Surgical services are typically the most profitable area for a hospital. With revenues often exceeding two-thirds of a hospital’s total, these services have become the lifeline sustaining US hospitals in this turbulent healthcare market.

Unfortunately, the culture and management structure in many hospital-based settings for surgical patient care has not changed much over the past 100 years. This slow progress has made it difficult for many hospitals to adapt to current value-based payment models and do more to overcome current financial woes.

Some of the improvements in surgical care have actually exacerbated challenges facing surgical services. For example, an estimated 48.3 million ambulatory surgical and nonsurgical procedures were performed in the US in 2010. Of these, nearly 20 percent of surgeries were inpatient with overnight stays.1 The remaining procedures were performed in either surgical offices, ambulatory surgery centers (ASCs) or outpatient departments. Indeed, noninvasive surgical technology, improved patient-centric care and revenue gain-sharing have fueled the continued out-migration of surgery from the hospital.