Sep 28, 2009
Ambulatory surgery centers (ASCs) have proliferated in the United States over the past 20 years. Their explosive growth concerns policymakers, especially in California, where ASC growth mirrors the national trend. RAND researchers examined how ASCs compare with hospital outpatient surgery departments in California and how California compares with other states in regulating ASCs.
Free-standing ambulatory surgery centers (ASCs) that offer same-day surgical procedures are becoming an increasingly important part of the health care infrastructure. ASCs have proliferated in the United States over the past 20 years: from 336 registered facilities in 1985 to 4,707 in 2006. Nationally, about 95 percent of ASCs are for-profit, and many are physician-owned.
Although ASCs offer more-convenient and cheaper services than hospital outpatient surgery departments, their explosive growth is generating concerns for policymakers. These concerns are particularly salient in California, where ASC growth mirrors the national trend: The 253 registered facilities in 1996 nearly doubled to 482 ten years later.
The California state legislature, during its 2007–2008 session, considered three bills that would change the way the state's ASCs are regulated. Although these bills were not enacted, the issue of regulation is expected to come up again in the future. To provide policymakers with needed data, the California Healthcare Foundation asked the RAND Corporation to examine how ASCs compare with hospital outpatient surgery departments in California and how the state compares with other states in regulating ASCs. This Research Brief summarizes the findings of the RAND study.
California is distinctive in licensing ASCs under a dual-track system:
RAND researchers assembled and analyzed a linked database of information covering 2005 and 2006 utilization and patient encounter data for both California ASCs and hospital outpatient surgery departments, with which ASCs compete. Key findings are highlighted below.
Patient Population. There were no large differences in race, sex, and ethnicity. However,
Procedures. The top six outpatient procedures are the same for ASCs and hospitals: three colonoscopy procedures, diagnostic endoscopy, cataract surgery, and pain management (spinal injection). However,
RAND researchers compared California's current approach to regulation with the approaches adopted by the 14 next-largest states and Medicare. These findings are summarized in the accompanying table.
|All states license ASCs, but requirements vary.||Quality regulation varies by state.|
|Inspection frequency||Is prior notice for inspection required?||Is accreditation related to licensing?||Implement quality-assessment or improvement programs?||Report encounter data to regulators?||Report quality indicators to regulators?|
|CA outpatient||As needed||Yes||Satisfies||No||No||No|
|CA surgical||As needed||No||No||No||Yes||No|
|New Jersey||As needed||No||Required||Yes||No||No|
|New York||By incident||No||Required||Yes||Yes||Yes|
|North Carolina||As needed||No||Satisfies||Yes||No||No|
a Prior notice not required, but timing must be reasonable.