After comedian Joan Rivers died a year ago during a reportedly minor outpatient procedure, a flood of news stories raised questions about the safety of ambulatory surgery centers.

Is the care delivered in these facilities equivalent to that provided in outpatient departments of hospitals? Are regulatory standards comparable? And how can patients and families research the quality of these centers before scheduling a procedure?

More than 54 million outpatient procedures are done each year in the US, a three-fold increase in the last 30 years. An increasing number are done in freestanding centers, many of which are owned by physicians.

Moving procedures out of hospitals and into outpatient settings has generally been a positive development in health care — one that reflects advances in science, technology, and consumer preferences. Outpatient surgery is more convenient than inpatient surgery, and data suggests it also may be more cost-effective. The Affordable Care Act promotes this sort of delivery system transformation because its goals are to make health care more accessible and convenient, while reducing costs and promoting quality and safety.

It seems clear that many more surgeries that have historically been done in hospitals will move to ambulatory surgery centers. But it’s important not to lose sight of how critical it is for this industry to meet public requirements and patient expectations for safety and quality — not just convenience or efficiency.

Right now in California, freestanding outpatient surgery centers owned by physicians are regulated by a different state agency — applying different criteria — from the regulator that oversees outpatient centers controlled by hospitals. The information available to the public about costs, quality, and patient-safety history also is highly variable. Oversight might vary based on the ownership model of the facility, which the average patient would not likely consider relevant to oversight of care.

To gain a better understanding of the patchwork of facility types, oversight, and information that’s publicly available, the California Health Care Foundation commissioned a study. The findings were released recently at a Sacramento briefing (video available) and captured in two reports, Limited Visibility: Making Information Available on Outpatient Surgery in California and Outpatient Surgery Services in California: Oversight, Transparency, and Quality.

In the video below, CHCF’s Steven Birenbaum interviews Betsy Imholz from Consumers Union about who has oversight of outpatient surgery in California.
 

 
CHCF also created a share-friendly infographic that compares what information is available for patients weighing whether to have a procedure in their doctor’s office, an ambulatory surgery center, or an outpatient hospital surgery facility.

It’s impossible to know whether Ms. River’s ultimately fatal complication would have occurred if the procedure had taken place in a hospital. But understanding how these kinds of outpatient surgery facilities differ, and making more comparative information available to the public, are key steps toward more patient-centric, higher quality, and safer care. As the health care system is transformed by social, scientific, technological, and economic forces, our patient-protection infrastructure and oversight must keep pace with changing care delivery models.

Sandra R. Hernández

Sandra R. Hernández, MD, is president and CEO of the California Health Care Foundation. Prior to joining CHCF, Sandra was CEO of The San Francisco Foundation. She previously served as director of public health for the City and County of San Francisco. Read More

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