The state of ASCs in California — 'Increasing cooperation rather than competition'

ASCs in California are thriving, with new development growing to meet demand of the state's population.

Here, Elizabeth LaBouyer, RN, executive director of the California Ambulatory Surgery Association, and Adela Simon, administrator at Carrillo Surgery Center in Santa Barbara, discussed the state of ASCs in California and where the industry is going in 2021.

Note: Responses were presented alphabetically and edited for style and content.

Question: How are ASCs in the state thriving, and what's in store for 2021?

Elizabeth LaBouyer: ASCs are well positioned for growth in 2021 and beyond. The COVID-19 pandemic accelerated the move away from large traditional hospital institutions, and expedited the move toward technology, telemedicine and ASCs. [Centers] showed how this approach to patient care can be safe, efficient and affordable. The pandemic has likely accelerated even further the level of consumer acceptance for ASCs based on their desire to avoid hospital settings.

There is no doubt that surgery centers have been facing incredible challenges over the last year with changing rules, business closures and lost revenue, but now they are working through a backlog of care and will rebound in the months ahead. ASCs will likely benefit from a lasting perception by both patients and physicians that ASCs don't pose the same risk of exposure to infection as a hospital setting.

We have seen increasing cooperation rather than competition between ASCs and hospitals as they had to communicate and plan patient care on a regional level while moving through the different phases of the pandemic. Moving forward this collaboration will continue to grow as hospital systems recognize that they can't afford to be left out of the ASC space and need to invest in or establish ASC partnerships.

Policy decisions are also helping drive growth for the industry. The CMS list of ASC-approved procedures has been growing rapidly in recent years as technological advancements and new pain management techniques have made it possible for more surgeries to be done safely in the outpatient setting. In California, there is now pending legislation to update state rules to allow a series of CMS-approved cardiac procedures to be performed in ASCs, which will present another area of opportunity for efficiently providing patient care in a more affordable setting. Overall, policymakers are focused on addressing healthcare affordability and increasing access to care, so we expect increasing recognition of the important role ASCs play in the healthcare system.

Adela Simon: We at Carrillo Surgery Center have a multidisciplinary team, including pain management, general orthopedics and spine surgery. As surgeries and other procedures move toward becoming less invasive, our proportionate cases that we do in an outpatient setting [have] gone way up.

Hospitals have been intermittently closed to elective surgeries due to COVID-19 issues. By performing surgeries at CSC, we have been able to take some of the burden off the local hospital, as well, and [have helped] patients [with their] spine problems.

One of the biggest changes we have seen has been with cervical artificial disc replacements. We now do almost all of our single-level and double-level cervical disc arthroplasties in our surgery center. In 2021, I think that cervical artificial disc replacements will become increasingly common in an ASC setting.

I think that patient satisfaction is also going to take on a more prominent role. It is very easy for most ASCs to compete with hospitals, and to provide a more favorable patient experience. In an ASC setting, such as we have at Carrillo Surgery Center, there is a designated team for procedures and surgeries, unlike in most hospitals. Patients can sense this cohesiveness, and I believe it makes them feel a lot more comfortable when faced with surgery or a procedure on their spine.

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