By Shakeel Ahmed, MD

“In this short Life

That only lasts an hour

How much – how little – is

Within our power.” —Emily Dickinson

Health care around the world faces an existential crisis. While the quality of medicine continues to improve, its cost remains unbridled and out of control. Better means more expensive, be it a drug or an imaging modality. The whole world is aware of this impending financial crisis, and heads are hunched together to find solutions. One of the most glaring aspects of financial waste is the dreaded facility fee for surgery. The monopoly of large health care systems worldwide has led to this perfect storm of mega-high surgical costs and lack of accountability. Yet, amid this doom and gloom, a powerful new force has been rearing its head in defiance: the outpatient surgery center. Owing to its substantial savings in cost and its safety profile, the ever-proliferating surgery center continues to flourish.

Having founded and operated the largest privately owned surgery center franchise in the Midwest USA, I can attest to the financial prowess of this entity. There’s a reason why an ambulatory surgery center (ASC) does well: it does things well!

The financial strategies of an ASC, or day surgery center as it is known in some parts of the world, are designed from the ground up—tailored for a win-win between the patient and the facility. Hospitals, on the other hand, are always playing catch-up with their physical plant (structure). As new technologies land on the medical landscape, the bigger, permanently entrenched hospitals must play a shell game, figuring out how to gain something new without losing too much of the old. (Where do you put a new MRI suite—where the ER is? Eat into the cafeteria?)

The large hospital’s bottom line isn’t straight but zigzags around the new technological realities that keep popping up. Playing catch-up is expensive because their bottom line—straight or otherwise—doesn’t start at the bottom but somewhere very inconvenient in the budget. In contrast, an ASC’s bottom line was set at the bottom during the architectural and construction phase; it is streamlined not only for growth but also for adapting to changes in technology. It’s a simple concept: when the foreseen plan of an ASC is, in fact, foreseen, the savings are built in. When the physical plan of a hospital is constantly blindsided, the expense is a surprise too, with trickle-down ramifications throughout the entire facility. And it’s a startling realization when costs at an ASC come in at half the cost of those at a hospital. Based on that, any case done in a hospital that could be done in an ASC is money wasted—usually at the patient’s expense (e.g., $10 for a Band-Aid®). If all such elective cases were done in ASCs, hundreds of billions of dollars could be saved annually in the country. Another way to look at it is to consider one of our country’s biggest black eyes—the recently forgiven student debt. If only elective orthopedic cases done in hospitals were done in ASCs, the savings would be equal to the amount needed to cover the forgiven debt. WOW. No partisan statements needed. The solution to fund that forgiven capital is right there for the taking.

Capitalism wins in the marketplace: Do the math!

When customers—be they clients, patients, subscribers, etc.—are pleased with their consumer experience, that experience’s popularity will rise to the top of the choices available to patients. In this vein, consider what an ASC offers. The reduced costs involved in doing “business” will be realized by the patient through reduced co-pays and/or deductibles. Also, since the ASC is a procedure-driven construct, procedures fit into a groove of fiscally designed interaction between ASC and patient. (Band-Aids® come with the procedures!)

The numbers speak volumes. Using the USA as the yardstick for these measurements, but extrapolating them to any geography, a simple colonoscopy can routinely cost $5,000 in a large hospital and as little as $400 in an ASC. Knee surgery can drop from $20,000 to $2,000, and cataract surgery from $4,000 to $1,500. Patients’ deductibles and co-pays are 75 percent less at a surgery center. Add that to the total savings, and the discussion can go on and on …

In addition to savings realized by patients, convenience is the other half of the capitalism formula. As consumers in a free enterprise society, we want value (in cost reduction or cost savings) and we want ease. And it is true that time is money. Convenience = ease. It has been said that the ASC offers twice the convenience of a hospital: e.g., parking, scheduling, pre-op, efficiency, etc.

Value + Convenience is directly proportional to the popularity of any product or service.

(V + C) ∝ P

An ASC succeeds in this formula every day, with every procedure, every minute, and every dollar.

Patients aren’t the only ones who benefit

Physicians who use ASCs also benefit in many ways. Scheduling is usually a kinder, friendlier experience, with the availability and quick turnover of cases that an ASC offers. Imagine a surgeon performing two to three cases on their surgery day at a hospital, starting on time at the mercy of the emergency room. Emergency surgeries, of course, take priority, but they can bump the surgeon’s elective cases for an unpredictable amount of time. In fact, it happens that elective cases are canceled altogether if emergencies dominate the hospital surgery area. Now, imagine that same doctor able to perform four to six cases in one day. This reduces any backlog of scheduled surgeries in the office, making it run more smoothly and efficiently for the patient who has taken off work to see the doctor.

The physical logistics are also friendlier for the physician. Hospitals are usually in urban areas, presenting traffic impediments to the physician’s time, whereas they can usually count on a convenient arrival at the ASC, walking in minutes before the case and leaving minutes after, provided it is safe to do so.

Another advantage for the physician is that they often have some ownership interest in the ASC, which encourages them to ensure it runs smoothly—an experience visible to the patient. Embracing ASC efficiency not only protects a physician’s investment but also improves the full spectrum of experiences, from doctor to patient. An owner, as a prudent administrator for their investment, makes for a better facility, thus a better patient experience.

And the winner is …

Everyone.

The patient, the physician, and the nation as a whole benefit financially. The support staff and clerical workers benefit by the fulfillment of being able to do their work efficiently and well, with tangible results seen one patient at a time by the end of each day. In the personalized care that an ASC provides, pride in one’s work gains traction, and its results are visible. The economy of scale benefits everyone involved with a more robust economy. When inefficiency dominates, things can bog down and break; when business runs smoothly, it creates room for more of the same on the thoroughfare of efficiency.

Conclusion

An ambulatory surgery center is designed from the ground up for savings, convenience, and efficiency. For every elective surgery that could be done at an ASC but is instead done at a hospital, money is wasted, impacting the economy from the patient’s wallet to the nation’s economy. These are not small numbers, so everyone can help save the economy by choosing an ASC when appropriate—the patient, the physician, and even the third-party payer. The bonus, thanks to competition and capitalism, is a friendly, personalized, and pleasant experience.

“In order to change the world, you have to get your head together first.”

—Jimi Hendrix

Shakeel Ahmed is a gastroenterologist.