Surging Surgicenters

You don’t always need a hospital for surgery. Ambulatory surgery centers are increasing in the state—and increasing the benefit to doctors and patients.

Dr. Victor R. Kalman, an orthopedic surgeon, performs arthroscopic procedures at the surgery center at Glasgow Medical Center near Newark. Photograph by Tom NutterAn hour before he was scheduled to see patients at The Bayhealth Wound Care Center, Dr. Thomas P. Barnett was busy performing back-to-back procedures four blocks away at his surgery center at Eden Hill Medical Center in Dover.

The procedures—a breast biopsy and the drainage of a perirectal ulcer—went off without a hitch, so Barnett was able to start his hospital rounds promptly at 8 a.m.

Barnett credits the efficiency of the ambulatory surgery center with letting him maintain a schedule that can respond to a patient at a moment’s notice. “The one patient had come to see me the day before, and I put him on the schedule for the next morning,” says Barnett, one of 34 physicians who own the Delaware Surgery Center. “I never could have done that at the hospital.”

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Ambulatory surgery centers have become the preferred choice of doctors for outpatient surgeries. Since the first one opened in 1970, they have emerged as a national healthcare phenomenon. Today about 22 million procedures are performed each year at more than 5,000 facilities across the United States. They’ve increased in Delaware, as well. Advances in surgical techniques and anesthesia have helped drive the growth.

“Thirty years ago patients were admitted to the hospital for a colonoscopy, and it was a one- or two-day procedure,” says Dr. Harry J. Anagnostakos, a gastroenterologist who last year sold his endoscopy center to Beebe Medical Center in Lewes. “Now patients are in and out in an hour and a half.”

Surgeons are attracted to ambulatory surgery centers because they better allow them to control their time and working environment. Twenty-two of the 24 free-standing surgery centers in Delaware are physician-owned.

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But even physicians who do not have a financial interest in a facility appreciate the benefits. “They’re smaller, so you can get a lot more done there. There’s not a lot of red tape,” says Dr. Victor R. Kalman, an orthopedic surgeon who performs arthroscopic procedures at the surgery center at Glasgow Medical Center. “Because things move along so quickly, I can do more patient care.”

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Surgery centers also give doctors access to a top-notch staff dedicated to their subspecialty. “We don’t have evening and weekend hours, and that’s attractive to the experienced personnel who have worked in hospital settings,” says Dr. Alex B. Bodenstab of First State Orthopaedics in Newark. “That spills over into the care that we render patients.”

All of this makes for a more satisfying patient experience. Doctors report that patients who choose ambulatory surgery centers for outpatient care appreciate the easy parking, high staff morale and relaxed atmosphere.

“There’s less anxiety. The surgery centers are set up to be the antithesis of the hospital from a decorative standpoint, with warmer colors and a more patient-friendly environment,” says Anagnostakos.

In addition, experts note that ambulatory surgery centers are helping to put a brake on spiraling healthcare costs by doing routine same-day surgeries without the overhead and bureaucracy of a hospital.

Hospitals acknowledge that ambulatory surgery centers contain costs more easily. In fact, the savings to insurance companies can be passed on to the hospital in the form of lower insurance utilization rates, says Gary Shaw, vice president of operations for the northern division of Bayhealth Medical Center, a partner in the Dover Surgicenter.

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But he admits that ambulatory surgery centers draw considerable business from hospitals. “They’ve siphoned off a tremendous amount of volume from hospitals and, as a result, many hospitals have lost revenue, which is traditionally revenue that would be re-projected back into the community through maintenance or expansion of services that a community needs,” Shaw says.

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Wayne Smith is president and CEO of the Delaware Healthcare Association, which represents the state’s hospitals. Smith says such lost revenue could be a problem for Delaware because it does not have a public indigent hospital.

“One of the realities of ambulatory surgery centers is that they tend to take some of the easier and more routine procedures from hospitals, which tends to put a dent in hospital revenues,” he says.

Another criticism leveled at the centers is that they don’t provide as much charity care as hospitals. But surgery centers maintain that the data can be misleading. “If you look at hospital charity care, a higher proportion of it is in two areas: emergency care and maternity care,” says Kathy Bryant, president of the Ambulatory Surgery Center Association. “Neither of those things can we provide by regulation, even if we wanted to.”

In Delaware, hospitals and ambulatory surgery centers are required to devote 2 percent of their services to charity care.

Other concerns with ambulatory surgery centers is that they are not equipped to handle patient safety risks. Hospital trade groups also worry that more ambulatory surgery centers will morph into doctor-owned specialty hospitals. The trade groups are concerned that physicians will refer patients to their own surgery centers in the interest of higher profits.

The relationship between surgery centers and hospitals doesn’t have to be adversarial. Bryant says most of the tension occurs between the associations rather than at the local level.

Indeed, healthcare providers readily acknowledge a more symbiotic relationship. “Ambulatory surgery centers benefit in that they offer a different setting, another point of access, and choice for the patient and physician,” Shaw says.

Anagnostakos agrees. “Of course, there’s competition for the healthcare dollar, but, as a physician, my concern is one thing: caring for the patient. I think it’s perceived as adversarial, but in reality all we’re out to do is provide the best service to the patient as we possibly can.”

Rise of the Surgery Center

Since the first ambulatory surgery center opened in 1970, they’ve become commonplace, even here in Delaware.

  • Today about 22 million procedures are performed each year at more than 5,000 surgery centers across the United States.
  • Of all ambulatory surgery centers in the United States, doctors own part of 91 percent.
  • Twenty-two of the 24 free-standing surgery centers in Delaware are physician-owned.
  • A recent study found that 70 percent of the growth in ambulatory surgery centers from 2000 to 2007 is the result of moving procedures from hospital outpatient departments into the less expensive ambulatory surgery center setting.

Sources: Ambulatory Surgery Center Association, Delaware Department of Health and Human Services

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