The disparity of care is a big topic in health care today, so it’s time to address how the Ambulatory Surgery Center industry can assist in lessening this issue. It’s important to ask ourselves – are we contributing to or worsening the chasm of care?
According to the Centers for Disease Control and Prevention (CDC), the social determinants of health (SDOH) are conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of-life risks and outcomes. Social determinants of health include aspects of the social environment such as discrimination, income, education level, marital status, and physical environments such as residence, crowding conditions, isolation, and transportation systems.
Examples of social determinants include:
- the availability of resources to meet daily needs, such as education, job opportunities, living wages, or healthful foods, and
- social norms and attitudes, like discrimination, exposure to crime, violence, and social unrest, can also be determinants.
Research shows that social determinants can be more important than health care or lifestyle choices in influencing health. For example, numerous studies suggest that SDOH accounts for 30-55% of health outcomes. Addressing SDOH is central to improving health and reducing inequities in care. All industries and civil society should participate, but ASCs do not seem to be front and center in this battle.
The CDC’s Current Framework
The CDC’s current framework, aligned with Healthy People 2030, breaks SDOH into five domains: healthcare access and quality, education access and quality, social and community context, economic stability, and neighborhood and built environment. The categories map closely onto what’s described above, but the formal breakdown gives ASC leaders a useful checklist when building out intake questions or community partnerships: does your current process account for all five, or just the one or two that come up most often?
How Can ASCs Help?
Most of us want to act, and recognizing the patients at risk is the first step. Income is perhaps the most apparent social determinant of health. Income level shapes overall living conditions, affects psychological functioning, and influences health-related behaviors such as quality of diet, the extent of physical activity, smoking, and excessive alcohol use. ASCs are for-profit and usually provide “elective” surgery. However, many surgeries are necessary to obtain the quality of life we all desire and deserve. Are you taking the time to identify those patients who need monetary assistance? If your center provides its fair share of charity work, that’s a significant first step, but SDOH identification does not stop at income.
Assessments help nurses objectively identify each patient’s unique needs and concerns and any potential barriers to care that may affect compliance and outcome. Perioperative nurses may encounter the effects of SDOH when patients express concern about:
- Surgery scheduling times
- Transportation
- Child care
- Post-operative assistance
- Other support-related issues during the perioperative period.
Some SDOH may be related to social identity (e.g., race, ethnicity, sexual orientation), resulting in fear of discrimination that some groups experience. Perioperative nurses can establish trust with their patients by identifying their needs and partnering with community-based organizations to address some of those needs (e.g., transportation, legal assistance, prescription medication sources, home health care follow-up). This type of resource assistance may help relieve stress for patients and promote better post-surgical outcomes. Healthcare workers can assist individual patients in addressing the effects of SDOH on their health and life for a particular surgical event. Still, policy and procedure changes are needed to ensure long-term benefits.
Where ASC-Specific Policy Stands Right Now
This is an area of active federal policy, and it has moved in both directions recently. CMS adopted a Facility Commitment to Health Equity measure and two new Social Drivers of Health measures, a screening rate and a screen-positive rate, into the ASC Quality Reporting Program beginning with the CY 2025 reporting period.
Specifically, the screening measure would have tracked the percentage of patients screened for five needs: food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety, while the companion measure would have tracked how many of those patients screened positive for at least one.
It’s a useful list to borrow from even without the reporting requirement behind it: several of those five needs already overlap with the Simple Steps questions below. The Ambulatory Surgery Center Association pushed back on the mandate itself, arguing that ASCs lack the data-collection infrastructure hospitals already have for this kind of measure. CMS’s Calendar Year 2026 final rule then reversed course, removing all three measures from the ASCQR Program.
That reversal doesn’t make the underlying issue any less real; it just means there’s no federal reporting mandate forcing the conversation right now. For ASCs that keep addressing SDOH anyway, it becomes a genuine point of differentiation rather than a box to check for a surveyor.
Simple Steps That Your ASC Can Start Now:
- Ask the right questions. Here are a few examples to add to your pre-operative questionnaire:
- The patient’s living conditions at home: Is it warm or cool enough? Do you have access to bathing facilities? Do you have resources lined up to check in and assist if necessary?
- Post-op care: Do you have access to the proper medications, and do you understand what is expected? Are you able to prepare meals for yourself? Do you have access to dressing change materials?
- Have a list of resources at your fingertips, and be prepared to follow up as necessary.
- Provide pre- and post-operative instructions to the patient in a format that they can understand and follow. Handing a patient written instructions that they may not be able to read or understand is of no value.
- What This Looks Like in Practice
The approach above isn’t theoretical. A recent study of a patient navigator program at an outpatient ophthalmic surgery practice found that navigators who addressed transportation, a missing surgical companion, or insurance gaps got 78% of referred patients to surgery, with transportation-related barriers resolved in 90% of cases and companion-related barriers resolved in 83%.
The same research also confirms what’s been documented for years: ASCs tend to cluster in higher-income neighborhoods, which compounds access barriers for patients already dealing with transportation or insurance gaps.
If you want a validated starting point rather than building a questionnaire from scratch, PRAPARE (the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences) is a standardized SDOH screening tool developed by the National Association of Community Health Centers, with core questions covering housing, transportation, food access, and personal safety, and it’s already built into several major EHR systems as structured data fields. It was designed for primary care, but the questions translate directly to a pre-operative intake form.
The stakes of catching these needs aren’t abstract: a separate inpatient study using PRAPARE found that patients with at least one identified social need were readmitted within 30 days at nearly three times the rate of patients with none, 42.5% versus 15%, and each additional need raised the odds of readmission by roughly 2.2 times. That study wasn’t looking at surgical patients specifically, but it’s a reasonable signal that unmet social needs affect recovery, not just whether a patient makes it to their surgery date in the first place.
Putting a name to this role helps. Whether it’s a scheduler, a financial counselor, or a dedicated patient navigator, having one person responsible for catching these barriers before the day of surgery, rather than leaving it to whoever happens to take the call, is what turns a good intake questionnaire into results. A few places this connects to work already in motion at your center:
- Multi-language intake forms and consistent risk flags across every referring office, so a language barrier or missed allergy doesn’t depend on which scheduler answers the phone. We covered this in our guide on Improving the Patient Experience: Best Practices for Pre-Assessment Workflows.
- Clear, upfront cost estimates and flexible payment plans, so income doesn’t become the reason a patient postpones a necessary procedure. See our article on patient financial services and prepayments.
- Staffing the role itself. Centers building out patient navigator, financial counselor, or bilingual patient access positions can find ASC-specific candidates through the ASC Job Board, a recruiting platform built specifically for ambulatory surgery roles.
Bridging the Gap Starts with You
The most significant step we can take is changing the process now. We cannot expect the clinics, offices, hospitals, and providers to be the only ones with their eyes on the potential issues. We all have a role in changing the status quo. The disparity of care is everywhere, and bridging the gap starts with you.