Use Research to Drive ASC Advocacy Studies find that patient outcomes at surgery centers are equal to or better than other sites of service BY ALEX TAIRA

Fact- and data-based studies that show ASCs provide high-quality and low-cost care make for a powerful tool to educate

legislators about the many benefits ASCs provide.

Research relating to ASCs takes a

variety of forms and can be leveraged to support increased migration of procedures to ASCs. Many studies examine a complex procedure, such as a total joint replacement or spine discectomy, and show that with good protocols the surgery can be performed safely in outpatient settings. Other studies look at a procedure or class of procedures and compare outcomes across sites of service, for example, post-surgery readmission or emergency department visits after the procedure is performed in an inpatient hospital, outpatient hospital or ASC setting. Other studies take a more economic approach and examine potential costs or savings associated with a certain site of service for a given group of procedures. The studies below back up ASCA’s

claims. For a list of regularly updated ASC-focused research, go to ASCA’s Advancing Surgical Care site at

Procedure-Focused Studies The most common form of research examines a single procedure or type of procedure and reviews its outcomes, such as safety, efficacy and patient satisfaction. This can allow the research to glean information about patient selection protocols, site of service recommendations or general procedure quality metrics. These types of studies often rely on data provided by a single surgeon or small group of surgeons, and

retrospectively examine a sample of patients over a given period time.

Outpatient and Inpatient Single-Level Cervical Total Disc Replacement: A Comparison of 30-Day Outcomes Published in SPINE, January 2019 This study from a research team at the Emory University Department of Orthopedic Surgery looked at patients who underwent a single type of sur- gery: single-level cervical total disc replacement (TDR) surgery. The study authors then compared 30-day post- operative outcomes such as complica- tion rate and reoperation rate between those patients who were treated as out- patients and those who were treated as inpatients. The authors found no dif- ference in any of the 30-day measures and offered the study as support that TDR can be performed safely in out- patient settings.

How it impacts ASC advocacy: As technology and surgical technique advance, more complex procedures are shifting from the inpatient to the outpatient space. Studies such as this are vital tools in showing patients and payers that these procedures can be

done safely on an outpatient basis. In regard to spine procedures specifically, a study published in PubMed in April 2009, “Trends and variations in cervi- cal spine surgery in the United States: Medicare beneficiaries, 1992 to 2005,” suggests that the volume of spinal pro- cedures has grown dramatically since 1990, likely the result of an aging popu- lation. According to another study pub- lished in Global Spine Journal in July 2014, “National Trends in Outpatient Surgical Treatment of Degenerative Cervical Spine Disease,” due to the development of better, minimally invasive surgical techniques, the proportion of such surgeries performed as outpatient has grown significantly as well. While this migration is encouraging for the outpatient surgery sector, patient safety remains paramount. Continually showing the safety and efficacy of complex procedures encourages payers and eligible patients that an outpatient site of service is a safe, cost-effective selection. Furthermore, the proliferation of research showing safe performance of outpatient spine procedures has directly translated to the Centers for Medicare & Medicaid Services (CMS) reimbursing for more of these procedures in hospital outpatient departments (HOPDs) and ASCs.

Site-of-Service-Focused Study A less common but equally or more useful category of study examines outcomes at ASCs specifically. These studies often focus on a specific procedure similar to the example above but are trying to reach conclusions about the ASC as a site of service rather than the procedure itself. These studies can be instrumental in showing that ASCs specifically achieve clinical and patient satisfaction outcomes on par or better than other care settings. The following


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