Ambulatory Surgery Centers are Multiplying, but so Are Mortality Rates
The number of ambulatory surgery centers is rising steadily, but so is the patient mortality rate.
Ambulatory surgery centers offer a less costly healthcare delivery model and are a source of revenue. But they are also bureaucracies rife with office politics.
Hospital operating rooms are busy, overcrowded and the cost of care is very expensive. Also, the privileging process for physicians is very rigid.
For decades hospitals have been a battleground of office politics.
Ambulatory surgery centers have a forward-looking business model and can be liberated from these petty politics. Depending on their size and structure, they can be more flexible.
The Need for Better Risk Assessment
ASCs offer less immediate access to emergency medicine, and that is a concern. But with better perioperative risk assessment and patient selection, there is less need for extreme acute settings and emergency medicine.
The management of ASCs boils down to carful patient selection and preventative measures.
Managing these centers requires thorough knowledge of complications experienced by populations of patients and individual patients. They require clinical expertise, administrative expertise and compliance expertise.
ASCs require a multidisciplinary approach to ensure patient safety. Although most centers are well-covered in respect to the above, some are walking on thin ice and are far from the comp line, especially in the face of ever increasing government mandates and requirements.
Another slippery slope they face is finding peers to defend in court against the “hospital mafia.” This is an exceptionally difficult task. The war between monpolisitic hospital chains and ASCs is a real one.
Some ambulatory surgery center facilities are run and owned by physicians, but some are non-healthcare-provider owned. But physicians most of the time are blamed if something goes wrong, even though the facility might be owned and operated by non-health provider who has no idea what healthcare is all about.
In majority of the states not every ambulatory surgery required to be accredited, and the rationale behind accreditation is to keep the patient safe.
But we have seen that bureaucracy always tends to turn a blind eye to reality. The government mandates must be backed by community support and vigilance to be balanced with reality. Unfortunately, when there are too many mandates the facility owners sometimes take shortcuts to satisfy rules and regulations and surveys.
Making accreditation mandatory has not solved the issue of complications in ambulatory surgery centers. Too many patients are still dying.
Some factors to consider in increased mortality include
· Quickly increasing government mandates
· Lack of staff training
· Lack of appropriate protocols
· Falling short of implementing protocols,
· Lack of risk-stratification protocol
· Financial gain
· Lack of resources
Who is to blame?
Accountability is a very important component of the quality assurance process. Accountability should not be just based on organizational performance but also based on individual performance.
Accountability and quality insurance must be a continuous process.
The problem with ambulatory surgery centers is just the tip of the iceberg
Proponents of hospital-based surgery centers will certainly argue that other surgery centers are not safe.
But more mandates and more regulations will lead to higher costs and make it harder to compete with hospital-based systems.
It is crucially important to find a structured solution to the problems, because ambulatory surgery centers need to stay in business.
What Does the Solution Look Like?
o Structured monitoring
o continuous feedback
o corrective action plan
Providing care at an affordable cost is essential to their survival.
Facility accreditation requirements must be addressed and completed only during periods of survey and audit. But what is happening between those periods is too often unaccounted for.
Assigning blame for problems depends on the organizational structure and individual responsibilities within that system.
The solutions for today’s ASC issues are not the ones created few decades ago. New problems requires new thinking and new approaches.
Physicians need training, and they need to be in charge. Risk stratification and triage are among the most important issues, and require new strategies and new technologies to manage,