Outpatient surgery brings care delivery innovation to patients

Outpatient care is one of the fastest growing spaces in U.S. healthcare. Ambulatory surgery centers (ASCs) are expected to perform around 70% of all surgical procedures over the next five years in response to technological advances, physician adoption, and payor interest in lower-cost cares sites, and shifting consumer preferences. ASCs are well-positioned to meet many of these needs. As ASCs continue to grow, it is a good time to take a closer look at the opportunities for ASCs and strategic considerations for the future of outpatient care. Here are five key trends in outpatient surgery that are driving changes to the healthcare ecosystem:

1. ASC Growth Proves Consumers are Shopping: Now, more than ever before, consumers are shopping around for the best healthcare options. Consumer research shows that the key factors that impact consumer preference for outpatient surgery include price and convenience. A recent study showed that price and travel time top consumers’ surgical care priorities: 53% cost of surgery; 10% travel time to hospital; 9.2% referrer’s recommendation; 5.5% location of follow-up visit; 4.0% quality of surgeon.1

2. Injured, Yet Otherwise Healthy Adults are Driving ASC Growth: ASCs typically provide elective surgery and procedures for patients with less complex surgical needs (so-called lower acuity), targeting younger and more active patients. ASCs enable providers to deliver the right care where it is most convenient to the patient. Many healthy adults, who have spent years running or doing high-impact exercise programs, are finding themselves with joint injuries. An analysis of the national trends found that between 2012 and 2015 there was a 47% increase in elective outpatient hip and knee procedures,2 and these numbers are projected to increase by 71% and 85% respectively in the next decade.3

3. Diversification in Ownership: Although the majority of ASCs are “physician owned,” many share equity stakes with hospital health systems, ASC management companies, and in some instances private equity firms. Health systems and hospitals will continue to play a critical role in healthcare, though their role will evolve. Many large health systems are actively building their own outpatient surgery centers in recognition of the benefits of outpatient surgery. As they grow in popularity, ASC ownership will continue to diversify.

4. Bringing Value Beyond Cost: As all players continue the shift to value-based payment, there is an increased focus on the multiple factors impacting value, from clinical outcomes and experience throughout the patient journey pre- and post-surgery to efficient supply management. These elements are even more important in the context of outpatient surgery.

5. Clinician Burnout Must be Addressed in ASCs: Beyond the Triple Aim, which is to deliver better patient care, reduced costs and an enhanced patient experience, the Quadruple AIM also incorporates the improved experience of providing care. In fact, a broad consideration for clinicians across healthcare settings is workplace burnout. According to a survey conducted by the Johnson & Johnson Medical Devices Companies, the Voices for Value Insight Series, conducted among health system executives and operating room clinicians, burnout is a concern among almost half (46%) of all clinicians (physicians and nurses) at large U.S. health systems.4 Only increased financial pressures (50%) rank higher as an area of concern among clinicians. It is increasingly important for ASCs to utilize tools to maintain a healthy workforce.

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Innovative solutions

The Johnson & Johnson Medical Devices Companies (JJMDC) are committed to bringing innovative solutions through the CareAdvantage approach to outpatient care sites as it aligns with the goals of value-based care to deliver the best care to the patient no matter where – inpatient or outpatient, health system or surgery center.

In one example, JJMDC worked with Excelsior Orthopaedics at Buffalo Surgery Center (BSC) to streamline outpatient joint replacement (OJR) delivering multiple benefits:

• The surgeon experience with outpatient joint surgery showed that an ASC can deliver exceptional outcomes with lower infection rates and fewer complications than hospitals, which have led to an increase in outpatient joint arthroplasty.5

• The costs of outpatient surgery and reimbursement were reduced: decreasing the top line reimbursement from $38,000 to $26,000 – a 32% savings.6

Furthermore, the patient experience is improved as patients don’t need to be admitted to hospital, have easier access to a local surgery centers and can leave to go back to their home and normal activities right after the procedure. At BSC, 99% of the patients treated stated they would return if they required further treatment.

While patients appreciate the convenience and affordability of ASCs, they also are embracing the fact that they must bear more responsibility for their own surgery preparation, rehabilitation and recovery. At BSC, tremendous emphasis is placed on patient education and care coordination throughout the entire episode of care. BSC also introduced the Digital Care Navigation capability, part of the Connected Health approach, to lead patients through their entire orthopedic joint replacement journey.

The hospital of the future

ASCs are well-positioned to meet multiple important needs, including, improved patient care, reduced costs, enhanced patient experience in an ambulatory care setting. Acute care and highly specialized units at hospitals will not be replaced by ASCs, but the hospital of the future will look different. They will likely become a network of entities connecting specialized, acute and intensive care centers with all levels of micro-hospitals, ASCs and primary care units utilizing digital and connected technologies that will help enhance the patient care journey. For patients, ASCs hold the promise of more choice, alternative care models, and the potential for enhanced cost and convenience.


1. Market Innovation Center (MIC). “Surgical Care Consumer Choice Survey.” Available at https://www.advisory.com/research/market-innovation-center/studies/2016/get-the-surgical-care-consumer-choice-survey-results [Requires MIC membership]

2. Dyrda L. “16 things to know about outpatient total joint replacements and ASCs.” Available at: https://www.beckersasc.com/asc-turnarounds-ideas-to-improve-performance/16-things-to-know-about-outpatient-total-joint-replacements-and-ascs.html

3. Projections of Primary and Revision Hip and Knee Arthroplasty in the United States from 2005-2030. Kurtz S, Ong K, Lau E. Mowa, F. Halpern M, The Journal of Bone and Joint Surgery, Apr. 1989 (4), 780-5.

4. Sloan M, Premkumar A, Sheth N. “Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030.” Available at: https://journals.lww.com/jbjsjournal/Abstract/2018/09050/Projected_Volume_of_Primary_Total_Joint.3.aspx

5. JJMDC Voices for Value Insight Series. Surveys were collected online between September 7-13, 2017, among 42 executives, including those director-level and above, and 50 clinicians, including both surgeons and operating room nurses, each from large health systems. The sampling margin of error is about ±10 percentage points for the total sample size (n=92). Available at: https://www.careadvantagejjmdc.com/voices-for-value/voices-for-value-insights-series

6. Stoeckl A, Violante N, Uba D. “Outpatient Joint Replacement and Achieving The Triple Aim.” Available at: http://go.beckershospitalreview.com/outpatient-joint-replacement-and-achieving-the-triple-aim


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