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AMBULATORY SURGERY: 48 million procedures U.S. total

Effect of the Great Recession on utilization

Another reason that ambulatory surgery visit estimates could have decreased and ambulatory surgery procedures remained steady, could be the deep economic recession that began in 2007.  By 2010, when NHAMCS began gathering ambulatory surgery data in both hospitals and [ambulatory surgery centers], the economy had not fully recovered. (p. 5)

The U.S. National Center for Health Statistics provides nationally representative estimates of the utilization of hospital-based ambulatory surgery and non-hospital-affiliated ambulatory surgery centers.  These statistics are based on a sample survey that is taken occasionally, not every year.  Statistics have been published recently for 2010.

Why has ambulatory surgery increased over the years?

  • Improvements in anesthesia/analgesia
  • Development of minimally invasive techniques
  • Medicare reimbursement changes

How many ambulatory surgery procedures in 2010?

  • 25.7 million (53 percent) in hospitals
  • 22.5 million (47 percent) in independent ambulatory surgery centers
  • 48.3 million (100 percent) total ambulatory surgery procedures

Who pays?

  • The primary payer is private insurance (51 percent of visits)
  • Next is Medicare (31 percent)

How long are ambulatory surgery visits [duration]?

  • 57 minutes (average operating room time)
  • 33 minutes (surgical time)
  • 70 minutes (postop time)
  • There are more granular data showing the difference between hospitals and independent ASCs for this measure

Source: Hall, M.J., and others. (2017, February 28). Ambulatory surgery data from hospitals and ambulatory surgery centers: United States, 2010. National Health Statistics Reports, 102.  Click here for free full text: https://www.cdc.gov/nchs/data/nhsr/nhsr102.pdf  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

Basics on Medicare Payment Systems by Provider Type

How Medicare calculates reimbursement rates for hospitals and other health facilities or services provided to Medicare patients can be complex.  The Medicare Payment Advisory Commission — MedPAC — has updated its Payment Basics series. The series provides a short overview for the different Medicare payment systems that will help in better understanding them. Here’s a list of what’s available in the series:

Source: Payment basics. Medicare Payment Advisory Commission, Oct. 17, 2014. http://www.medpac.gov/-documents-/payment-basics

Posted by AHA Resource Center (312) 422-2003, rc@aha.org


Number of Medicare-certified ambulatory surgery centers (ASCs)

  • 4,798  2007
  • 5,001  2008
  • 5,111   2009
  • 5,203  2010
  • 5,291  2011
  • 5,357  2012
  • 5,377  2013 (3rd quarter)

Over the period 2007 to 2012, the number of Medicare-certified ASCs grew by 12 percent overall, but a higher annual growth rate was seen in 2007 and 2008 than in more recent years, during which the growth rate has fallen to well under 2 percent per year.  MedPAC speculates that this may be due to many factors, including the economy, a major revision of the ASC payment system in 2008, saturation of the market, and an increased trend toward physician employment by hospitals.

Number of Operating Rooms in ASCs?  MedPAC reports average of 2.8 and a median of 2 ORs/ASC.  Last year, I called and found that MedPAC does not have the total count of ORs.  The analyst suggested multiplying the average by the total number of facilities.  So, here we go:

  • 5,377 ASCs in 3rd Quarter 2013 x 2.8 average ORs/facility =15,056 total ORs in ASCs.  But, since we’re estimating anyway, let’s round it to about 15,000  total ASC operating rooms currently in the US.

Procedures migrating from hospital outpatient setting to ASCs?  Trend has stalled.

Top types of procedures done in ASCs?  These make up about 50% of procedures (I believe this analysis is for Medicare beneficiaries only):

  1. Cataract with intraocular lens insert, 1 stage (this is the top procedure by a wide margin — 20 percent of volume)
  2. Upper GI endoscopy, biopsy
  3. Diagnostic colonoscopy
  4. Colonoscopy with biopsy
  5. After cataract laser surgery
  6. Lesion removal colonoscopy
  7. Injection spine: lumbar, sacral (caudal)

Source:  Ambulatory surgical center services, in: Medicare Payment Policy: Report to the Congress.  Washington, DC: MedPAC, 2014, Chapt. 5, pp 121-138.  Click here for full text free:  http://medpac.gov/documents/Mar14_EntireReport.pdf    Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

100 Surgery Center Benchmarks & Statistics to Know

Becker’s ASC Review has compiled 100 operational, revenue cycle, clinical, and growth benchmarks for ambulatory surgery centers. Among the benchmarks included are total operating expenses per OR, nurse hours per case, average number of cases per day, and more. The benchmarks cited come from these sources which you may want to contact for more context:

Source: Miller L. 100 surgery center benchmarks & statistics to know. Becker’s ASC Review, Oct. 7, 2013. http://www.beckersasc.com/lists/100-surgery-center-benchmarks-statistics-to-know.html

Posted by AHA Resource Center (312) 422-2050, rc@aha.org