Outpatient endoscopy. The case for the ambulatory surgery center

Since the late 1970s, there has been a dramatic shift of GI endoscopy services from the inpatient to the outpatient setting. Outpatient GI endoscopy has migrated from the hospital endoscopy unit to the office and then on to the EASC. This evolution has been brought about by many forces, including the drive for health care cost containment, a desire for enhanced service, cost pressure on physicians, and demands for quality assurance. Although there are advantages and disadvantages to each of the outpatient settings (see Tables 5 and 6), the EASC seems to offer the most value to patients, payers, and physician owners. That value is defined as good outcomes, excellent service, and reasonable cost. Those attributes of the EASC that are most important in guaranteeing this value are physician control, time efficiency, convenience, and adequate reimbursement. The endoscopic ambulatory surgery center seems to be the best environment for delivering endoscopic services. The office AEC can only approach the attractiveness of an EASC when restrictive certificate-of-need laws prevent the development of an EASC; when groups lack a critical number of endoscopists to support an EASC (at least three endoscopists with a potential procedure volume of 1200 to 1800 procedures per year [11]); when excess office capacity and personnel can be used for the office AEC; and, perhaps most importantly, when there is an ability to secure favorable contracts for facility payment from private health plans to the office endoscopy center. The evolution of EASCs over three decades has demonstrated many advantages to patients, physicians, and payers. Although further questions and challenges are inevitable, EASCs can adapt quickly and deliver value. The author believes the future is deservedly bright for such facilities.