Ambulatory Surgery Centers: The Urgent Need Of Our Time

“Do the right thing, because it’s the right thing to do.”

-Immanuel Kant

The field of outpatient surgery is an art. Surgical medicine, the great science of modern-day patient care, gave birth to this art around half a century ago. Until the mid-20th century, surgery was confined to hospital corridors. Performing a sedated procedure outside a hospital was once considered sacrilege.

Two brave anesthesiologists brought a paradigm shift by opening the first outpatient center in the late 1960s, creating the Ambulatory Surgery Center (ASC). Fast forward fifty years, and the ASC is the fastest growing component of modern medicine in the United States. Having spent the last 25 years building and running outpatient surgery centers in the Midwest, I can say with conviction that moving elective surgeries into outpatient settings isn’t just financially sound, it’s ethically right.

Global Financial Reality 

The United States, Europe, and the rest of the developed world face an existential crisis in the form of increasing healthcare costs and debt. The U.S. has the highest healthcare costs in the world, with one-third of its GDP spent on healthcare, much of it driven by hospital facility fees. Policymakers and providers alike are searching for ways to relieve future generations of this unsustainable burden. One solution already exists: the shift to ambulatory surgery centers (ASCs).

Despite strong resistance from hospital lobbies, ASCs continue to expand rapidly. Around the world, ASC associations are collaborating to introduce the model in markets that previously had little awareness of its potential. Even surgeons who once hesitated at the idea of performing anesthesia-supported procedures outside traditional hospital settings are now embracing the shift with growing enthusiasm.

Across Europe and Africa, nations are tentatively stepping into the world of outpatient surgery, testing the waters with understandable hesitation. Yet that initial apprehension fades quickly, as the data make clear: in OECD countries, for example, same-day admissions now account for 90% or more of all cataract surgeries in roughly three-quarters of the countries with available data. Meanwhile, the European ASC market generated US $54.7 billion in revenue in 2023, and is projected to grow to around US $83.1 billion by 2030, a compound annual growth rate (CAGR) of about 6.1%.

This surge underscores the inherent strength of the outpatient surgery model, despite the loud moralizing from hospital-executive suites opposing it. Innovation doesn’t stay bottled up. Coal miners of yesterday learned that. Carriage drivers of yesteryear learned it. Hospital administrators are learning it today.

The Fiscal Wake-Up Call

The U.S. national debt has ballooned to over $35 trillion, a staggering figure that underscores how fragile our economic foundation has become. In the wake of COVID-19, the most devastating global pandemic of our time, we have witnessed financial insecurity and loss on an unprecedented scale. Millions of lives were lost, and trillions of dollars were spent to keep the economy afloat. The result is a fiscal burden so enormous that it now threatens to choke future innovation in healthcare and infrastructure while saddling future generations with this crushing debt.

Why Outpatient Surgery Matters

Some may view my argument as the self-serving case of an ASC industry executive. To that I say, the data speak for themselves. Nearly two-thirds of all bankruptcies in the United States are attributed to medical bills, and three-quarters of those individuals had health insurance when they fell ill.

In this context, ASCs stand out as a rare beacon of medical efficiency. Medicare payment data show that ASCs reduced program costs by $4.2 billion in 2018, with projected savings of $12 billion by 2028. If just half of routine joint replacements shifted from hospitals to ASCs, 500,000 patients could avoid overnight stays, saving $3 billion annually. Scaling the ASC model isn’t just smart economics; it’s national fiscal responsibility.

The Price of Inaction

Consider the screening colonoscopy, a test that saves more lives than any other medical procedure in the country. In ASCs, it costs 53% less than in hospitals. I recently reviewed the bill for a patient’s colonoscopy at a hospital, coming in at a whopping $10,000. The fee for the same procedure at an ASC was only $800-$1000. How is this defensible? Patients would fare better financially, emotionally, and clinically in the outpatient setting.

It’s not just this one procedure, as the same pattern repeats across specialties. According to the Ambulatory Surgery Center Association, Medicare consistently reimburses ASCs at substantially lower rates than hospital outpatient departments for comparable procedures.

For privately insured patients, the gap is even wider:

• Cataract surgery: $1,000 at an ASC vs. $2,300 in a hospital
  
• Knee arthroscopy: $2,000 vs. $5,000
  
• Colonoscopy: $350 vs. $1,000
  

Even patient copays tell the same story:

• Diagnostic colonoscopy: $115 at an ASC vs. $190 in a hospital
  
• Cataract removal: $313 vs. $515
  
• Knee arthroscopy: $369 vs. $659

These aren’t minor accounting differences; they represent billions in unnecessary spending, and reduced access to care.

Winds of Change

The tides, thankfully, are turning. In states such as New York and Wisconsin, major insurance companies now require pre-certification for inpatient gastrointestinal and orthopedic procedures, effectively directing non-urgent cases toward ASCs. A decade ago, that was unthinkable. Today, it’s sound policy.

We are on the right track, but if we don’t accelerate this shift, we risk creating a healthcare system where elective procedures are available only to the wealthy. Need a gallbladder removed? Wait a year. Have a hernia? Live with it. This scenario isn’t fiction; it’s the daily reality of countries that delayed reform. 

A Call to Action

I am not a politician, and I am not an economist. I am a physician, and an ASC administrator who has seen firsthand what this model can achieve. Outpatient surgery is one of the most effective tools we have to reduce costs without compromising care. But the time to act is now. Those who ignore the warning bells of financial doom in healthcare risk sinking the ship for all of us.  

As Martin Luther King Jr. said, “In the end, we will remember not the words of our enemies, but the silence of our friends.”