Rural Disparities in Ambulatory Surgery Center Access: Trends and Supply-side Factors

• In Event: When Distance Matters: Rural Healthcare Access and Disparities

Abstract

Affordable rural access to healthcare is a key policy concern. Since 2010, over 150 rural hospitals have closed, leading to effects on patient care. However, there is limited evidence on how access to non-hospital settings has evolved and how these facilities depend on local hospital access and physician labor supply.

This study examines trends in access to ambulatory surgery centers (ASCs) and the relationship between ASCs and the availability of hospitals and surgeons. ASCs are used for procedures such as colonoscopies, cataract surgeries, cardiac catheterizations, and knee replacements, but are reimbursed half as much as hospitals, key to affordability.

We combined CMS provider of services files and public use files summarizing Medicare billing to study these relationships. Since 2014, we found that the number of ASCs decreased by 5% in rural counties while increasing by 11% in urban counties. We show that these trends align with both shifts in physician practice locations and hospital availability, but more so with physician supply.

Next, we will estimate causal effects of hospital and physician availability on access to ASCs using a staggered adoption design. We will compare exit and utilization at ASCs that lose their nearest hospital to closure. We will also compare ASC count and utilization in counties that have their high-volume surgeons depart. We expect our results to shed new light on how access to low-cost providers depends on health care infrastructure and labor supply.

Author

• Anthony Yu, RAND Corporation
  Presenting Author