Good news for SDS: You’re winning cases, $$$
Here’s how to benefit from growth trend
Same-day surgery centers are beating the competition with rapidly growing case volumes, according to two recent reports on same-day surgery (SDS) trends. The loser: office-based surgery, which has declined steadily since 1991.1
While advanced technology such as lasers has expanded the scope of outpatient procedures, its high cost has forced physicians to move cases out of their offices to surgery centers and hospitals. Some SDS managers are taking advantage of this trend by creating a special area to handle minor procedures. (See story, at right.)
Meanwhile, overall case volumes are exploding at freestanding surgery centers, which recorded 33.9% more surgeries in 1995 than in 1993, according to SMG Marketing Group of Chicago. "The growth has been strong and will remain strong for the next few years," says Peter Wojcik, project director for alternate care research at SMG Marketing.
Hospitals also are benefiting from the movement of procedures out of physicians’ offices. For example, Egleston Children’s Hospital in Atlanta saw a 200% growth in the second year of its minor procedure area, handling 160 cases in the first six months of 1996. Both physicians and parents appreciate the day surgery setting for procedures such as removal of foreign bodies for example, a piece of glass in the foot, says Janette Issa, RN, CAPA, administrative director of day surgery and pre-op.
"Some [physicians] were doing a few of these cases in their offices, but they weren’t quite comfortable with the level of monitoring," Issa says. The minor procedure area also saves physicians time, she says. "Instead of running back to their office at the end of the day, they come to see us," she says.
The movement of procedures out of doctors’ offices contributes to strong prospects for SDS programs. Despite a squeeze in reimbursement from both managed care and Medicare, SDS managers can look forward to continued strong revenues, says Wojcik. Revenues at surgery centers grew by about 20% from 1994 to 1995, SMG reported.
It’s not just cost-effectiveness that gives them the edge, says Dave Foster, PhD, MPH, senior director of research at, a Baltimore-based health care information firm. Demand for consistency and accountability in health care also favors surgery centers and hospitals over physician offices, he says.
Foster analyzed a 5% random sample of Medicare claims data from 1991 to 1994, which encompassed about 31 million same-day surgery procedures. Office-based procedures declined from 69.5% of all Medicare procedures in 1991 to 63.5% in 19941, a trend Foster believes will continue. (See chart on time trends in surgical procedure claims, above.)
"The doctor’s office down the street will continue to go the way of the little market down the street," he says, comparing competition in health care to the impact of bargain-oriented megastores. "All the variability is getting squeezed to provide patterns of care that are more uniform."
Foster did note that in areas of higher managed care enrollment, procedures were somewhat more likely to occur in physician offices. But that tendency isn’t strong enough to reverse the bigger shift toward surgery centers, he says. "The technology [in same-day surgery] is getting so complex that a lot of physician office settings are not capable of supporting it," Foster says.
Reference
1. Foster D. Outpatient shift analysis: Surgical service intensity 1991-1994. Presented at the HCIA Industry Conference. Palm Springs, CA; March 1996.
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