Catholic Health Partners also believes that technological advances and an increase of minimally invasive procedures will lead to a migration to ambulatory settings, but that riskier procedures will not move to ASCs.
"We have criteria we will continue to follow to ensure safety in that regard," Messer says. "For example, an elderly person with a high risk of complications would still receive procedures in an inpatient setting."
Covert agrees that at Banner Surgery Centers risky procedures will not prematurely move to outpatient facilities.
"Banner Surgery Centers have carefully established the parameters surrounding which patients can access our services," he says. "Physicians and clinical leadership carefully risk-stratify cases in support of this."
For example, over the past 10 years Banner Surgery Centers have been able to safely manage higher-acuity patients. The organization started out not working with patients with a BMI higher than 35. Later, it increased the maximum BMI to 40. Now, they defer to their medical director and the surgeon about what is safe, often increasing the measure to 50.
"Having noted that, the screening process is critically important," Covert says. "Managing patients beyond our capability is not in the best interest of patients, and it would drive up our postsurgery hospital admission rates. Clearly, that is what we are trying to avoid."
Any migration of complicated procedures to an outpatient setting would ultimately be beneficial for patients, ASCs, and hospitals, Priest says.
"One of two things will happen," he says. "First, it will shift so we'll have more medical and nonsurgical patients [in the hospital] because across the country we're seeing the growth of admissions to the hospitals for patients with chronic illnesses. So there may be a shift to those complex medical patients being admitted and filling up beds of those surgical patients with lower acuity."
The second option is that medicine will evolve and develop a new procedure that will require hospitalization, Priest says.
"American medicine is good at solving patient problems," he says. "We'll figure out how to operate because people have a need. There will be a new complex procedure on the brain or a cancer procedure that will take up that backfill in the hospital. It will be more complex and will be something we didn't think we could do today."