Ambulatory Surgical Care

Fellowship Class 2013-2014


As one of the fastest growing sectors of health care delivery, ambulatory surgical care currently accounts for $209 billion dollars, or 8%, of domestic health care spending. Yet it is also highly inefficient, providing vast opportunities for improvement of the patient experience.

Safely reducing per capita spending for ambulatory surgery

CERC’s surgical care redesign team found three addressable failure points in current methods of delivery of ambulatory surgical care. Team members addressed these failure points via a new care model with three core elements: (1) reduction of the volume of surgeries, targeting overuse, through the routine use of patient decision aids, provider clinical decision support, and primary care provider case coaching; (2) resetting the location of the majority of elective ambulatory surgery to free-standing ambulatory surgical centers operating with expanded hours (18 hours a day/7 days a week); (3) standardizing processes through the implementation of coordinated transitions, homogenized inputs, and streamlined operations.

Estimated Savings

A conservative estimate of national savings from full implementation of the CERC surgical model is $45 billion per year in direct health care spending by the end of year five, or 21% of annual domestic spending on outpatient surgical care.


Kimberly Brayton, MD, JD, Feryal Erhun, PhD, Maziyar Kalani, MD, Christine Nguyen, Terry Platchek, MD, Donna Zulman, MD, MS, Arnold Milstein, MD, MPH, 2014