Bringing the care to the people…and doing it for less! New research involving Hospital for Special Surgery and The Children’s Hospital of Philadelphia indicates that surgery at an ambulatory surgical center (ASC) could result in a cost savings of up to 43%.
“There was a savings in direct costs of 17 to 4%, depending on the procedure, when performed at an ambulatory surgery center rather than at a university hospital, ” says Peter D. Fabricant, M.D., M.P.H., in the December 1, 2016 news release. Dr. Fabricant is an orthopedic surgeon at the Hospital for Special Surgery and lead author of the study performed at The Children’s Hospital of Philadelphia. The savings, Dr. Fabricant explained, appear to be the result of more efficient usage of time and resources due to streamlined care processes at the ASC compared to those at the university hospital (UH) for the same bone and joint procedure.
“If orthopaedic practices gained access to an ASC for day surgery, they would be able to deliver the same care at a decreased cost, and improve patient satisfaction by offering the convenience of care location options, ” says Dr. Fabricant. “From the patient and family perspective, care closer to one’s home and family is of higher value. Hospital systems have started to respond by shifting resources into developing satellite centers.”
The authors say, “…patients with medically complex conditions are not eligible candidates for care in a satellite setting. The ASC in this study offered services/care performed close to people’s homes—which may not be available in all regions or practice settings—and requires less operational overhead than a UH often located in an urban setting.”
Dr. Fabricant commented to OTW, “This was my fellowship project at Children’s Hospital of Philadelphia. We were interested in quantifying costs and cost savings using direct calculations rather than previously used methodology of hospital charges and cost-to-charge ratios as surrogates. Those methods are known to be inherently inaccurate due to the nature of estimates that use population-level data rather than patient-level data. This novel study methodology may be used by other institutions to perform similar related research.”
“It has been known (or at least thought) that ASCs are more cost efficient but no one has quantified this effect. We were somewhat surprised to see how large of a savings in direct costs there were by doing comparable cases at the ASC.”
“By identifying unique encounter-level identifiers in an electronic medical record, future research may utilize the same methodology by linking clinical and accounting hospital databases in order to evaluate cost and cost savings of a study intervention.”
“In our study, neither the ASC nor the UH utilized an anesthesia ‘block room’ to perform regional anesthetic blocks in parallel with OR procedures to smooth and speed the transition between surgical cases. Therefore, although it did not contribute to any differences in cost savings observed in the current study, it remains an area of clinical and future research interest for improving efficiency and further decreasing the cost of providing care.”
