The rise of the right-sized outpatient setting — A timeline of 25 key events

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The traditional, hospital-centric U.S. healthcare delivery system is being replaced with one where acute care is delivered in outpatient settings that better match the problem's scope and acuity, according to outpatient-focused consulting firm Avanza Healthcare Strategies.

This trend — which experts say will only be accelerated by the COVID-19 pandemic — began taking root decades ago. Avanza published a timeline of this progression toward a "right-sized" delivery model. Below are some highlights.

1966 — The American Medical Association promotes the virtues of outpatient surgery.

1970 — The nation's first freestanding ASC opens in Phoenix.

1971 — The AMA endorses outpatient surgery under general and local anesthesia for select patients and procedures.

1973 — The American Society of Anesthesiologists issues ASC guidelines.

1974 — The Federal Ambulatory Surgery Association is formed.

1975 — The Joint Commission establishes its ambulatory care accreditation program.

1978 — There are 58 freestanding emergency departments in the country.

1979 —Two important organizations are formed: the Accreditation Association for Ambulatory Health Care and the American Association of Ambulatory Surgery Centers.

1981 — Ninety-three percent of outpatient surgeries are performed in hospital-owned facilities.

1982 — Medicare approves payment to ASCs for 200 procedures.

1985 — The Society for Ambulatory Anesthesia is founded.

1986 — The average stay in a U.S. hospital costs $2,789.

1987 — Medicare approves payment to ASCs for 1,535 procedures.

1988 — The number of accredited and operational ASCs surpasses 1,000.

1995 —Medicare approves payment to ASCs for more than 2,000 procedures.

2000 — As the average cost of a hospital stay for U.S. patients reaches $17,390, the Medicare Outpatient Prospective System is established.

2005 — Hospital-owned facilities perform 45 percent of all outpatient surgeries.

2007 — Nearly 4 in 10 hospital visits in the U.S. are to the emergency department.

2008 — FASA and AAASC merge to form the Ambulatory Surgery Center Association. There are now 284 freestanding emergency departments in the U.S.

2010 — The average cost of a U.S. hospital stay is $33,079. The Patient Protection and Affordable Care Act is signed into law.

2011 — Medicare approves payment to ASCs for more than 3,500 procedures. The number of accredited and operational ASCs surpasses 5,000.

2013 — Ambulatory care center visits are up 300 percent since 2003.

2015 — MedPAC recommends that CMS create a value-based purchasing program for ASCs by the end of 2016.

2016 — MedPAC reiterates its previous recommendation that ASCs be directed to share cost data with CMS. Blue Cross Blue Shield of America publishes a study showing the substantial savings achieved by shifting elective procedures from inpatient to outpatient settings. ASCs become included in bundled payments, integrated practice units and accountable care organizations.

2018 — Fifty-nine percent of hospitals have an affiliation with or ownership of an ASC.

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