By Chris Richardson, Client Executive
The number of ambulatory surgical centers (ASC) is increasing exponentially as providers and payers work to reduce the costs of healthcare. According to a recent report, more than half of outpatient procedures were performed in an ASC in 2017, up from 32% in 2005. And that percentage is just going to continue to grow.
Several factors contribute to growth in outpatient surgery and ASCs. Providers acknowledge that the current reimbursement advantage they have for procedures performed in an outpatient setting within, attached to, or near a hospital will be eliminated in the next few years and all procedures will be reimbursed at a level at or close to what is paid to a freestanding ASC. This promises to continue the trend of moving procedures to a lower cost setting. Also, Centers for Medicare and Medicaid Services (CMS) and other providers continue to expand the type of procedures and the complexity/acuity that can be performed in an outpatient setting.
Traditional planning for ASCs has been based around the concept that
the procedures are less invasive and require less care during recovery. But as
surgical procedures done in an outpatient setting become more invasive,
planning and design need to be adjusted to accommodate the variety of
procedures that will be performed.
Physicians want to maximize their productive surgery time, but it can come at a cost of other staff, supplies, and additional space. Engaging a planner who can design the optimal process that balances these concerns will allow the facility provider a better chance of maximizing their return.
Surgical prep and recovery protocols, scheduling, and turnaround time all have major implications on the relationship between the different zones and areas for the facility. Along with current state and national standards, they will drive the optimal quantity of preparation spaces, potential need for dedicated spaces for anesthesia blocks, post-anesthesia (PACU), and stage 2/advanced recovery areas. A planner with good operational modeling capabilities can help the facility provider balance the facility costs with staff and physician efficiency.
Technology’s impact to the surgical department has exploded, including the use of minimally invasive surgical techniques using scopes, robotic surgery, and intraoperative imaging. In addition to integrating these with room controls and layout, intraoperative video and sometimes audio require substantially more computer/data and low-voltage support. It isn’t unusual to need a server rack for each operating room that should be housed in a space that is close and accessible for maintenance without entering the OR. As surgical procedures continue to migrate to outpatient settings technology support and the resulting spatial and building infrastructure needs will become increasingly important in both outpatient and inpatient settings.
It’s increasingly important that the planner/designer of an outpatient surgery department or ASC understand and incorporate flexibility into planning. This includes not only the ability to grow clinical and patient support without interrupting operations but also allowing for flexibility between prep and recovery from time of day and day-to-day to manage the fluctuation in volumes and demand. It also includes understanding how to anticipate the new requirements for types of surgical cases that may be moving to an outpatient setting in the future.
Remember the Patient
The focus on patient comfort, satisfaction, and ultimately affordability will continue to increase. Many patients are primarily focused on the quality of their surgical staff. At the same time, they are quick to let the surgeon know how well, or poorly, they perceived their overall experience, and that drives many surgeons’ expectations as well. Patients expect ease of access for the procedure, convenient parking, a discrete pick-up after the procedure, and comfort for the patient and family member/caregiver throughout the experience. At the same time many patients and family members are sensitive to the impression of excesses on the part of staff and facility.
The planning/design of the operations and facility must encourage and help the clinical and support staff provide a positive experience. Much has been written about patient-focused care and evidence-based design. The true implications are substantial because almost every visit and procedure is followed with a request for the patient to complete a survey. The survey results are compiled into patient satisfaction scores that are used to determine the amount a provider is paid for their services.
Outpatient surgical and ASC planning and design continues to be dynamic in its growth, development, and needs. Involving an experienced team for planning and design is important in a facility’s future success. The team should include members who have not only good understanding of current practices and technology but insight into future trends and technology. They also need the skills to work with the provider’s team members, challenging them to think beyond their current methods and practices and balancing the multiple perspectives and needs of those who will work in and experience the facility.
 2018 Ambulatory Surgery Center Market Report. https://www.researchandmarkets.com/research/644v8f/2018_ambulatory?w=4.