Ambulatory surgery center

An ambulatory surgery center can also known as outpatient surgery centers or same day surgery centers.

An ambulatory surgery center (ASC) is a health care facility that specializes in providing surgery, pain management and certain diagnostic (e.g., colonoscopy) services in an outpatient setting. Overall, the services provided can be generally called procedures. In simple terms ASC qualified procedures can be considered procedures that are more intensive than that done in the average doctors office but not so intensive as to require a hospital stay. An ambulatory surgery center and a specialty hospital often provide similar facilities and support similar type of procedures. The specialty hospital may provide the same procedures or slightly more complex procedures and the specialty hospital will often allow an overnight stay. Ambulatory surgery centers do not provide emergency services.

'Procedures' performed in surgery centers are broad in scope. In the 1980s and 1990s, many procedures that used to be performed exclusively in hospitals began taking place in ambulatory surgery centers as well. Many knee, shoulder, eye, and other surgeries are currently performed in ambulatory surgery centers. Some heart procedures are even taking place in certain ASCs. In the United States today, over 50% of Colonoscopy services are performed in ambulatory surgery centers.

The first ASC was established in Phoenix, Arizona in 1970 by two physicians who wanted to provide timely, convenient and comfortable surgical services to patients in their community, avoiding more impersonal venues like regular hospitals.

Ambulatory surgery centers rarely have a single owner. Physicians partners who perform surgeries in the center will often own a small part of the facility. A 1% or less ownership might be common, but percentages can vary considerably. Occasionally, a surgery center is entirely physician-owned. However, it is most common for development/management companies to own a percentage of center.

Some large healthcare companies own many types of medical facilities, including ambulatory surgery centers. The largest operator by revenue is Surgical Care Affiliates, which is the former surgery division of HealthSouth Corporation, with 141 centers in 35 states. United Surgical Partners International (USPI) manages 138 centers in the US, HCA manages 95. There are currently four publicly traded companies in the US who specialize in operating ASCs: NovaMed, AMSURG, and Symbion. There are also many privately held companies in the US who specialize in developing, managing and operating ASCs: Facility Development and Management.

In the United States, over six million surgeries a year are performed in over 4,000 ASCs. ASCs are in all 50 states and can be found throughout the world. In the US, most ASCs are licensed, certified by Medicare and accredited by one of the major health care accrediting organizations.

Although complications are very rare, ASCs are required by Medicare and the accreditation organizations to have a backup plan for transfer of patients to a hospital if the need arises.

Trade organizations of ASCs include the Federated Ambulatory Surgery Association (FASA) and American Association of Ambulatory Surgery Centers (AAASC).

Accreditation organizations are separate from the general trade organizations. Accreditation organizations for ASCs provide standards of medical care, record keeping, and auditing for ASCs. Some of the goals of these organizations include continuous improvement of medical care in surgery centers and providing an external organization the public can get information on overall operation of surgery centers. These accreditation organizations require members to receive periodic audits. These audits will come every one to three years, depending on the accreditation organization and the circumstances of the surgery center. In an audit, a team of auditors will come to the facility and examine the surgery center's medical records, written policies, and compliance with industry standards.

In 1996, California was the first state to require accreditation for all outpatient facilities that administer sedation or general anesthesia. Many other states have followed and require accreditation.