Routine GI Endoscopy Already Popular in ASCs, Will EUS Be Next?

The first Ambulatory Surgery Center (ASC) in the U.S. opened in 1970, offering an opportunity for patients to have access to the quality care they needed, without the wait time and cost often associated with hospitals.

Fast forward 50 years and the global COVID-19 pandemic fueled an already growing trend of patient preference for the convenience of ASCs. Today, more than 30 million surgeries and procedures are performed at more than 5,800 ASCs nationwide every year.

Large investments from MedTech industry giants may help fuel the still growing trend for out of hospital care. A recent partnership of GE Healthcare and Medtronic announced in April promises “cost-effective advanced technology” support for the growing suite of ASCs across the country.

The question remains how ASCs will be able to adapt to the increased demand for outpatient care when it comes to more advanced procedures – especially those performed by physicians with specialized training and requiring costly equipment, typically only found in hospitals.

GI Care in the ASC

In gastroenterology, there has been a huge uptick to procedures in ASCs, especially for routine endoscopy. Since ASCs typically offer a more convenient location, time-saving, and cost-saving alternative, they can be especially attractive to patients needing a routine colonoscopy.

The ASC Association lists endoscopy as one the primary specialties certain ASCs may offer (about 32 percent). Definitive Healthcare reported colonoscopies topped the list of reported procedures charged at ASCs in 2018 – approximately $3.2 billion in submitted claims.

Since average costs for colonoscopies can range from around $3,000 to as high as $19,000, it’s not surprising patients are choosing ASCs over the hospital for routine care.

As another example, a review of South Carolina colonoscopy rates and locations found that while the number of procedures stayed constant between 2001 and 2017, there was an 125 percent increase in colonoscopies performed in urban ASCs in that timespan.

EUS Outside of the Hospital

As the number of ASC sites grows and advanced medical technology becomes more readily available, there have been signs that more specialized gastroenterological endoscopy procedures may become more popular at the ASC as well.

Endoscopic ultrasound (EUS) is a minimally invasive procedure used to diagnose disease in the digestive and respiratory tracts. An alternative to surgery, EUS tools allow physicians to take images and samples for biopsies with specialized endoscopes. EUS is typically performed in the hospital endoscopy unit with patients under general anesthesia.

Given the expense of EUS technology and specialization required from physicians, transitioning procedures to an ASC could prove burdensome, with few doctors able to perform the procedures at these locations. A 2016 study from Dr. Shaffer R. S. Mok, et al, out of the MD Anderson Cancer Center in Jersey shows the feasibility and safety of EUS in the ASC, and the idea has gained more traction in recent years.

Continued innovation of EUS technology could be one of the ways to help move procedures to the ASC from the hospital, at great benefit to patients.