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Greenville Business Magazine

Ambulatory Surgery Centers on the Rise in South Carolina

Oct 03, 2022 11:14AM ● By Liv Osby

Bon Secours St. Francis Health System plans to break ground this fall on a new ambulatory surgery center at its Millennium Campus that will take a substantial portion of the orthopedic, spinal, and ENT patients now seen in its hospitals.

The $30 million Millennium Surgery Center is a partnership between Bon Secours, Compass Surgical Partners, and two physician groups – Piedmont Orthopedics and Carolina ENT – and reflects a growing trend across South Carolina and the U.S.

Nationwide, the number of Medicare-certified outpatient surgery centers grew from 1,000 in 1988 to 6,072 as of March 2022, according to the Ambulatory Surgery Center Association.

And in South Carolina, the state Department of Health and Environmental Control has issued 20 certificates of need for ambulatory surgery centers – eight of them to hospitals – since January 2018, officials said.

By comparison, 11 CONs were issued – four to hospitals – from November 2014 through December 2017, DHEC reports.

“Interest in the (ambulatory surgery center) model has increased steadily over time as advances in pain management, technology, and surgical techniques have allowed more surgical procedures to be performed in the outpatient setting,” said Amanda Hawkins, president of the ASCA board of directors and administrator of The Surgery Center of Charleston.

Ambulatory surgery centers are popular among patients for convenience, comfort and quality of care, while physicians appreciate the scheduling efficiencies and the environment for their patients, she said.

All stakeholders, including payers, appreciate the cost savings, she said.

On average, reimbursement at ambulatory surgery centers runs about 40 percent less than in hospital settings, said Scott Bacon, vice president of development for Compass Surgical Partners, an independent management and development company headquartered in Raleigh, North Carolina, that has more than 200 surgery centers nationally.

“ASC reimbursement rates are below those of hospital ORs,” he said, “so a primary benefit is reducing the cost of care to the patients, the employers, and the payers in the Upstate.”

BlueCross BlueShield of South Carolina, the state’s largest insurer, declined comment about costs for this story.

Outpatient surgery centers don’t have to maintain the same infrastructure and regulatory environment as traditional hospitals, said Schipp Ames, spokesman for the South Carolina Hospital Association. That allows providers to triage more common procedures, like hip and knee replacements, into a potentially more cost-effective and convenient setting, he said. 

“Hospitals appreciate the value of delivering services in the outpatient setting for an appropriate subset of patients,” he added. “Freestanding surgery centers allow hospitals to provide care to higher acuity patients in a more monitored setting, ultimately improving access, outcomes, and lowering overall costs.”

Hawkins said interest in ambulatory surgery centers intensified recently because they were able to provide safe care during the pandemic.

ASCA CEO William Prentice said that while the association is seeing increased interest in hospital-owned surgery centers, joint ventures that also include physician partners, and often an ASC management company – like the Millennium Surgery Center project – still appear to be more popular. 

“Conditions in the local marketplace are often the driving force behind these decisions,” he said.

The ASC model also will allow the Millennium center to partner with large employers in the area to provide bundles that mean more cost transparency for them, said Dr. Stephen Ridgeway, an orthopedic surgeon who will be working at the new center.

“This will have some real benefits to patients and payers,” he said, “and to doctors because of the ability to operate in a smaller environment and have more control.”

The single-story, 22,000-square-foot Millennium Surgery Center is planned for land Bon Secours already owns off Laurens Road. 

It will be located behind the St. Francis Cancer Center and house six operating rooms and two procedure rooms, according to Bacon. 

It will serve the greater Upstate area, he said, and is expected to open by the first quarter of 2024.

Among the orthopedic surgeries it will offer are most sports, foot and ankle, and hand surgery and robotic joint procedures like hip and knee replacements, Ridgeway said. 

Orthopedic surgery has been transitioning to the outpatient setting for years thanks to medical advances that allow operations with shorter and eventually no hospital stays, he said. 

“Even spine surgery, now a significant proportion is done in outpatient surgery,” he said. 

Of course, some surgery will continue to be done in the hospital based on the patient’s health and the type of procedure, he said. 

“We have criteria to determine who should be done in the surgery center and who shouldn’t,” he said.

Ridgeway said the joint venture allows physicians greater autonomy and more practice input while maintaining the support and other benefits Bon Secours can provide.

While nurse staffing is a problem everywhere because of a workforce shortage, Ridgeway said the center will be an attractive option because of the shorter hours. 

“In the surgery center, we want to be shut down by 4 or 5 in the afternoon,” he said. “That’s a lot different than a hospital open 24 hours a day seven days a week.”

St. Francis is part of Bon Secours Mercy Health, one of the 20 largest health systems in the U.S. and the fifth-largest Catholic health system in the country, with facilities in Florida, Kentucky, Maryland, New York, Ohio, South Carolina, Virginia, and Ireland. 

The partners are funding the equity required with additional financing coming from Southern First Bank in Greenville, Bacon said, noting that Compass will be overseeing management of the center. 

“We are really excited about this,” said Ridgeway. “This is a true outpatient setting with all the modern technology and robotics that you’d have in a hospital, but in a nicer … less intimidating setting.”