At an ASC industry gathering this year, one of the speakers invoked former U.S. Congressman J.C. Watts, who once said, "Confidence is the feeling you have before you fully understand the situation."

The ASC industry today evokes a range of feelings, most of them grounded not in confidence but in confusion, particularly with regard to the regulatory machinations in Washington.

Confidence does appear to have a place, though, thanks to a number of factors that portend a strong market for growth. Rising health-care costs are expected to continue to make outpatient surgery more attractive to the government and private insurers. Technology, too, is a positive driver of the number and kind of techniques that are possible in an ASC. The idea that retinal surgery, for example, could find a home in outpatient settings might have been unthinkable until very recently. Yet, as part of our report this month on ASCs, Phoenix surgeon Pravin Dugel, MD, makes a strong case that the concept is not so far out.

In fact, ASC volumes are growing faster, at 8 to 10 percent a year, than hospital volumes, at 1 percent, according to Adam Feinstein, an analyst for Lehman Brothers.

At least in the near term, however,  confidence would not be the first word to describe those who labor in the regulatory trenches. Washington experts Mike Romansky and Eric Zimmerman, who understand the regulatory situation as well as anyone, particularly as it relates to ophthalmology, say that ASCs are entering a critical period. In the first of two parts, their article this month details recent regulatory decisions and actions that have brought the industry to a crossroads.

How the next two years play out, in terms of the industry's ability to influence federal regulators attempting to recast the ASC payment system—over the voices of an increasingly influential hospital lobby—will be critical to the growth of ophthalmic ASCs. Look for part two of their report next month.
The road to the bright future that many foresee for ASCs is under construction as we speak. Like most projects under construction, at the moment it looks like a mess.