Ambulatory surgery centers are often considered low-cost alternatives to expensive in-hospital care, but a new report from Kaiser Health News and USA Today raises questions about the safety of ASCs and the regulations that govern their practices.
Here are five things to know about the report.
1. The report claims the proliferation of increasingly complex surgeries at ASCs has shone a light on facilities' poor preparation for emergency scenarios. ASCs are required to have patient transfer agreements to local hospitals in the event of an emergency, complying with state and federal regulations. The report cited examples of patients who were transferred from ASCs in rural areas where hospitals were up to 30 miles away and were unable to access the emergency care needed.
2. ASCs are a surgical site option for elective procedures for patients who are good candidates for the outpatient setting, typically otherwise healthy patients without comorbidities. Not every patient is a good candidate for outpatient surgery; those with pre-existing conditions are better suited for the hospital.
Preexisting conditions can complicate even the most routine surgeries, and the report claims over 260 patients have died since 2013 after procedures at ASCs. Though federal regulations require ASCs keep resuscitation equipment on hand in case of emergencies, a number of the patient deaths detailed in the article took place in facilities that skirted these regulations. However, the Ambulatory Surgery Center Association issued a statement March 2 in response to the article, reporting more than 200 million successful procedures have been performed in ASCs across the country over the same five year period.
3. The report cites examples of patients who felt hurried out of ASCs and dying on the way home.
"The stories these reporters tell are indeed tragic and will no doubt be deeply concerning to readers. Unfortunately, the article fails to provide a comparison to other sites of care and make clear that medical errors occur across all sites of care, including hospitals, and typically at much higher rates than in ASCs," said Rebecca Craig, RN, MBA, the CEO of Fort Collins, Colo.-based Harmony Surgery Center and Peak Surgical Management.
4. In the third quarter of 2017, the most recent data available, the rate of all cause emergency department visits within one day of ASC discharge was 0.69 percent, according to statistics from ASC Quality.
5. Physicians are allowed to have ownership in ASCs, collecting a percentage of the facility fee for each case. The article's authors suggest this ownership may influence their decision to direct cases to the center , but the laws governing ASC referrals vary by state, with some states barring surgeon referrals to any ASC in which they or a family member maintain a financial interest.