The landscape of healthcare delivery changes rapidly, and nowhere is this more evident than in the rise of Ambulatory Surgery Centers (ASCs). In Texas especially, ASCs are an increasingly popular choice for patients and their doctors, offering an ever-wider range of surgical procedures at costs usually lower than at hospitals. As the number and complexity of surgeries performed in these outpatient facilities grows, it is crucial to recognize that not all ASCs are created equal.
The Growth of Ambulatory Surgery Centers in Texas
Ambulatory Surgery Centers, often referred to as same-day or day surgery centers, are specialized outpatient facilities that provide surgical services to patients who do not require overnight hospital care. These centers have been on the rise since the first ASC opened in Phoenix, Arizona, in 1970. In Texas, the trend has been no different. According to the Texas Health & Human Services, there are currently 569 ASCs across the state, and that number that continues to grow.
The shift from hospital-based surgeries to ASCs is notable. In 2005, 59% of surgeries were still performed in hospitals, while 41% took place in ASCs or other outpatient facilities. By 2020, these figures became roughly reversed, with 60% of surgeries occurring in ASCs and offices, compared to just 40% in hospitals.
Not All ASCs Are Created Equal
While the rise of ASCs offers patients some benefits, including shorter hospital stays and lower costs, it’s important to recognize that not all ASCs operate at the same level of quality and safety. The disparity in quality among ASCs is likely greater than that among hospitals.
One potential reason: ASCs are not regulated and inspected the same as hospitals. The Texas Ambulatory Surgical Center Licensing Act, first enacted in 1985, sets forth certain standards for these centers, but there remain significant variations in how individual ASCs operate, particularly in areas like anesthesia administration, patient monitoring, and emergency preparedness. In addition, state regulators are often stretched thin and may not inspect ASCs as frequently as necessary, and many ASCs do not participate in Medicare, and therefore are not required to meet Medicare’s requirements. A 2019 report by the U.S. Department of Health and Human Services’ Office of the Inspector General found that 25% of ASCs who do not participate in Medicare had multiple serious deficiencies.
Also, ASCs generally lack the oversight of a larger hospital system. While hospitals are often required to meet strict staffing, training, and emergency equipment standards, ASCs have different legal requirements, and often far less personnel, structure and culture for oversight.
Finally, ASCs vary widely in their ownership structures, and many are owned entirely or partially by physicians. While this arrangement may provide some upsides for patients, it can also create conflicts of interest. Physician owners have a financial stake in referring patients to the ASC and in discharging patients early. ASC’s may as a result host overly complex surgeries, create complications that require emergency transfers to hospitals, or discharge patients prematurely.
The Things That We’ve Seen
At ASCs, we’ve seen: a patient be severely injured when she was dropped to the O.R. floor while fully sedated; a patient suffer an intraoperative bleed and not survive the lengthy transfer to a nearby hospital for the massive blood transfusion; a patient become septic from rampant infection caused by a specific pathogen frequently seen in outpatient cosmetic surgeries; a patient languish for hours in an ASC’s post-anesthesia care unit (PACU) until she finally went into hemorrhagic shock; a patient bypass the PACU entirely after a complicated operation and bleed to death shortly after arriving home; a patient suffer a severe blood clot and die after being discharged home from a hip surgery with no deep vein thrombosis (DVT) prevention medication.
One way we help prevent needless tragic events like these from happening is we hold ASCs and the health care providers practicing there accountable to those they injure.
Conclusion
The complexity and volume of surgical procedures performed in ASCs will no doubt continue to rise. But mechanisms for ensuring reasonably high patient safety standards in ASCs struggle to keep pace.
If you learn of someone who suffered medical negligence at an ambulatory surgical center, please call us. We can help.
