Outpatient surgical centers represent one of the fastest-growing sectors of health care in the nation.
The percentage of procedures done in outpatient settings (sometimes referred to as ambulatory surgical centers) grew to 32 percent of all outpatient surgeries in 2005, and surpassed 50 percent in 2017, according to Fierce Health Care, a health care/business news organization.
Procedures conducted through the centers is expected to continue growing by 6-7 percent annually, according to Fierce.
Two Jefferson City-based health care providers are opening outpatient surgery centers this year.
Jefferson City Medical Group (JCMG) is holding a grand opening at 3 p.m. Wednesday for its center in the 3500 block of West Edgewood Drive.
Capital Region Medical Center (CRMC) is expected to open its outpatient surgical center in September. CRMC's center is located in the first floor of its Physician's Building, 1125 Madison St.
Like the national trend, rapid growth is one of several factors that helped spur both organizations to expand.
In November 2020, CRMC announced its plans for a 24,000-square-foot outpatient surgery center in a space that was being used for parking. At an estimated cost of $20 million, the space located beneath the hospital's existing outpatient wing, is to include operating suites, endoscopy suites, advanced imaging capabilities and room for more growth.
JCMG the following month announced its plan to spend $17 million on a new 28,000-square-foot outpatient surgery center on Edgewood Drive, about 2 miles west of the JCMG main campus on Stadium Boulevard.
JCMG President Jeffrey Patrick said the new building would more than triple the size of the provider's existing outpatient facility.
"Growth was an issue for us," Calvaruso said. "It was the thing that was pushing us."
He said CRMC has been "very successful" recruiting new surgeons to the area, but the surgeons want to remain on the leading edge of the medical field.
Another national trend that is influencing decisions to expand outpatient surgery opportunities is the patient experience, Patrick said.
"Patients want convenient outpatient surgery in a convenient, fairly private environment," he said.
Once patients leave either facility's lobby, they are escorted to private pre-operative rooms. From there, they essentially cross a hallway to an operating suite or an endoscopy suite. Post-operative rooms are nearby. And each of the facilities has covered, private exits.
"That experience of dropping off, walking in and having everything kind of flow," he said. "This place is designed for those -- I don't want to say easy cases -- but the more, same-day-type of cases that are within the walls of the hospital as well."
The hospital will retain the procedures that require overnight stays.
"For those orthopedic cases and ENT cases (otolaryngology surgery performed on the head or neck area to treat problems with ears, nose and throat) -- things that are half a day -- this is just going to be a much better experience for those patients," he said.
The JCMG facility includes two extended care suites, for patients who may want to spend the night, just for precautions. The suites look like large hotel rooms and have medical devices concealed in cabinets.
Family members would be allowed to stay with patients, should they wish. Administrators remind patients they can't keep people more than 23 hours and 59 minutes.
A third driver of demand is the "payer," whether that is the Centers for Medicare and Medicaid Services, private insurance or even an individual, who all want procedures done at cost savings.
Private insurers, Patrick said, used to pay for a three-night hospital stay when certain procedures, such as knee replacements occurred. Then, as technology and pain management improved, they saw that people were staying in the hospital only two nights, then one.
They wondered why they were still authorizing three-night stays and began to push for more outpatient services.
Fierce reported the outpatient surgery market, particularly in North America, is expected to reach $120.8 billion by 2026 (at a growth rate of 27.6 percent per year).
The federal government announced in 2019 that it would expand traditional Medicare coverage for a number of procedures, including total knee replacement and several cardiac surgeries, according to Fierce. Gastroenterology was also expected to experience significant growth because of increasing reports of digestive disorders associated with lifestyle changes and excessive intake of high- cholesterol foods.
The federal government is pushing the out-patient surgery setting because of the cost savings to taxpayers, Patrick said. It's a national trend that isn't likely to stop.
According to the Advisory Board, a spin-off of a company that former "Atlantic" owner David Bradley founded in 1979 to discover the best ideas in health care, the federal government's demands for lower costs are a main driver of the industry growth.
The Advisory Board said in the report, "(Outpatient surgery centers) are growing even faster than you think. How can hospitals respond?" Medicare reimburses an outpatient center $3,721 for an average pacemaker implant, compared to $7,731 for the same facility done at a hospital-based outpatient department (HOPD) setting. Medicare reimburses $14,540 for the procedure done in a hospital inpatient setting.
The report says there has been a shift of outpatient surgeries from HOPDs to centers. So, where once HOPDs were responsible for about 59 percent of the procedures, they are now responsible for about 40 percent, with centers responsible for about 60 percent.
The flip is reflected in the growth of outpatient surgery centers. Volume in the centers increased by 22.9 percent in 2017, the report said.
"There's a lot of changes from a payer standpoint that are wanting more of a reduced-cost environment," Calvaruso said. "This (new center) really allows us to reduce costs.
"The benefit of all this -- being here on this campus we believe -- is the hospital is right there," Calvaruso said. "We have all the resources of a community hospital. Upstairs here, there are 40 providers. Their colleagues are all one continuous flow for -- not only our providers and our staff -- but for the patients that have those resources near them, right on site is super beneficial to the public."