgeries, diagnostic tests and procedures are typically considered outpatient procedures. In other words, they don’t require a patient to stay overnight in a hospital. They can include anything from a colonoscopy and biopsy, to cataract surgery, gallbladder removal, rotator cuff surgery and hernia repair.

Typically, patients would visit a hospital outpatient department for these types of surgeries or procedures. However, as the need for accessible, convenient and affordable care that doesn’t require hospitalization grows, more and more people are turning to ambulatory surgery centers (ASCs), also referred to as day surgery centers. Fully equipped with the latest technology, ASCs provide same-day surgical and diagnostic care for minimally invasive surgical and diagnostic procedures that can be done in the outpatient setting.

But what exactly are ambulatory surgery centers, and how do they differ from traditional hospital outpatient departments?

What Are Ambulatory Surgery Centers?

Ambulatory surgery centers are freestanding outpatient facilities that specialize specifically in surgeries and diagnostic procedures that do not require patients to stay overnight. They allow patients to be discharged on the same day as their surgery and safely recover in the comfort of their own homes. Some ASCs can also be owned by or in partnership with a hospital or health system.

In contrast, hospital outpatient departments are part of a larger hospital system and offer a wider range of services and have more immediate access to the full gamut of hospital resources to handle more complex, invasive procedures that may require longer, more extensive postoperative monitoring.

The two outpatient facilities differ based on:

— Types of procedures offered

— Types of patients treated

— Cost

— Infection rates

— Patient satisfaction

[READ Navigating Insurance and Costs for Ambulatory Surgery: A Comprehensive Guide on How to Pay]

Types of Procedures Offered

One of the major differences between ambulatory surgery centers and hospital-based outpatient departments is the types of procedures they perform.

Ambulatory surgery centers are freestanding outpatient facilities that specialize specifically in surgeries and diagnostic procedures that do not require patients to stay overnight. In contrast, hospital outpatient departments offer a wider range of services and have access to the full gamut of hospital resources to handle more complex, invasive procedures that may require longer, more extensive postoperative monitoring.

“The key distinction in terms of the patients that flow through is that hospital outpatient departments do more varied procedures than an ambulatory surgery center,” explains Bill Prentice, CEO of the Ambulatory Surgery Center Association. “We do a more prescribed list of procedures … and use patient evaluation criteria to make sure that patients are healthy enough to be seen in an outpatient setting away from a hospital campus.”

Common surgical, diagnostic and screening procedures performed at an ambulatory surgery center include:

Hip replacements

Knee replacements

— Rotator cuff repairs

— Diagnostic endoscopies

Colonoscopies and colon cancer screenings

— Fracture or dislocation treatments

— Retinal procedures

— Corrective eye surgery, including LASIK

Kidney stone removal

— Prostrate biopsy

[Does Medicare Cover Cataract Surgery and How Much Does It Cost?]

Types of Patients Treated

Whether you receive treatment at an ambulatory surgery center or a hospital will also depend on your health status: If you have a generally clean bill of health and do not have any serious medical conditions that may require extra support, chances are your primary physician will recommend you for treatment at an ambulatory surgery center.

On the other hand, traditional hospital-based outpatient departments are equipped with more staff, equipment and resources to treat less healthy patients who have significant medical problems.

Serious health issues can include:

— Morbid obesity

— Poorly controlled diabetes

Kidney disease

— Heart disease

Respiratory disease, such as chronic obstructive pulmonary disease (COPD)

— Other chronic health issues

“(Ambulatory surgery centers) can really decant some of that capacity for trauma or for more complex care that really needs to be done within a hospital so that the hospital can truly focus on the sickest of the sick and taking care of those who have high-complexity cases,” says Teal Holden, senior vice president of ambulatory services, post-acute care and community health at Memorial Hermann Health System. Holden oversees Memorial Hermann’s hospital outpatient departments, as well as the hospital’s joint ventures for ambulatory surgical centers.

The decision to either undergo a procedure at an ambulatory surgery center or hospital is largely based on a discussion you’ll have with your physician, who will review your medical history, condition(s), treatment plan and risk of complications.

[SEE: What Makes a Good Doctor: Qualities to Look For]

Cost

One of the major selling points of having a procedure done at an ambulatory surgery center is cost. Patients often save money by paying lower copays and deductibles for procedures at ambulatory surgery centers than hospitals due to lower facility fees and overhead costs of outpatient care.

Because ambulatory surgery centers specialize in minimally invasive procedures that do not require as much space, equipment, staff and time as more complex procedures performed in a hospital, these streamlined facilities are able to operate more efficiently than hospital-based outpatient surgery departments. The lower overall cost of care at an ambulatory surgery center is reflected in lower charges for insurance companies.

According to ASCA, having procedures performed in ambulatory surgery centers versus hospitals saves Medicare and its beneficiaries an annual average of $5.3 million and could save $47.4 billion from 2024 to 2028 if current outpatient surgery continues to migrate to ambulatory surgery centers.

“We provide a good counterpoint (to hospitals) to show that there are ways to be more efficient and to provide care in a very customer-friendly, safe, high-quality way at a lower cost,” Prentice says.

This model is not only cost-effective for the facility and the health care system, but for the patients as well.

“We provide a nice incentive in the health care system to show that there are ways to provide this high level of care at lower costs to the patient,” Prentice adds.

Cost comparisons of common procedures

Here are a few examples of the cost differences of procedures at ambulatory surgery centers and hospital outpatients departments, according to Medicare.gov:

How ASCs vs. hospitals bill

Ambulatory surgery centers and hospitals also have slightly different billing approaches, so it helps to understand these distinctions as they can affect the overall cost of your medical procedures.

Ambulatory surgery centers typically bill for procedures using a “bundled” facility fee approach that covers all related surgical services and supplies, but excludes the anesthesiologist and certain medical supplies.

The surgical services and supplies built into ASC facility fees include:

In contrast, hospitals often use a fee-for-service model in which each aspect of the procedure — such as room charges, professional fees and ancillary services — is billed separately. Hospital facility fees, in this case, refer to another fee that is added when patients receive care in an outpatient setting or clinic separate from the hospital campus.

This fee, which can cost anywhere from a few dollars to thousands of dollars, is becoming standard practice among hospital-based outpatient centers due to the growing trend of hospital systems acquiring more and more physician’s offices, leading to higher operational expenses and patients footing a more expensive bill. In fact, a study showed that the prices at hospital-acquired outpatient clinics increased an average of 14.1%.

As a result, the more streamlined billing approach at ambulatory surgery centers often makes these facilities more cost-effective for many patients.

Infection Rates

One advantage ambulatory surgery centers have over hospitals is their lower infection rates.

Hospital-acquired infections — including central line-associated bloodstream infections, catheter-associated urinary tract infections, pneumonia and surgical site infections — result from the various types of devices and procedures used to treat patients and pose serious risks to their health and safety. An abundance of research shows that the longer a patient stays in the hospital, the more likely they are to be exposed to infectious agents. As a result, this increases their risk of developing an infection in the health care setting, especially for those who have underlying comorbidities and require invasive procedures.

However, ambulatory surgery centers typically are able to keep their infection rates low, according to experts. This is because ambulatory surgery centers:

— Focus on outpatient procedures on healthy patients who do not have comorbidities or chronic health issues that may make them more susceptible to acquiring an infection

— Perform screening protocols prior to surgery

— Have smaller patient volumes compared to hospitals

— Typically discharge patients same day, allowing them to recover from surgery at home rather than in a health care facility

“The longer you stay in a hospital, the more likely you are to potentially come in contact with an infection or a patient who’s sick,” Prentice says. “The quicker you can get in and out of the health care setting reduces that risk.”

Patient Satisfaction

As if undergoing surgery weren’t nerve-wracking enough, having to navigate a large hospital can add to the anxiety. With countless buildings, corridors, units, floors and hallways, large hospitals are notorious for being complex mazes that can make it difficult and challenging to find your way around.

“We know that ASCs sometimes give a better patient experience because you aren’t having to go into the four walls of a hospital, which can be a little bit more daunting for a patient,” Holden says.

But it’s not just the physical building that’s an intricate labyrinth to navigate. Scheduling appointments and coordinating care with multiple departments or specialists can lead to confusion and delays due to limited availability. Staffing shortages of physicians, nurses and administrative personnel often cause longer wait times, so by the time a patient is seen, the process can feel rushed and impersonal.

Ambulatory surgery centers pride themselves on providing an improved patient experience. With easier scheduling, shorter wait times, faster procedures and more personalized care, it’s no wonder these facilities often achieve higher patient satisfaction rates among healthy patients.

According to the Centers for Medicare and Medicaid Service’s most recent Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare providers and Systems Survey, ambulatory surgery centers received top rating among 89.2% of patients, whereas hospitals received the same score among 85.7% of patients. In addition, patients’ rating of ambulatory surgery centers was 95.1% versus 93.9% at hospitals, and 87% patients would “definitely recommend” an ASC to family or friends, whereas 82.2% of patients would “definitely recommend” a hospital.

“At an ASC, we make everything simplified. Whereas at a hospital, everything is inundated and difficult to carry out the plan of action. Here, it’s simple,” says Megan McDougle, director of nursing at the San Francisco Surgery Center. “We really know our patients before they come out. Our preoperative phone call and getting their labs, EKGs and whatever we need to do happens before they come here. That’s because these are planned procedures, so we can plan and make sure everything is mitigated by the time they’re here.”

Prentice likens going to a hospital outpatient center versus an ambulatory surgery center to shopping at a big box department store versus a local, boutique shop.

“One of the things we chafe against in modern society is the fact that the institutions that we interact with … are getting bigger and more impersonal. We’re finding it harder and harder to actually get the customer service in the care that we used to expect,” Prentice says. “The benefits that one sees from being in that smaller store — that smaller environment where there’s more customer care — there’s more one-on-one interaction. That’s something that I think the surgery center brings to surgery that may not have existed previously.”

How to Choose

When deciding between having a procedure done at an ambulatory surgery center or a hospital, it’s important to first consult with your physician.

Here are a few factors you and your physician should consider:

Your health status. Ambulatory surgery centers are better suited for patients who are overall healthy with no comorbidities or serious health issues, whereas hospital outpatient centers are more appropriate for less healthy patients with morbid obesity, uncontrolled diabetes, heart disease or other chronic health concerns and may require additional resources and support.

The type and complexity of the procedure. Minimally invasive procedures that have a low risk of complications can generally be done at ambulatory surgery centers. However, hospitals are better equipped to handle more complex and invasive surgeries, especially if they require a multidisciplinary approach that involves other medical specialists.

“In a hospital setting, you’re going to have that full-tier team right there versus having the risk of being transferred and experiencing a delay in getting the care you may need if you do have a complication,” Holden says.

Anesthesia requirements. The type of anesthesia a patient needs can affect which setting your surgery takes place in. Procedures that only need local anesthesia or sedation may be better for an ambulatory surgery center, while those that require general anesthesia and extensive monitoring may be better off seeking treatment at a hospital.

Postoperative needs. If you require extensive postoperative monitoring and recovery by a care team because of your health condition and/or the complexity of the procedure, your physician will likely encourage you to have the procedure done in a hospital setting, where a full medical staff can keep you for observation. This helps avoid patients being readmitted to the hospital after being discharged.

Insurance and cost. Your health insurance plan‘s coverage and the associated costs at each type of facility can be a significant deciding factor. Many insurance plans, including Medicare and Medicaid, typically cover procedures at an ambulatory surgery center, but the amount of coverage and out-of-pocket costs may vary. For more detailed information about your specific plan and coverage, contact your health insurance provider.

If paying with an original Medicare plan, you can compare national average prices for ambulatory surgical centers and hospital outpatient departments online using the Medicare.gov’s Procedure Price Lookup tool.

Personal preference. With all the other factors in mind, it’s important to communicate your preference of outpatient setting with your physician when discussing your treatment plan.

“Marrying together the clinical knowledge of the surgeon with what the patient can afford to pay and what they want results in the patient being seen in the right setting at the right time,” Prentice says.

While ambulatory surgery centers are an attractive option because of their various advantages, it’s important to remember that these surgery centers are not a one-size-fits-all facility.

“It’s always best to make sure that you know exactly where the best place for your care needs to be based on your individualized needs,” Holden says. “Always consult with your physician while you’re deciding because you want to make sure that you have the right resources in place in the case you need them.”

Bottom Line

Ambulatory surgery centers and hospital-based outpatient departments both provide high-quality care, but they differ in the procedures they perform, patients they treat, cost, infection rates and patient satisfaction.

“In the small area of health care that surgery centers exist in, we provide a good example that there are ways to build on efficiencies without compromising patient comfort, patient safety and good outcomes,” Prentice says.

Ultimately, whether you have a procedure done at an ambulatory surgery center or hospital outpatient department depends on several factors — including your health status, the type and severity of the procedure and your risk of complications — that you and your physician should discuss together.

More from U.S. News

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What Is an Ambulatory Surgery Center, ASC? originally appeared on usnews.com

Update 01/27/25: This story was published at an earlier date and has been updated with new information.

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