Factors affecting patient selection of outpatient surgery venue: Are ambulatory surgery centers attracting a healthier patient population than hospital outpatient departments?

Abstract

To assess the claim that ambulatory surgery centers (ASC) attract healthier patients than hospital outpatient departments, patient selection across these two venues was analyzed for four common outpatient surgical procedures: colonoscopy, knee arthroscopy, cataract repair, and hernia repair. Using a consumer choice framework and complete data on outpatient surgeries performed in Florida in 2004, we estimate a probit model to evaluate factors that affect patients' selection of outpatient surgery venue. Across all four procedure types, patients with more complex surgical cases, as assessed by the number and intensity of procedures and the number and types of diagnoses, were significantly less likely to seek treatment in an ASC. Policymakers should consider favorable patient selection, as well as information about ASC's relative costs and efficiency, in setting future Medicare and Medicaid outpatient reimbursement rates.