Hospitals are ending services — here's how 'the ASC industry is reshaping itself'

While hospitals continue to close service lines, a window of opportunity appears to be opening for ASCs.

Leopoldo Rodriguez, MD, chair of the American Society of Anesthesiologists' committee on ambulatory surgical care, connected with Becker's to discuss how ASCs are affected by hospitals closing service lines.

Note: This response has been lightly edited for length and clarity.

Dr. Leopoldo Rodriguez: Hospitals are closing some service lines due to a lack of staffing, supply chain problems or lack of profitability. So hospitals must concentrate resources on lines of service they have an advantage on, for example, high-level spine surgery, neurosurgery, vascular, cardiovascular surgery, electrophysiologic labs and robotic surgery, which may be too costly for ASCs. Patients still need the procedure performed. 

This is not a problem; it is an opportunity for growth. The ASC industry is reshaping itself. As private entities, ASCs will choose profitable procedures and engage those service lines.

For example, gastroenterology in a hospital is not an efficient service line. The service is offered for GI bleeders, but a hospital can't usually perform at the same velocity and high quality that an ambulatory surgery center can perform elective gastroenterology services because in the ASC there are no emergency cases bumping the schedule, which makes it undesirable for a gastroenterologist.

Another great example is urology procedures; hospital operations are less efficient than an ASC performing [extracorporeal shock wave lithotripsy], cystoscopies, ureteroscopy, stenting and even new minimally invasive prostatic procedures.

Invasive cardiology procedures are flocking to outpatient cardiac catheterization labs as the CMS inpatient-only list changes.

As procedures change facilities, anesthesiologists remain the best-qualified physician to lead and help ASCs select patients and procedures appropriate to ASCs. The goal is to prevent complications, transfer to a higher level of care, improve outcomes using evidence-based medicine, decrease the number of hospital visits after discharge, and increase patient satisfaction by implementing advanced regional anesthesia and continue developing enhanced recovery protocols.

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