The Downeast Surgery Center in Bangor is opening this Wednesday. The surgical suite is owned by a group of local surgeons. Credit: Gabor Degre

A group of Bangor surgeons has opened a new outpatient surgery center near the Bangor Mall that allows them to more easily do advanced types of surgery, in particular same-day knee, hip and shoulder replacements.

On Wednesday, Downeast Surgery Center officially opens its larger facility at 73 Ridgewood Ave. off Stillwater Avenue, which features three operating rooms, extra storage space and state-of-the-art technology.

The new building replaces the surgical suite that Downeast Surgical Center had until recently been leasing at the Acadia Medical Arts Building at 404 State St., which is owned by Northern Light Health and had just two smaller operating rooms.

The extra space gives the orthopedic surgeons more room to perform outpatient total joint replacements, according to Dr. John Pyne, the president of DownEast Orthopedics, an affiliated medical group that’s located across the street from the new surgical center. Plastic surgeons from Bangor Plastic & Hand will also use the center.

The Bangor surgical center’s expansion is part of a national shift in health care toward freestanding, specialized surgical centers. The shift poses significant competition for local hospitals because some patients might find the setting more appealing than a hospital and because freestanding centers typically offer markedly lower prices.

“It’s a smaller, more intimate experience,” Pyne said. “You’re not lost in the shuffle. You’re not getting there hours ahead of time. We can control how it operates.”

Whereas many surgeries have traditionally been performed in hospitals on an inpatient basis, changing technology allows independent surgeons to do a small but increasing share of their work in freestanding centers that specialize in particular types of operations, according to John Morrow, managing director of Franklin Trust Ratings, which provides industry data to help health care clients make decisions.

Some of the greatest evidence of that shift has been the handful of vision care centers that have opened between Bangor and Ellsworth, according to Morrow, who lives in Maine and has analyzed the growth of freestanding outpatient surgery centers across the country. Colonoscopies are also among the most common outpatient procedures nationally.

New technology has made it easier for surgeons to do more complicated procedures such as joint replacements and heart surgery on carefully screened patients, according to Morrow.

Freestanding surgical centers can provide those services more affordably and efficiently than hospitals because they can specialize in one area, such as orthopedics or gastroenterology, Morrow said, comparing them to “a production line.” Because they charge less for the work, the federal Centers for Medicare and Medicaid Services has been increasingly willing to pay for it to be done in those facilities.

Those dynamics could drive even more patients to start seeking surgery in freestanding centers, Morrow said, taking away business from large health care systems such as Portland-based MaineHealth and Brewer-based Northern Light Health, which has grown to include nine hospitals stretching from Presque Isle to Portland.

In a 2017 analysis of the country’s 50 biggest health care markets, Morrow found that freestanding surgical providers had claimed as much 80 percent of the surgical volume in some markets. If those markets all managed to reach that 80 percent threshold, the report forecast cuts to hospital revenue of $24 billion and savings to consumers, employers and insurers of $10.5 billion, according to the analysis.

“This is going to pose a big problem for these old-school hospital systems who are behind the times and are aggregating bricks and mortar,” Morrow said. “They’re going to lose patients to a better, faster, cheaper way of getting care.”

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Representatives of both Downeast Surgery Center and Northern Light Eastern Maine Medical Center said they did not expect much patient volume to shift from the hospital to the new center as a result of the expansion.

When patients go to Downeast Surgery Center, Pyne said they are carefully screened to make sure their age, weight and overall health qualify them for surgery outside a hospital. If the patients don’t pass that screening, the surgeons can still operate on their patients at Northern Light Eastern Maine Medical Center or St. Joseph Hospital.

The new suite cost about $7 million to build and equip, and construction started on it last summer. A dozen surgeons will operate there — often operating for less than Bangor’s two hospitals.

Patients can view some of those price differences on the website CompareMaine, which breaks down the average amounts individual health care facilities across the state are paid for some procedures.

The average cost for carpal tunnel release surgery, for example, is $3,125 at Downeast Orthopedics, which is below the state average of $3,822, according to the database. In Bangor, the other costs for that procedure are $8,210 at Northern Light EMMC and $4,619 at St. Joseph Hospital.

Downeast Surgery Center also offers lower prices for surgical arthroscopy of the knee and shoulder, according to the database. It does not yet carry price information about outpatient knee and hip replacements.

In a statement, Northern Light Health spokeswoman Suzanne Spruce said the system’s Bangor hospital expects to be able to provide same-day knee replacements beginning this summer.

As a large hospital, Spruce said, Northern Light EMMC must be prepared to offer a wider array of surgical services than are available at the private outpatient center and that it must offer emergency care regardless of patients’ ability to pay for it, all of which can contribute to higher prices.