As technology has improved, more surgeries have moved from inpatient to outpatient settings. Ambulatory
surgical centers (ASCs) were created as a "same-day surgery" alternative for routine inpatient procedures for
otherwise healthy patients. There are more than 450 licensed ASCs in Florida.
ASCs are not subject to the patient safety and quality standards necessary to ensure patients have sufficient
access to critical care services, should a complication arise. In recognition of this, the state requires ASCs to
maintain a collaborative agreement for transfer with a hospital. A 2018 investigation by Kaiser Health News
and the USA TODAY Network discovered that more than 260 patients have died since 2013 after in-and-out
procedures at surgery centers throughout the country. Dozens of patients, some as young as two years old,
have died after routine operations, such as colonoscopies and tonsillectomies. Yet, very little information is
available regarding patient outcomes following ambulatory operations.
Furthermore, ASCs are only classified for business occupancy by Florida Building Code. They are not required
to meet the same safety standards as hospitals, including backup for complications, disaster preparedness, special capabilities and stringent building codes.
The Centers for Medicare and Medicaid Services has stated surgery services that necessitate active medical monitoring and care, and patient stays beyond midnight, are not on the ASC-approved procedure list.
Therefore, they are not reimbursable. ASCs are not currently required to treat uninsured patients or contribute to the cost of the Medicaid program.