Ambulatory Surgery: Choosing a Facility
If you need surgery in 2018, chances are increasing, that it will be done as an outpatient. The latest report from the federal government estimated nearly 29 million visits were made for ambulatory surgery in 2010 (National Health Statistics Report #102, 2017). This compares to just over 7 million visits for hospital inpatient surgery (2014 data from the Healthcare Cost and Utilization Project). Some common procedures like cataract and lens insertion are almost exclusively done on an outpatient basis.
When considering outpatient surgery, consumers may explore options at an area hospital as well as a freestanding ambulatory surgery center. Your primary care doctor and surgeon will likely make recommendations. Here are four additional considerations when exploring where to have your surgery performed.
- Cost and Volume. Many people assume the freestanding ambulatory surgery center is the least expensive way to go. That may be true, or not. When I recently checked prices for outpatient cataract surgery for a 65-year old in the Fort Lauderdale area, the most expensive places were the hospitals. By thousands of dollars. The hospital-based surgery centers started at $11,438 (April 2016 to March 2017), whereas the freestanding surgery centers listed prices as low as $1850. The least expensive place also had the second highest volume in the area.Then I checked the tonsillectomy prices for a 17-year old. As before, three hospitals were the most expensive, with prices starting at $15,000. The lowest price listed was a freestanding surgery center at under $4000. But not all freestanding ambulatory surgery centers were so low – two showed prices in the $12,000 to $13,000 range. Their prices were more expensive than two hospitals who were doing the surgery for as low as $8000 to 10,000. One of the mid-priced hospitals had a relatively high visit count (379) for Tonsil and Adenoid Procedures; the cheapest surgery center did just 88 procedures. In the Fort Lauderdale area, the places who did at least 200 tonsil procedures that year, were all hospitals.
- Quality. Factors like your surgeon’s and anesthesiologist’s experience, volume of procedures performed on a regular basis, accreditation, state inspection reports and patients’ assessments of quality can be important to consider when choosing where to have your surgery. Accreditation and inspection results should be easy to find, although some states are better at making it easy. Florida, for example, includes a notation as to whether the surgery center is accredited or not. They also provide a link to inspection reports and findings that led to citations or fines. Their website applies to both hospitals and freestanding surgery centers.Consumers will also want to be honest about their own risk factors. Are they otherwise in great health, or do they have conditions that might make them higher risk, and therefore potentially need to rely on the hospital back-up systems? Consumers should expect that freestanding surgery centers have emergency procedures in place to transfer patients to a hospital, if the need arises. However, ambulatory surgery expects that patients will be discharged directly home. A question to ask is – how often does the center transfer a patient to the hospital? Overall, about 3% of outpatient surgery cases get admitted to a hospital, sent to the emergency department or discharged to another recovery care facility. A high number might indicate they have too many emergencies.
- Convenience. A freestanding ambulatory surgery center will almost always score higher on the convenience meter. Parking is simpler. Distance to the check-in desk might be shorter. Staff often work at making you feel welcomed and reassured, since they fully realize you have a choice in where to get care. But consumers shouldn’t take convenience for granted. As hospitals have recognized the need to compete on consumer-friendly service, many have developed amenities. These might include free valet parking, specials in the cafeteria, and good browsing in the gift shop while waiting for the patient to come out of surgery.
- For-Profit or Not-for-profit Status. If all things above were equal – although they probably won’t be – here’s one more factor to consider. Is the organization that owns the surgery center for-profit or not-for-profit? The reason this can make a difference is that non-profit hospitals need to have some volume of profit-making services – like surgery – to offset some of the services they offer that do not make money. Such as offering charity care to people who can’t afford it. Or running an ER and back-up diagnostic services 24 hours a day including holidays, just in case you need it. If the surgery center is owned by local doctors, does the business give substantial charitable donations to the community? By no means should this factor override quality considerations, but choosing a nonprofit hospital, or a community-minded surgery center, may be a way to support your local community.
For more information and to check your ambulatory surgery costs, see: