Ambulatory surgery centers (ASCs) have seen tremendous growth in the United States over the past few decades. These healthcare facilities allow for surgical procedures to be performed on an outpatient basis, with patients arriving for their surgery and then going home the same day. ASCs offer more convenient options for many low-risk surgical procedures as compared to traditional hospital-based outpatient departments or inpatient admissions. This article will explore the rise of ASCs in the U.S., their benefits over other settings, and projected trends for the future.

Growth of ASCs

According to industry data, the number of ASCs in the U.S. has grown from around 1,000 facilities in the 1990s to over 5,600 facilities currently. This growth has been driven by a few key factors. Firstly, many common surgical procedures such as cataract removal, colonoscopy, and orthopedic procedures can safely be performed in ASCs as opposed to requiring an overnight hospital stay. Secondly, ASCs are typically lower-cost settings compared to hospital outpatient departments due to lower overhead expenses. They do not need to support the full services of an acute care hospital. Thirdly, ASCs can offer patients and surgeons more scheduling flexibility and shorter wait times than packed hospital schedules.

The types of surgical specialties serviced in ASCs have also expanded over the years. While early ASCs focused mainly on ophthalmology, gastroenterology, and pain management procedures, now facilities have capabilities for orthopedics, podiatry, ENT, gynecology, and other areas. The largest ASC companies have made acquisitions and developed “specialty hospitals” focused on specific clinical areas like orthopedic surgery. The country's largest ASC company, Surgery Partners, now operates over 180 surgical facilities across 30 states. Private equity firms have also invested heavily in building national ASC platforms over the past decade.

Benefits of ASCs

ASCs offer clear benefits for both patients and the overall healthcare system when medically appropriate procedures are performed there versus in hospital settings. For patients, ASCs allow for convenient, scheduled surgery close to home without an overnight hospital stay required. Most patients prefer the ASC model when given a choice between it and traditional outpatient hospital care.

Regulatory and Payment Pathways

Given their growth and importance as lower-cost alternatives, Medicare and many private insurers have developed designations and payment pathways specifically for ASCs in recent years. For Medicare patients, CMS has established ASC payment groups based on procedures and their clinical characteristics and risk levels. Payments are made at a pre-determined rate for each payment group. Commercial insurance companies also typically reimburse ASCs at percentages of hospital outpatient department rates, providing incentives for use of ASCs over hospital outpatient settings when possible.

Projected Growth and Impact

Looking ahead, industry analysts project continued strong growth of the ASC market sector. As health systems increasingly turn to joint ventures, management agreements, and development deals with large ASC companies, the number of facilities is projected to increase to over 8,000 by 2025. With ASCs estimated to handle half of all elective outpatient procedures within the next decade, this growth will likely lower total spending on healthcare infrastructure in the United States.

In conclusion, ASCs have revolutionized where many low-risk surgical procedures are performed in America. By providing high-quality, convenient outpatient care at lower costs than traditional hospital settings, ASCs offer patients, payers and the healthcare industry realized savings that can benefit all stakeholders. Though questions remain regarding oversight, quality reporting and payment reform, continued growth of ASCs nationwide will be instrumental for controlling escalating medical costs while meeting consumer demand for affordable, accessible surgical care close to home.