The field of outpatient services has grown rapidly over the last several years, spurred by changes to reimbursements for inpatient procedures from health plan providers. One result of this is an increasing number of hybrid surgery centers — facilities that operate as both an office-based laboratory (OBL) and an ambulatory surgical center (ASC). Usually, a hybrid suite contains the imaging equipment typical of an OBL, as well as the equipment and sterilization standards necessary for surgical and non-surgical interventions [1]. While hybrid surgery centers can offer advantages to both patients and healthcare providers that a traditional hospital setting cannot, the transition to this structure may prove difficult. OBL-ASC facilities are complex structures that have many financial, legal, and practical hurdles.
The flexibility of hybrid suites is advantageous to medical organizations and patients alike. The ability to transition from office to OR can improve patient outcomes in the event of an emergency during a routine procedure [2]. It also allows for non-surgical and surgical procedures to be performed consecutively or simultaneously, thus reducing the number of hospital admissions and shortening the length of stay for patients, which saves money and increases efficiency [3]. Hybrid centers have the potential to guide the standard for medical treatment toward a more integrated approach [4]. Improving patient outcomes and satisfaction is also beneficial for medical providers as the industry shifts toward value-based care [5]. Structurally, the hybrid center is less bureaucratic than the traditional hospital and allows physicians to increase their income through equity ownership [6].
Despite these prospective benefits, there are many logistical obstacles to instituting a hybrid surgery center. Legal regulations can make it difficult to build a hybrid suite or convert existing offices. Under federal law, in order for an OBL and ASC to operate within the same facility, they must maintain different hours of operation and keep medical records separate. Certain states also restrict the proliferation of outpatient clinics based on need and access [7]. The performance of hybrid procedures must be accommodated not only by new facilities but by new, interdisciplinary working dynamics. Optimizing the design of hybrid centers will require repeated study of the workflow in these environments, and improved collaboration between medical professionals [7].
Despite the difficulties of establishing hybrid surgery centers, these facilities are growing rapidly and encompass a large share of healthcare services in the country. This trend is the result of a confluence of factors. Many insurance providers no longer cover routine procedures when performed in a hospital because of the higher costs associated with inpatient procedures [8]. Patients, too, object to high costs and have demanded alternatives, pressuring the industry to embrace hybrid centers [5]. The most recent development accelerating the shift, however, is more urgent than market forces. In order to minimize exposure and free up hospital resources for COVID-19 patients, pressure for outpatient centers to increase their caseload has grown. While the pandemic is ongoing, outpatient facilities, including hybrid centers, are easing the strain on hospitals by providing care that would otherwise have been delayed [9].
References
[1] Bazzi, May, et al. “The Drama in the Hybrid OR: Video Observations of Work Processes and Staff Collaboration During Endovascular Aortic Repair.” Journal of Multidisciplinary Healthcare, vol. 12, 2019, pp. 453-464, doi: 10.2147/JMDH.S197727.
[2] “Hybrid Surgical Procedures.” Hybrid Operating Rooms & Hybrid Cath Labs, J.M. Keckler Medical Co., hybridoperatingroom.com/hybrid-surgical-procedures/.
[3] Bazzi, May, et al. “Team Composition and Staff Roles in a Hybrid Operating Room: A Prospective Study Using Video Observations.” Nursing Open, 2019, doi: 10.1002/nop2.327.
[4] Davidson, Michael J. and Tsuyoshi Kaneko. “Use of the Hybrid Operating Room in Cardiovascular Medicine.” Circulation, vol. 130, no. 11, 2014, pp. 910-917, doi: 10.1161/CIRCULATIONAHA.114.006510.
[5] Derek Long, David McMillan, et al.| CPA, ASA | Apr 1, 2019. “HOPDs vs. ASC: Understanding Payment Differences.” 1 Apr. 2019, https://www.hfma.org/topics/hfm/2019/ april/hopds-vs–asc–understanding-payment-differences.html.
[6] Tim van Biesen and Todd Johnson | Healthcare Private Equity Advisers | Sept 23, 2019. “Ambulatory Surgery Center Growth Accelerates: Is Medtech Ready?” Bain & Company, 23 Sept. 2019, https://www.bain.com/insights/ambulatory-surgery-center-growth-accelerates-is- medtech-ready/.
[7] Cilek, Jacob A. and Jason S. Greis. 12 Business and Legal Considerations for Developing a ‘Hybrid’ Office-Based Laboratory–Ambulatory Surgery Center. McGuire Woods, Sept. 2019, https://media.mcguirewoods.com/publications/2019/OBL-ASC-Hybrid-Article-12-Considerations.pdf.
[8] Karen Blum | Office of Johns Hopkins Physicians | Apr 25, 2018. “Shifting Low-Risk Procedures to Ambulatory Surgery Centers.” BestPractice News, 25 Apr. 2018, https://www. hopkinsmedicine.org/office-of-johns-hopkins-physicians/best-practice-news/shifting-low-risk-procedures-to-ambulatory-surgery-centers.
[9] Jacqueline LaPointe | Revcycle Intelligence | Mar 17, 2020. “Hospitals Delay, Shift Surgeries to Outpatient Due to COVID-19.” Revcycle Intelligence, 17 Mar. 2020, https://revcycleintelligen ce.com/news/hospitals-delay-shift-surgeries-to-outpatient-due-to-covid-19.