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5 david shapiro-ambulatory-surgery-centers-in-usa_ncas_2011
1. Ambulatory Surgery Centers
in the
United States of America
David Shapiro, MD
National Conference on Ambulatory Surgery
Bangalore
2. Dr. David Shapiro
Physician
Anesthesiologist (Specialization in Outpatient Anesthesia)
Florida Society of ASCs (FSASC) : Board Member
ASC Association (ASCA) : Chairman of the Board
ASC Quality Collaboration : Co -Chair
AAAHC : Surveyor
AORN ASC Administrator Course : Faculty
Certified Administrator Surgery Center (CASC) by the Board of Ambulatory Surgery
Certification
Certified in Health Care Quality and Management (CHCQM) by the American Board of
Quality Assurance & Utilization Review Physicians
Certified in Healthcare Compliance (CHC) by the American Hospital Association
Certified Professional in Healthcare Risk Management (CPHRM) by the Health Care
Compliance Board
Licensed in Healthcare Risk Management (LHRM) by the State of Florida
3. History of ASCs in the United States
Opened February 12, 1970 in Phoenix, Arizona
Founded by
Wally Reed, MD
John Ford, MD
Named “Surgicenter”
Originally 4 ORs
Now 6 ORs, 4 Endoscopy Suites
4. First sketch of Surgicenter
made on the back of a tent
table ad at Smuggler’s Inn
in Chicago in 1968.
5. John L. Ford, MD and Wally Reed, MD in the OR on Surgicenter’s opening day, February 12, 1970.
6.
7. ASC Timeline
Wallace Reed, MD, and John
Ford, MD, commit their idea for
a freestanding ambulatory
surgery facility to paper for the
first time and develop
objectives for the facility. They The Society of Freestanding
begin collecting endorsements Ambulatory Surgical Care
from the governmental bodies (ASCA’s original name) is
and members of the health incorporated during an ASC
care community to obtain seminar conducted in
financing for the project. Phoenix, Arizona.
1970 1975-1976
1968 1974
Reed and Ford’s idea becomes Rapid growth. A total of 42
reality when on February 12 surgery centers are in
Surgicenter, the nation’s first operation in the US by 1975
freestanding ambulatory and an additional 25
surgery facility, opens for facilities open in 1976.
business. Five physicians
perform five procedures at the
facility that day, four requiring
general anesthesia.
8. ASC Timeline
The industry continues to
grow, with the number of
ASCs reaching triple digits.
ASCA and others join together Medicare modifies the ASC
to form the Accreditation list to use specific CPT codes
Association for Ambulatory and expands the list to
Health Care (AAAHC). include 1,535 procedures.
1982 1988
1979 1987
Medicare approves payment The number of ASCs in the
to ASCs for approximately 200 US reaches 1,000. Using the
procedures, which are placed information from a 1986
in one of four payment groups cost survey of ASCs,
with payment rates between Medicare implements a new
$231 and $336, based upon a payment system, which
cost survey of 40 ASCs. remains the basis for ASC
payments today.
9. ASC Timeline
ASCs go international when
the International Association
for Ambulatory Surgery More than 5,300 ASCs exist
(IAAS) is founded during the in the US today, performing
1st International Congress on 23 million surgeries
Ambulatory Surgery in annually. Medicare has
Brussels. Medicare expands granted approval for ASCs
the ASC list to cover more to perform more than
than 2,000 procedures. 3,500 procedures.
2002
1995 2011
Seventy-eight individuals earn
the CASC credential, the first-
ever ASC-specific credential,
establishing the ASC
administrator as a separate
and distinct career from other
health care management and
clinical positions.
18. ASC Regulation
• Federal Regulation
Center for Medicare & Medicaid Services (CMS)
• State Regulation
Various State Health Department and/or Agencies
• Local Regulation
Primarily Building and Fire Code Compliance
Enforcement
19. CMS: Definition of an ASC
Effective May 18, 2009 -
“means any distinct entity that operates
exclusively for the purpose of providing
surgical services to patients not requiring
hospitalization and in which the expected
duration of services would not exceed 24 hours
following an admission.”
42 CFR 416.2 DEFINITIONS
20. CMS
• Defines ASCs in Federal Law
• Determines Payment Policies
– Allowable Procedures
– Applicable Rates
– Annual Updates
• Determines ASC’s Participation in Federal Programs
– Conditions of Coverage
-Infection Control Checklist
• Administer Quality Reporting Programs
21. ASC Accreditation
ASCs are Accredited by 4 different Organizations:
Accreditation Association for Ambulatory Health Care (~3,010)
Joint Commission (~637)
American Association for Accreditation of Ambulatory Surgical
Facilities
American Osteopathic Association
As of Spring 2011: Over 70% of ASC facilities in the U.S.
are accredited by one of these four organizations
28. Impact
Growth in Growth in
Outpatient Surgery Number of ASCs
12 12
Year-over-Year % Change
Year-over-Year % Change
10
8
8
4
6
0
4
-4
2
-8 0
1998 2000 2002 2004 2006 2008 2010 1998 2000 2002 2004 2006 2008 2010
29. ASC Future
ASCs: The Innovative Solution for Health Care
Access
Convenience
Provision of Critical Services
Cost
Efficiency
Transparency
Quality
Clinical Outcomes
Patient Satisfaction
30. Ambulatory Surgery Centers
in the
United States of America
David Shapiro, MD
National Conference on Ambulatory Surgery
Bangalore
