Ambulatory health care

Ambulatory care covers a wide range of health care services that are providedfor patients who are not admitted overnight to a hospital. These services are performed at outpatient clinics, urgent care centers, emergency rooms, ambulatory or same-day surgery centers, diagnostic and imaging centers, primary care centers, community health centers, occupational health centers, mental health clinics, and group practices.

Ambulatory health care has grown tremendously since the early 1980s. Its growth has been driven by a desire for insurers and the United States governmentto control health care costs. In addition, advances in technology make many tests and surgeries that were formerly done as inpatient procedures in hospital settings safe to do in freestanding clinics or centers. The development ofexpensive specialty equipment such as magnetic resonance imaging (MRI) has lead to the establishment of specialty centers for diagnostic testing. Some health maintenance organizations (HMOs) have developed their own freestanding ambulatory health care centers. Other insurers encourage patients to use ambulatory care centers by limiting their reimbursement to specific centers and refusing to cover the full cost of certain procedures when done in hospital inpatient settings.

The growth of ambulatory surgical centers, also called outpatient or same-daysurgery centers illustrates the shift in procedures away from hospitals. In1970 the first ambulatory surgery center in the United States opened in Phoenix, Arizona. The next year, the American Medical Association (AMA) passed a resolution supporting outpatient surgery under general or local anesthesia forlow risk patients needing selected procedures. By 1976 there were 67 outpatient surgery centers in the United States.

Outpatient surgery has grown with extraordinary rapidity since 1982 when theUnited States government approved Medicare reimbursement for surgeries performed in ambulatory surgery centers. By 1998, there were over 2,400 outpatientsurgery centers performing over 5 million surgeries annually in the United States.

Cost is the primary factor driving the expansion of ambulatory health care services. It is estimated that a procedure performed in an outpatient surgery center costs 30-60% less than the identical surgery performed in an inpatienthospital setting. Convenience is another factor in the rise of ambulatory care. Many patients find it more convenient and less stressful to recover at home rather than in a hospital. Advances in microsurgery have made it safe for many procedures that once required a hospital stay to be done as day surgery.

All ambulatory care facilities that receive Medicare reimbursement are regulated and inspected by the federal government. Forty-one states also regulate some types of ambulatory care centers. Centers can also seek voluntary accreditation from organizations such as the Accreditation Association for Ambulatory Health Care (AAAHC) or the Joint Commission on Accreditation of HealthcareOrganizations (JCAHO). Individuals associated with ambulatory care centers may join the Society for Ambulatory Care Professionals, an organization that promotes standards and education for ambulatory care workers.

In choosing an ambulatory care facility, clients should inquire about licensing or certification from the appropriate state agency and certification by Medicare. The center's physicians should be board certified in the area in which they practice. Other questions that might be asked when selecting high quality ambulatory care could include: Is the center associated with a hospital?Does the center have a hospital transfer plan in case of emergencies? How isanesthesia administered and monitored? What is done to insure confidentialityof patient information, and under what circumstances is patient informationreleased? Will the insurance company reimburse for services provided at thiscenter? How much experience does the center have with the particular procedure or test the client needs done?

Ambulatory health care is an increasingly important source of health care services in the United States. Since 1973, the National Center for Health Statistics has conducted the National Ambulatory Medical Care Survey to collect information on who uses ambulatory care and for what reasons. This survey showsa steady increase in the use of ambulatory care facilities.

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