By William Prentice
On February 12, 1970, in Phoenix, Arizona, five physicians performed the first surgeries ever provided inside a freestanding ASC. This year, thanks to everyone in the ASC that day and to the legions of health professionals and others who have helped make the ASC model a success, ASCA is proudly celebrating 50 years of ASCs.
Prior to 1970, much like today, both policymakers and patients were concerned about the escalating cost of health care and patient access to affordable care. Unlike today, with more than 5,800 Medicare-certified ASCs serving patients throughout the U.S., the idea of performing same-day surgery in a facility that operated independently from a hospital had never been tested. As government officials, insurance providers and physicians continued to look for answers, Wallace Reed, MD, and John L. Ford, MD, took action.
In 1968, a sketch of the facility the two physicians envisioned was committed to paper for the first time. Soon after, Reed and Ford defined objectives for their facility:
- To make the “ambulatory patient” a matter of greater concern
- To streamline the delivery of his/her medical services
- To reduce the cost of his/her care
- To work for a broadening of his/her insurance coverage
- To provide a pleasant atmosphere for patient, staff and surgeons
What followed was a long series of firsts and years of careful, steady progress toward initial acceptance of their idea and, much later, the overwhelming popularity of the ASC model we see today.
Considering the complicated regulatory environment ASCs operate in today and the millions of satisfied patients who have enjoyed the personalized service and high-quality care ASCs provide, it might be difficult to imagine a time when there were no regulatory, licensing or accreditation requirements for ASCs and many patients were wary of having surgery outside a hospital. It might also seem counterintuitive that, initially, many insurers and investors were skeptical of the idea, while government officials in the states and Washington, D.C., embraced and promoted it. Physicians, according to Reed, expressed a great deal of interest in the idea from its inception. Many hospital administrators, however, did not share their enthusiasm.
Fortunately, Reed, Ford and the others who quickly followed them, opened their own ASCs and devoted time and energy to giving patients access to the many benefits ASCs provide. They never lost sight of the critical need to put patients first. At the same time, they worked inside their own facilities to provide only the best in ambulatory surgical care. The founders of the ASC community also worked in their state legislatures, in Washington, D.C., and with local and national licensing and accrediting bodies to establish standards of care that would guarantee patients an exceptional experience as well as outcomes that easily met or exceeded those in hospitals.
That tradition has carried through the entire 50-year history of ASCs. When ASCs began to seek approval for Medicare beneficiaries to have surgery in an ASC, members of the ASC community scheduled meetings, presented data and worked together with federal officials to create a framework that would ensure patient safety and top-quality care. That work continues today. Later, when ASCs saw the need to demonstrate the quality of care they provide, they not only asked Medicare to institute a national ASC quality reporting program, they helped develop quality measures that would be meaningful for patients, providers, insurers and others. That work also continues today.
Over the years, ASC physicians and staff also dedicated their time and talents to making surgery a better experience for patients. They have led advances in minimally invasive procedures, pain control and recovery care while meeting and exceeding their patients’ expectations for comforting, comfortable care. At the same time, they found ways to cut the cost of ambulatory surgery without compromising on quality.
I suspect that few who helped open and staff the first freestanding ASC in Phoenix, Arizona, in 1970 would have predicted that 50 years later, patients in the U.S. would have access to more than 5,800 Medicare-certified ASCs and that more than 80 percent of all surgeries, including total hip and knee replacements and several spine and cardiology procedures, would be performed as outpatient procedures. Yet, that is where we stand today.
In 2004, Reed made a prediction:
“I think the future is bright. I think the potential for growth is tremendous if the focus remains on providing excellent patient care and keeping costs reasonable. We need to continue to make the patient the absolute top priority, continue VIP treatment for surgeons and continue to make certain that there are financial benefits to the patient, the facility and the surgeon.”
With the ASC community’s continuing commitment to those guiding principles, his vision is just as true today as it was in 2004. ASCA is looking forward to seeing and celebrating the evolution of outpatient surgery over the next 50 years.