Who would have thought it possible that we would be performing total hips, knees, multiple level spinal fusions, cardiac caths, stent placements, and send patients home the same day?

We treat a Chinese client who says China keeps patients hospitalized in a bed for 14 days following total joint replacement. Needless to say, they are shocked (and the local hospitals nervous) about the pace of outpatient surgery in the West.

Like many of you, I keep thinking, “No way that can be done on an outpatient basis.” Yet, technology, pharmacological advances, and the need to reduce healthcare costs keep pushing it farther than any of us could imagine. We are constructing a freestanding ASC that will incorporate robotics. That was completely unheard of outside the walls of a hospital just a couple of years ago.

I have read and confirmed it with our spine docs that 98% of all spine surgery can be performed within a two-night stay in the hospital. Surgery centers can keep patients up to 23 hours and 59 minutes right now. How long do you think that wall will remain?

It is not just the freestanding for-profit surgery centers that are “amping up” and pushing the envelope. Many hospitals are expanding their offsite outpatient surgery facilities (hospital outpatient departments) to preserve as much of this business as possible and to keep it out of the hands and pocketbooks of the entrepreneurial surgeons. Hospitals also realize that they need a more cost-effective, efficient facility to compete with the for-profit bundling of these prized procedures. By developing what is essentially their own freestanding surgery centers (without physician investors), they can jump on the growing need for more outsourced surgical services and nonhospital rates.

Feeding on the chum-churned water, vendors are adding to the mix the availability of lower cost for the necessary equipment to perform this growing list of procedures outside the mothership. While the mainstream vendors are slow to lower costs, the secondary markets are jumping in with both feet to capture a piece of the expanding pie.

Although outpatient surgery normally was a place for only the healthiest and fittest, the ASA 1s and 2s, that’s not true anymore. We are pushing into the 3s and even the 4s to be eligible for the esteemed outpatient qualified status. Helping us are the companies that take much of the burden of the preadmission process and evaluation outside the realm of the on-staff nurses and put it in the hands of the more efficient professionals who only deal with the patient assessment and can communicate better with patients via social media than we ever could with our typical staffing schedules.

The bottom line: The cost of healthcare will continue to rise in the United States and around the world. We are getting older, sicker, and more demanding. Ten thousand people turn 65 years old every day in the United States and will continue to do so for the next 20 years. That is a lot of knees, hips, spines, stents, shoulders, and transplants. The marketplace will find a way to provide surgery to all of them — and still be profitable. Will you?

Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Earnhart & Associates can be reached at 5114 Balcones Woods Drive, Suite 307-203, Austin, TX 78759. Phone: (512) 297-7575; Fax: (512) 233-2979; Email: searnhart@earnhart.com; Web: www.earnhart.com.