Ambulatory surgery centers: harbinger of managed care shift.

Since the late 1960s, elective surgery in the US has been shifting from traditional hospitals to freestanding, independent, corporate or hospital-owned ambulatory surgery centers (ASCs). At present, over three million surgeries are performed yearly in some 2,100 ASCs across the nation. Many underlying forces have been at work influencing this change in the surgical environment. For example, technological advances in minimally invasive procedures have gained acceptance by physicians and patients alike. And these new surgical developments are used in ASCs. Patients have chosen convenience over the institutional approach. And finally, managed care has demanded the lower overhead costs and the efficiencies that ASCs provide. This article examines the growth of ASCs. It also looks specifically at how Columbia/HCA's 130 ambulatory surgery centers purchase products and services.