Does procedure profitability impact whether an outpatient surgery is performed at an ambulatory surgery center or hospital?

@article{Plotzke2011DoesPP,
  title={Does procedure profitability impact whether an outpatient surgery is performed at an ambulatory surgery center or hospital?},
  author={Michael Robert Plotzke and Charles Courtemanche},
  journal={Health economics},
  year={2011},
  volume={20 7},
  pages={
          817-30
        }
}
Ambulatory surgery centers (ASCs) are small (typically physician owned) healthcare facilities that specialize in performing outpatient surgeries and therefore compete against hospitals for patients. Physicians who own ASCs could treat their most profitable patients at their ASCs and less profitable patients at hospitals. This paper asks if the profitability of an outpatient surgery impacts where a physician performs the surgery. Using a sample of Medicare patients from the National Survey of… 
View on PubMed
libres.uncg.edu
44 Citations
Background Citations
7

44 Citations

Citation Type

Citation Type

The Financial Impacts of Ambulatory Surgery Centers on General Surgical Hospitals
TLDR
The results of two-stage least squares suggest that both hospital revenue and operating expenses will increase when ASCs enter the market, with operating expense increasing more, resulting in a decrease in profit margin, and this negative financial impact likely comes from the change in hospital inpatient-severity mix upon ASCs’ entry.
Returns to specialization: Evidence from the outpatient surgery market.
Price Increases Were Much Lower In Ambulatory Surgery Centers Than Hospital Outpatient Departments In 2007-12.
  • K. Carey
  • Medicine, Political Science
    Health affairs
  • 2015
TLDR
This study examined the revenue side of ASC growth by using a large national claims database that contains information on actual prices paid, and found no evidence that ASCs are successfully pressuring hospital outpatient departments to lower their prices.
Ambulatory Surgery Centers and Prices in Hospital Outpatient Departments
  • K. Carey
  • Medicine
    Medical care research and review : MCRR
  • 2017
TLDR
Examination of evidence for price competition between ambulatory surgery centers (ASCs) and hospital outpatient departments finds HOPDs may have less negotiating leverage with commercial insurers on price in markets with high ASC market penetration, resulting in relatively lower prices.
Ambulatory Surgery Centers and Their Intended Effects on Outpatient Surgery.
TLDR
The opening of an ASC in a Hospital Service Area resulted in a decline in hospital-based outpatient surgery without increasing mortality or admission, and in markets where facilities opened, procedure growth at ASCs was greater than the decline in outpatient surgery use at their respective hospitals.
Does competition from ambulatory surgical centers affect hospital surgical output?
Kathleen Carey Price Increases Were Much Lower In Ambulatory Surgery Centers Than Hospital Outpatient
TLDR
This study examined the revenue side of ASC growth by using a large national claims database that contains information on actual prices paid, and found no evidence that ASCs are successfully pressuring hospital outpatient departments to lower their prices.
Patient Mix in Outpatient Surgery Settings and Implications for Medicare Payment Policy
TLDR
Assessment of patient selection across ASCs and hospital outpatient departments for four common surgeries in Florida from 2004 to 2008 suggests that modifications to the Medicare outpatient payment system may be appropriate to account for the different populations that each setting attracts.
Procedures take less time at ambulatory surgery centers, keeping costs down and ability to meet demand up.
TLDR
Using data on procedure length, it is shown that ambulatory surgery centers (ASCs) provide a lower-cost alternative to hospitals as venues for outpatient surgeries and can help fulfill the Affordable Care Act's goals of reducing costs while improving the quality of health care delivery.
Hospital Safety , Endogenous Entry and Competition by Ambulatory Surgery Centers
TLDR
The results find that patient safety indicators are informative and have significant effects on allocation of outpatients across available facilities, and indicators of low hospital safety are clearly shown to be significant in the probability of ASC entry.
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 25 REFERENCES
Free-Standing Ambulatory Surgery Centers and Hospital Surgery Volume
  • J. Bian, M. Morrisey
  • Medicine
    Inquiry : a journal of medical care organization, provision and financing
  • 2007
TLDR
Examination of the association of free-standing ambulatory surgery centers with hospital surgery volume suggests that an increase of one ASC per 100,000 people was associated with a 4.3% reduction in hospital outpatient surgical volume, but was not associated with inpatient surgical volume.
The Effects of Cardiac Specialty Hospitals on the Cost and Quality of Medical Care
Where do I send thee? Does physician-ownership affect referral patterns to ambulatory surgery centers?
TLDR
Findings indicate that physicians at physician-owned facilities are more likely than other physicians to refer well-insured patients to their facilities and route Medicaid patients to hospital outpatient clinics.
Single Specialty Hospitals and Service Competition
  • K. Carey, J. Burgess, G. Young
  • Medicine, Political Science
    Inquiry : a journal of medical care organization, provision and financing
  • 2009
TLDR
Results suggest that general hospitals are stepping up their own offerings of services that are in direct competition with those of specialty hospitals, which is associated with significantly higher growth in high-technology diagnostic imaging services in the general hospitals in those markets.
Physicians' responses to financial incentives. Evidence from a for-profit ambulatory care center.
TLDR
It is concluded that substantial monetary incentives based on individual performance may induce a group of physicians to increase the intensity of their practice, even though not all of them benefit from the incentives.
A tale of two bounties: the impact of competing fees on physician behavior.
TLDR
The findings are consistent with the predictions for a number of procedure groups, but not for all of them, and suggest that societal savings from Medicare fee reductions are overstated if one does not also consider spillover effects in the private insurance market.
Specialty versus community hospitals: referrals, quality, and community benefits.
TLDR
Although physician-owners are more likely than others to refer to their own facilities and treat a healthier population, there are rationales for these patterns aside from motives for profit.
Physician reimbursement by salary or fee-for-service: effect on physician practice behavior in a randomized prospective study.
TLDR
Evaluating visits by American Academy of Pediatrics' guidelines indicated that fee-for-service physicians saw more patients for well-childcare than salaried physicians because they missed fewer recommended visits and scheduled visits in excess of those recommendations.
How do financial incentives affect physicians' clinical decisions and the financial performance of health maintenance organizations?
TLDR
The use of some, but not all, financial incentives, as well as the type of HMO, does influence the behavior of physicians toward patients, and it remains to be determined how these factors affect the quality of care.
Focused factories? Physician-owned specialty facilities.
Using data from Round Four of the Community Tracking Study site visits, this paper describes the recent rapid increase in physician-owned specialty hospitals and ambulatory surgery centers, reasons…
...
1
2
3
...