AMBULATORY SURGICAL CENTER’S

[Pages:24]AMBULATORY SURGICAL CENTERS' UTILIZATION REPORT, INDIANA, 2004

TABLE OF CONTENTS Introduction

Characteristics of Ambulatory Surgical Centers Annual Utilization Statistics Outcome from Surgery

Table A ? Summary of Key Resources and Utilization Table B ? Number of 50 Most Frequent Procedure Groups

Introduction

On a quarterly basis, the Indiana State Department of Health requests licensed ambulatory surgical centers to describe their resources, utilization, and outcome from the surgical procedures. This report summarizes the information for calendar year 2004.

Characteristics of Ambulatory Surgical Centers

As of December 31, 2004, there were 125 ambulatory surgical centers in Indiana, located in 30 of the 92 counties. The majority of these centers have the following characteristics

CHARACTERISTICS OF CENTERS Number of surgical centers Percent of centers in urban counties of Indiana Percent of centers with all physicians focusing on a single specialty Percent that are MD owned Percent of for-profit corporations Average number of operating rooms

STATEWIDE STATISTICS

125 95.0% 48%

54% 97% 2.5

These centers are established, equipped, and operated primarily for the purpose of performing needed medical surgical procedures and services. These centers are an alternative source of surgery performed in hospitalbased outpatient operating rooms.

Annual Utilization Statistics

In 2004, physicians, dentists, or podiatrists performed 497,054 procedures on 391,469 patients in 125 centers. Each surgical center performed an average of 331 procedures every 30 days.

It is estimated that this surgical volume represented 5 percent of all outpatient surgeries performed. In Fiscal Year 2004, the Indiana Hospital and Health Association determined that physicians in hospital-based outpatient operating rooms performed 10,111,101 procedures. The remaining one percent of surgeries are performed in offices of independent physician practices.

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The ambulatory surgical centers serve three distinct patient populations: the middle-aged population seeking assistance with digestive problems, the elderly seeking removal of cataracts, and all other patients seeking general outpatient surgical care.

CHARACTERISTICS OF PATIENT POPULATION Percent of Females Percent of Patients aged 1 to 17 years Percent of Patients aged 18 to 64 years Percent of Patients aged 65 years and older Percent of Patients reimbursed under Medicaid

STATEWIDE PERCENT

54.6% 6.9% 57.1% 36.0% 6.4%

The number of operating rooms, total annual procedures, and principal surgical focus by center is shown in Table A. The trend line on the growth of centers and procedures is shown below:

2002

2003

2004

Total Ambulatory Surgery Centers Total Procedures

114 398,295

119 444,368

125 497,054

In 2004, the majority of these centers focused on performing procedures on the eye and the digestive system. The most frequent surgical procedure groups filed in quarterly reports are seen below.

NAME OF MOST FREQUENT CPT

PROCEDURE GROUPS

CODE

# OF ASCs

Integumentary (Skin) System 10040-19499 32

Musculoskeletal System

20000-29909 44

Respiratory System

30000-32999 16

Digestive System

40490-49999 54

Urinary System

50010-53899 10

Genital System

54000-58999 23

Nervous System

61000-64999 49

Eye and Ocular System

65091-68999 52

Auditory System

69000-69999 29

Cardiac Catheterization

93501-93572 7

Other

-

Total Of All Reported Procedures Total

125

NUMBER OF

PROCEDURES

7,552 21,946 8,552 113,972 5,168 7,178 52,102 78,722 10,832 7,510 183,520 497,054

AVERAGE PER CENTER 236 499 535 2,111 517 312 1,063 1,1513 373 1,074 3,976

1. Procedure codes are abstracted from the AMA Physician Current Procedural Terminology (CPT-4).

2. The number of the 50 most frequent procedure groups by CPT diagnostic category in the state for all centers is seen on Table B.

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Outcome from Surgery

Patients are referred to a surgical center based on recommendations from their health care provider. Most patients arrive with low risk for surgery and have no prior chronic problem that may interfere with the new procedure. Most patients are treated within two or three hours and discharged to family members under the care of their family physician.

A small percent of these patients do expect limited problems after the operation, and are referred to an acute care hospital for treatment of stable or unstable medical conditions. The percent of inpatient transfer is higher with patients with existing cardiac or acute problems seen prior to surgery.

OUTCOMES FROM SURGICAL PROCEDURES Number of patients transferred to a hospital with stable medical conditions. Number of patients transferred to a hospital with unstable medical conditions Number of patients with a post-surgical wound infection Number of patient deaths Percent of patients with no other medical problems other than need for surgery Percent of patients with an other chronic (mild) systemic disease prior to surgery Percent of patients with an other acute (severe) systemic disease prior to surgery

STATEWIDE STATISTICS 1,278 of 497,054 patients 82 of 497,054 patients 242 of 497,054 patients 0 Deaths 38.5 % 46.6% 14.9%

It is recommended that individuals considering outpatient surgery discuss the need with their physician, discuss coverage with their insurance representative, and notify the surgeon of any prior conditions prior to arrival at the surgical center.

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TABLE A SUMMARY OF KEY RESOURCES AND UTILIZATION, 2004

AMBULATORY SURGICAL CENTERS, INDIANA

NAME OF CENTER

Advanced Surgery Center Aesthetic Surgery Center Akin Medical Center Allied Physician Surgery Center Apac Surgery Center II Athens Diagnostics Surgical Cnt Beltway Surgery Centers Bloomington Endoscopy Center Bloomington Surgery Center Calumet Surgery Center

Care Labs Carmel Ambulatory Surgery Centers for Pain Management Center for Special Surgery Central IN Laser & Surgery Central IN Orthopedic Surgery Central IN Orthopedic Surgery Central Indiana Surgery Center Chandana Surgery Center CLI Surgery Columbus Eye Surgery Center Columbus Surgery Center Community Surgery Center Digestive Health Center Dupont Surgery Center Eastern IN Cnt for Ambulatory Elkhart Clinic Endoscopy Center Endoscopy Center Evansville Deaconess Evansville Newburgh Center Eyecare Consultants Surgery Cnt Foot & Ankle Surgery Center FW Cardiology Cath FW Endoscopy Center FW Ophthalmic Surgery Center FW Orthopaedics Surgicenter

COUNTY NAME

Tippecanoe

# OF

KEY

TOTAL

OPERATINGPROCEDURAL 2004 Procedure SPECIALIZATION PROCEDURES

ROOMS

5

Eye

2,795

Hamilton 3

Plastic

899

Floyd

2

St Joseph 10

Lake

1

Montgomery 2

Marion

9

Monroe

3

Monroe

3

Lake

5

Allergy General Pain General General Digestive Eye General

823 10,177 1,776 3,455 10,208 6,113 3,649 4,379

Marion

1

Hamilton 7

Lake

2

Marion

2

Howard

2

Delaware 2

Madison 2

Marion

3

Porter

3

General General General Pain Eye Orthopedics Orthopedics Eye General

656 5,677 3,969 1,356 919 3,185 1,867 1,379 2,733

Allen

3

Eye

1,166

Bartholomew 1

Eye

1,575

Bartholomew 3

General

3,128

Lake

8

Hamilton 2

Allen

7

Wayne

4

Elkhart

5

Hamilton 2

Marion

3

Vanderburgh 7

Warrick

5

Vanderburgh 2

Marion

3

Allen

1

Allen

3

Allen

4

Allen

5

General Digestive General General General Digestive Digestive General General Eye Podiatry Cardiology Digestive Eye General

7,822 4,570 11,920 7,282 1,175 2,783 6,412 6,095 3,667 1,818 2,176 1,052 4,726 3,156 6,901

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CENTER NAME

COUNTY # OF ORs

Franciscan Surgery Center

Marion

6

Gastrointestinal Endoscopy Cnt Vanderburgh 2

Goshen Ambulatory Care Center Elkhart

4

Grand Park Surgical

Lake

2

Grossnickle Eye Surgery Center Kosciusko 4

IMA Endoscopy Surgical

Lake

2

Indiana Eye Clinic

Johnson

2

IN Surgery Center Noblesville Hamilton 8

Indiana Surgery Howard

Howard

5

Indiana Surgery Center North

Marion

8

IN Surgery Cnt 16th Street

Marion

6

Indiana Surgery South Campus Marion

5

Indianapolis Endoscopy Center Marion

3

John Kenyon Surgery For Eye Clark

3

KK & A Surgery Center

Floyd

4

Lafayette Amb Surgery Center Tippecanoe 4

Lafayette Cath Lab

Tippecanoe 1

Lake Park Surgicare

Lake

6

Lakeside Surgery Center

Lake

2

Lakeview Ambulatory

Lake

3

Laser & Skin Surgery Center

Hamilton 2

Marion Surgicenter

Grant

3

Medical Consultants Endoscopy Delaware 4

Medical Group Surgery Center LaPorte

4

Meridian Endoscopy Center

Marion

4

Meridian Plastic Surgery Center Marion

3

Merrillville Center Advanced Clos Lake

2

Michiana Endoscopy Center

St Joseph 3

Mid-America Surgery Center

Delaware 4

Midwest Surgery Center

Vigo

3

Muncie Ambulatory Surgicenter Delaware 4

Muncie Cataract and Laser Eye Delaware 3

Munster Same Day Surgery Cnt Lake

4

Naab Road Surgery Center

Marion

7

North Central Health Services Tippecanoe 2

North Meridian Surgery Center Hamilton 3

Northeast IN Endoscopy Center Allen

2

Northside Cardiac Cath Lab

Marion

2

Northside Gastroenterology Endo Marion

4

Northwest Surgery Center

Marion

5

Novamed Eye New Albany

Floyd

8

Novamed Eye Merrillville

Lake

3

Oakview Surgery Center

Fulton

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SPECIALTY General Digestive General General Eye Digestive Eye General Howard General General General Digestive Eye Orthopedics General Cardiology General General General Dermatology General Digestive General Digestive Plastic Digestive Digestive General General Eye Eye General General General General Digestive Cardiology Digestive General Eye Eye Podiatry

# PROC. 5,685 5,004 2,953 1,171 5,580 3,100 2,930 4,522 5,271 11,113 7,704 6,277 8,547 1,552 3,992 752 1,937 5,767 2,347 5 841 1,905 3,687 2,837 6,447 3,598 3,927 8,697 4,127 1,568 3,660 1,382 2,833 10,085 485 2,684 5,264 4,131 8,592 6,076 4,608 2,077 130

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CENTER NAME OSMC Outpatient Surgery Center Premier Surgery Center Richmond Cataract & Laser Richmond Surgery Center River View Surgery Center Riverpointe Cardiovascular Lab Riverpointe Surgery Center Sagamore Surgical Service South Bend Clinic & Surgicenter South Central Surgery Center South Emerson Surgery Center Southeast Surgery Center Southwest Surgical Suites Southern Indiana Endoscopy Southern Indiana Surgery Center Southwest Surgical Suites Spine Rehab Ambulatory Spring Mill Surgery Center St Charles Surgical Pavilion St Mary's Freestanding Cath Sullivan Surgicenter Surgery Center Pain Southern Surgery Center Eye Specialty

Surgery Center (Hand) Surgery Center of Indianapolis Surgery Center of Ophthamology Surgery Center Southeastern IN Surgery Center Plus Surgery Center (Allen) Surgery One Surgical Care Center Surgical Center of New Albany Surgicare LLC Surgicare @ Cross Point Surgicare Outpatient Surgery Cnt Terre Haute Heart Center Cath Unity Surgery Center Unity Surgical Arts Valley Surgery Center Vincennes Surgery Center Vision SC Springhill Wabash Valley Eye Welborn Clinic Surgery

COUNTY # of ORs

Elkhart

3

Allen

8

Wayne

3

Wayne

4

Grant

9

Elkhart

1

Elkhart

6

Tippecanoe 3

St Joseph 2

Johnson

4

Marion

3

Marion

4

Allen

3

Floyd

3

Monroe

6

Allen

3

Marion

2

Hamilton 9

St Joseph 2

Vanderburgh 1

Sullivan

4

Monroe

2

Marion

2

Marion

3

Marion

5

Allen

3

Decatur

4

Marion

4

Allen

3

Allen

5

Marion

4

Floyd

4

Monroe

2

Vanderburgh 5

Vanderburgh 8

Vigo

1

Tippecanoe 4

St Joseph 6

Vanderburgh 3

Knox

8

Clark

2

Knox

3

Vanderburgh 5

SPECIALITY General General Eye General General Cardiology General General General General Orthopedics Pain Plastic Digestive General Plastic Pain General General Cardiology General Pain Eye

Orthopedics General Eye General General Digestive Orthopedics General General General General General Cardiology General General Eye General General Eye General

# PROCED. 5,317 4,438 343 4,108 5,588 383 7,232 2,088 2,038 1,062 2,343 4,770 1,999 4,262 8,223 2,971 1,569 2,255 2,305 93 163 5,152 4,764

4,284 6,897 1,074 1,083 1,929 5,426 8,404 3,890 2,834 4,080 390 11,602 626 10,083 746 2,326 1,544 3,173 1,630 7,450

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Whitewater Valley Surgery Cnt Williams Eye Surgery Center Women's Physician Surgery Woodlawn Healthcare Subtotal 125 ASCs

Montgomery 2

Lake

3

Marion

5

LaPorte

2

(30)

(476)

General Eye General General -

1,571 2,025 12,665 5,677 497,054

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TABLE B NUMBER OF 50 MOST FREQUENT PROCEDURE CODES* BY CURRENT TERMINOLOGY DIAGNOSTIC CATEGORY,

AMBULATORY SURGICAL CENTERS, INDIANA, 2004

ANATOMICAL CPT

SYSTEM

CODE

Skin

19120

10040-19499 19125

19325

Other

Subtotal

Muscles

20680

20000-29909 26055

27096

28285

29826

29827

29877

29880

29881

29824

Other

Subtotal

Respiratory

30140

30000-32999 30520

31255

31267

31288

Other

Subtotal

Digestive

42820

40490-49999 42830

43239

43245

43248

45378

45380

45383

45384

45385

47562

49505

Other Subtotal

PROCEDURE DESCRIPTION

Excision of cyst or breast tissue (36) Excision of breast lesion (37) Mammoplasty with implant (19)

Of Procedures of Integumentary System Removal of deep implant (36) Tendon Sheath (20) Injection in Sacroiliac joint (27) Hammertoe operation (35) Arthroscopy with acromioplasty (15) Arthroscopy for acromioplasty (42) Chondroplasty (23) Arthroscopy mesiscectomy and lateral (47) Arthroscopy with meniscectomy (9) Arthroscopy with lysis of adhesions (48)

Of Procedures of Musculoskeletal System Submucous resection turbinate (22) Septoplasty or submucous resection (17) Endoscopy with ethmoidectomy (18) Sinus Endoscopy with polyp removal (28) Sinus Endoscopy (32)

Of Procedures of Respiratory System Tonsillectomy (12) Adenoidectomy (37) Upper gastrointestinal with biopsy (3) Closure of esophagostomy transthoracic (40) Gastrointestinal endoscopy tube (14) Colonoscopy, flexible (2) Colonoscopy with biopsy (6) Sigmoidoscopy diagnostic (41) Colonoscopy to remove tumor (10) Colonoscopy to snare/remove tumor (5) Cholecystectomy excision (21) Repair of inguinal hernia (31)

Of Procedures on Digestive System

# CASES

679 660 1,572 4,641 7,552 732 1,558 1,178 741 2,046 649 1,506 528 5,531 508 6,969 21,946 1,517 1,662 1,587 1,062 837 1,887 8,552 3,888 714 18,829 666 2,516 34,151 13,403 662 5,067 14,197 1,518 889

17,472 113,972

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