Pure chaos — What a world without ASCs would look like

ASCs have been an integral part of healthcare for the last 50 years, but what if tomorrow they all were ordered to close?

Becker's ASC Review sought out answers to the hypothetical doomsday question. Joan Dentler, president and CEO of Avanza Healthcare Strategies, was nice enough to entertain our request and laid out insightful, comprehensive answers to this thought exercise.

Note: Responses were edited for style and content.

Question: If ASCs had to close tomorrow, what would happen to healthcare?

Joan Dentler: This is difficult to fathom. After all, ASCs are now ingrained in our health system. There are roughly as many surgery centers as hospitals. Surgeons perform millions of procedures annually in ASCs. Surgery centers employ the equivalent of more than 100,000 full-time workers, and ASC case volume is on the rise as procedures continue migrating out of the inpatient setting.

If all ASCs suddenly closed, and they could not easily be converted to another type of surgical facility, there would be nothing short of chaos. In the immediate aftermath, surgeons would scramble to determine where they could perform procedures. Their offices would be overwhelmed with trying to find new sites for their patients' procedures.

Some procedures would be redirected to hospitals and hospital outpatient departments and some would go to office-based surgical practices. Surgeons would likely request more hospital privileges and operating room time and may explore opening office-based surgical practices of their own. The surgical schedules of these settings would fill up quickly, leaving a majority of patients and surgeons in the lurch. Those 100,000 full-time workers would be out of work.

Currently, there are many people who proceed with a surgical procedure they need because they can afford the cost of the procedure when the surgery is performed in an ASC. If they have to seek care in a more expensive setting, many may decide to delay the procedure or simply skip it all together resulting in an unhealthier and possibly less mobile population and workforce. This could have ripple effects across the economy.

Hospitals, insurance companies and the government would come under tremendous pressure to determine solutions to accommodate patients and surgeons. Suffice it to say, it would be a good time to be in the facility development business. Hospitals would work to fast-track the development of new surgical facilities or renovate existing space to accommodate surgical demand. Surgeons would work to fast-track the development of surgical practices. Development, [however], is not a fast process, even if fast-tracked. With every day that passed, the number of patients in need of a surgical procedure would grow.

At least some of the now-unemployed ASC workers — specifically those with strong clinical skills — would be scooped up quickly by hospitals, practices and other settings. But many would need to consider alternatives to the roles they were filling in ASCs.

Patients with the financial ability to leave the country would likely seek out surgical providers in other countries, with some U.S. surgeons also going abroad. But these would be few and far between.

Eventually, there would be enough new operating and procedure rooms in hospitals/HOPDs and office-based surgical practices to accommodate the available volume. How long that would take is impossible to estimate. It would be many years, at least. All of this does not consider how the public would react to learning that they may need to wait years for surgical care.

Q: How would the closure affect competition?

JD: Competition between hospitals and medical groups to hire surgeons and clinical staff and contract with consultants, architects, construction companies and engineers would be fierce. Competition between insurance companies would also ramp up, with the major players going aggressively after hospitals and medical groups that have the ability to rapidly grow and accommodate surgeons. One can also envision significant competition between private equity firms looking to make investments in all of the players — hospitals, medical groups, management firms and construction firms — to profit off of the high demand.

Q: What would happen to government initiatives to lower the cost of care?

JD: In the short term, one would think that the government would put value-based initiatives on hold and move entirely back to a fee-for-service model for surgical care. This might be preferable, as hospitals and medical groups would need as much time and energy to focus on developing new facilities and accommodating patients and surgeons quickly.

Q: How would patient care be affected?

JD: This is where the damage of all ASCs closing would be most felt. While procedures in ASCs are technically elective, that does not mean they are not time-sensitive. Delays in colonoscopies would lead to a surge in colorectal cancers. Delays in cataract and glaucoma surgery would lead to a surge in blindness. Delays in brachytherapy would contribute to the deaths of those with prostate cancer. Delays in spine procedures would result in more people in wheelchairs.

For most ASC specialties, you can easily find such examples of significant patient harm. Many people would experience a decline in their quality of life that could have been avoided had ASCs remained open. This would obviously impact employees' abilities to work and ultimately lead to increased unemployment.

In the short-term, panic would ensue. Emergency rooms and urgent care centers would be flooded with patients needing or desiring more immediate surgical attention. Considering these facilities would be unable to handle the rush, riots would likely break out. The fallout of all ASCs closing would undoubtedly lead to damage of immeasurable proportions.

Ms. Dentler can be reached for professional consulting services here.

More articles on surgery centers:
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Physician-owned eye group acquires California practice 

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