How About Reporting the Good News About Ambulatory Surgery Next Time?

Glenn A. deBrueys, CEO, of American SurgiSite Centers responds to USA Today article "How a push to cut costs and boost profits at surgery centers led to a trail of death,” USA Today, March 2, 2018 Written by C. Jewett and M. Alesia

Dear Ms. Jewett and Mr. Alesia;

No surgery ought to be considered simple, least of all spine surgery. There are some surgeries however which are less invasive, and therefore provide the patient with a lower risk of complication than other types of surgeries. Before I respond to specifics in your article, I wish to make a few points in general about outpatient surgery centers.

During the past 30 years, outpatient surgery has become an increasingly important part of medical care in the US The number of outpatient procedures has risen at a rapid rate since 1981. The majority of surgeries performed in the US now take place in an ambulatory surgery center (ASC).

ASCs provide the patient, the insurance company, and the Federal Government tremendous savings because of the high percentage of patients insured by Medicare. ASCs offer a lower-cost alternative when compared to hospitals as a venue.

This cost reduction is driven by the fact that ASCs’ reimbursements are significantly lower than hospital outpatient departments (HOPDs). ASCs leverage the advantage for lower prices from vendors.

As surgical volume has moved from the hospital to the ASC setting, efficiencies and economies of scale have had a positive impact on direct costs, which benefits the insured. Patients have lower payments for deductibles and unpaid balances.

For years the value of the ASC seemed lost on the hospital. However in recent years, hospitals have come to recognize their these facts. . According to statistics, in 2012 in 28 states, 14.4 million visits involved invasive therapeutic surgeries. Over half of the visits (53.1%) occurred in HOPDs.(hospital ambulatory setting). “Nearly all of the hospital based surgical procedures related to the eye (98.8%) and ear (91.5%) were outpatient.”

The patient has benefitted both financially and statistically from the specialized environment afforded by the growth in ambulatory surgery centers. Standardization and the creation of repeated processes, account for perhaps the most critical element for any type of surgical procedure in a care-delivery system.

Care and cleaning of the equipment, when equipment is highly utilized, results in lower rates of breakdowns and infections. With respect to infections, patients and family members are not exposed to the same high level of germs, viruses and bacteria that are more prevalent in the hospital environment. Infection rates in the ASC are a fraction of those for the same types of surgeries performed in the hospital environment.

Your article mentions 260 deaths in surgery centers across the country since 2012. It would be less sensational and more informative if you were to give the total number of procedures performed in ASCs. How about comparing those figures to the death rates as a percentage of the number of procedures performed in the HOPD environment?

According to ASCA, more than 200 million procedures have been performed over the last five years in ASCs. By your own statistic, the death rate is approximately one person, per year, per state. This seems low to me. In 30 years of operating, on average, eight surgery centers a year, and performing, on average, approximately 50,000 ophthalmic procedures a year, thank goodness we have only one death to report. One death is too many.

The year was 2009. The cause was a natural death. Fortunately, it was not a system or human error on our part, but it was an event that none of us who knew about it will ever forget.

As your article points out, we are required to transfer a patient to a local hospital when a life-threatening incident occurs. Our staff is trained to carry out the protocols as planned. For the record, our ASCs perform between 80 to 200 surgeries a week. In an average year, we will have to call for EMT support once a year. Before the EMT support arrives, our Board-Certified anesthesiologists have already stabilized the patient and as a matter of routine, the patient is then safely transported to a local hospital, typically within a five-mile radius.

There is much more in your article that I would like to respond to, however time does not permit. To date, our company has performed just under one million cataract procedures, and our surveys tell us that we enjoy a 95.6% satisfaction rate from our patients. We have saved the Federal Government an estimated $1.6 million dollars during that time, and our surgeon complication rate is under one percent.