Here are 101 ASC benchmarks on operational, financial, revenue cycle and quality benchmarks gathered from several sources across the industry.
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Operational
The following ASC salary and benefits statistics are from the HealthCare Appraisers "ASC Valuation Survey 2017: How Do ASC Companies Assess Value?" that includes responses from 24 ASC companies representing more than 700 surgery centers throughout the United States. The centers include only those that are in-network. Here is the percentage of revenue used on ASC operating expenses.
Salary and benefits
1. 10 percent to 19.9 percent of revenue: 5 percent of respondents
2. 20 percent to 29.9 percent of revenue: 57 percent
3. 30 percent to 39 percent of revenue: 33 percent
4. 40 percent to 49.9 percent: 5 percent
Occupancy
5. 0 percent to 9.9 percent of revenue: 47 percent of respondents
6. 10 percent to 19.9 percent of revenue: 47 percent
7. 20 percent to 29.9 percent of revenue: 5 percent
Drug, medical supplies and implantables
8. 0 percent to 9.9 percent: 5 percent
9. 10 percent to 19.9 percent of revenue: 5 percent
10. 20 percent to 29.9 percent of revenue: 67 percent
11. 30 percent to 39.9 percent of revenue: 5 percent
Management fees
12. Management fees vary based on revenue levels: 41 percent
13. ASC management fee arrangements where a portion of the fee is at risk: 14 percent
14. Minimum fees:
• Less than $100,000: 30 percent
• $100,000 to $199,999: 50 percent
• $200,000 to $299,999: 10 percent
• More than $300,000: 10 percent
15. Threshold when ASC management fees decrease:
• Average annual income less than $5 million: 25 percent
• $5 million to $7.49 million: 38 percent
• $7.5 million to $9.9 million: 0 percent
• $10 million to $12.49 million: 25 percent
• $12.5 million to $14.99 million: 0 percent
• More than $15 million: 13 percent
16. Billing fees as a percentage of net revenue:
• 2 percent to 2.9 percent: 10 percent
• 3 percent to 3.9 percent: 10 percent
• 4 percent to 4.9 percent: 38 percent
• 5 percent to 5.9 percent: 19 percent
• 6 percent to 6.9 percent: 14 percent
• More than 7 percent: 10 percent
Staffing
The following statistics are based on VMG Health’s Intellimarker Ambulatory Surgical Centers Financial & Operational Benchmarking Study 2017 report. The study includes an analysis of more than 278 licensed freestanding ASC covering more than 1.3 million cases.
17. Employee salaries and wages:
• As a percentage of net revenue: 22 percent
• Per square foot: $137
• Per operating room: $481,000
• Per case: $422
18. Employee benefits:
• As a percentage of net revenue: 4.7 percent
• Per square foot: $29
• Per operating room: $106,000
• Per case: $93
19. Staff hours per case:
• Nurse: 7
• Tech: 3
• Administrative: 4.5
• Total: 14.5
20. Hourly wages:
• Nurse: $35.58 per hour
• Tech: $23.32
• Administrative: $26.24
Revenue cycle
The following benchmarks are based on the Regent RCM ASC Revenue Cycle Benchmarking Video Series and include the Regent RCM Gold Standard benchmarks unless otherwise noted.
21. Clean claims — claims with no edits or rejections: 95 percent industry standard
22. Days outstanding/days in accounts receivable: 30 days
23. Days outstanding for out-of-network claims: 50 days
24. Percent of A/R over 90 days: 12 percent
25. Denials: 10 percent industry standard
26. Net collection rate: 97 percent
27. Claim lag and charge lag: 48 hours
28. Statement lag — time balance becomes the patient's responsibility to the time the statement goes out the door: Less than five days
29. Staffing — business office FTEs per 1,000 cases: 1.5
Payer mix
The following statistics are based on VMG Health’s Intellimarker Ambulatory Surgical Centers Financial & Operational Benchmarking Study 2017 report. The study includes an analysis of more than 278 licensed freestanding ASC covering more than 1.3 million cases.
30. Medicare:
• Mean: 27 percent
• 25th percentile: 15 percent
• Median: 24 percent
• 75th percentile: 37 percent
• 90th percentile: 48 percent
31. Medicaid:
• Mean: 7 percent
• 25th percentile: 3 percent
• Median: 5 percent
• 75th percentile: 8 percent
• 90th percentile: 15 percent
32. Commercial:
• Mean: 56 percent
• 25th percentile: 47 percent
• Median: 58 percent
• 75th percentile: 69 percent
• 90th percentile: 76 percent
33. Workers Comp:
• Mean: 10 percent
• 25th percentile: 3 percent
• Median: 5 percent
• 75th percentile: 12 percent
• 90th percentile: 18 percent
34. Self-Pay:
• Mean: 5 percent
• 25th percentile: 2 percent
• Median: 3 percent
• 75th percentile: 5 percent
• 90th percentile: 10 percent
35. Other Pay:
• Mean: 7 percent
• 25th percentile: 2 percent
• Median: 4 percent
• 75th percentile: 9 percent
• 90th percentile: 14 percent
Quality
The following data is based on the ASC Quality Collaboration Quality Report from the second quarter of 2017. There were 1,477 ASCs participating, representing more than 1.8 million admissions. The data was collected April 1, 2017 through June 30, 2017. There were 892 multispecialty ASCs and 585 single specialty ASCs from all 50 states. However, not all ASCs provided data for each quality measure.
36. Patient fall rate per 1,000 ASC admissions: 0.115 per
37. Patient burn rate per 1,000 ASC admissions: 0.015
38. Hospital transfers/admissions per 1,000 ASC admissions: 0.930
39. Rate of wrong site, side, patient, procedure, implant per 1,000 ASC admissions: 0.020
40. Rate of prophylactic IV antibiotic timing: 99 percent
41. Percentage of ASC admissions with appropriate surgical site hair removal: 98 percent
42. Percentage of eligible ASC patients with normothermia: 97 percent
43. Percentage of ASC cataract patients with unplanned anterior vitrectomy: 0.43 percent
44. Rate of toxic anterior segment syndrome per 1,000 admissions: 0.24
45. Rate of emergency department visits within one day of discharge per 1,000 admissions: 0.70
46. Rate of unplanned hospital admissions within one day of ASC discharge per 1,000 admissions: 0.35
Clinical benchmarks
Cataract surgery
Benchmarking study from AAAHC based on clinical studies of cataract extraction surgeries with lens insertions between January and June 2017. The study includes 51 organizations with a combined 104,049 cataract surgeries per year.
47. 83 percent of patients wait less than one month after scheduling cataract surgery before undergoing the procedure.
48. 94 percent of patients are able to schedule their cataract surgery at their desired time in the ASC.
49. 93 percent of patients resume daily living within a week of undergoing cataract surgery.
50. 94 percent of patients reported improved vision after cataract surgery in an ASC.
51. 98 percent of patients say they're comfortable while undergoing cataract surgery in the ASC and 99 percent are comfortable after discharge.
52. 99 percent of patients report they would recommend cataract surgery after undergoing the procedure in an ASC.
53. Pre-procedure time is 83 minutes for cataract surgeries.
53. Procedure time for cataract surgeries in ASCs is 12 minutes.
55. Discharge time for cataract surgeries is 18 minutes.
GI/endoscopy
Benchmarking study from AAAHC on clinical findings for colonoscopy from 35 organizations performing 177,109 colonoscopies between January and June 2017. Additional information from the AAAHC benchmarking study on clinical findings for 35,083 esophagogastroduodenoscopy procedures performed at 21 organizations between January and June 2017 is also featured in this section.
56. 77 percent of colonoscopy patients report little or no discomfort during bowel preparation.
57. 70 percent of colonoscopy patients wait less than a month between scheduling their colonoscopy and having the procedure.
58. 99 percent of colonoscopy patients report being comfortable after discharge.
59. 97 percent of colonoscopy patients report little or no discomfort during the procedure and 99 percent would recommend it to others.
60. 100 percent of colonoscopy patients report understanding the procedure.
61. Colonoscopy procedure time is 10 to 54 minutes.
62. Pre-procedure time for colonoscopy is 29 to 111 minutes, covering patient check-in to scope insertion.
63. Colonoscopy discharge time is 15 to 54 minutes for ASCs.
64. 89 percent of esophagogastroduodenoscopy (EGD) patients wait less than a month between scheduling their EGD and having the procedure.
65. 99 percent of EGD patients report being comfortable after discharge.
66. 100 percent of EGD patients report little or no discomfort during the procedure and 99 percent would recommend it to others.
67. 100 percent of EGD patients report understanding the procedure.
68. EGD procedure time is three to 18 minutes.
69. Pre-procedure time for EGD is 24 to 98 minutes, covering patient check-in to scope insertion.
70. EGD discharge time is 20 to 80 minutes for ASCs.
Knee arthroscopy
The following is based on a benchmarking study from AAAHC on clinical findings for knee arthroscopy in the ASC based on data from 19 organizations that perform a combined total of 5,161 knee arthroscopies annually. The study was conducted between January and June 2017.
71. Pre-procedure time for knee arthroscopy is 106 minutes, and organizations with shortest times attribute results to using a standardized process that includes calling the patient before the procedure day and scheduling all routine cases at the beginning of the day.
72. Knee arthroscopy procedure time is 25 minutes in the ASC.
73. Discharge time for knee arthroscopy is 84 minutes in the ASC, and organizations with short discharge times attribute results to not over-sedating patients, providing written and verbal discharge instructions and prohibiting the use of cell phones in the PACU.
74. 73 percent of knee arthroscopy patients wait less than a month for their procedure after scheduling.
75. 85 percent of knee arthroscopy patients are able to schedule the procedure as soon as they wanted in the ASC.
76. 99 percent of knee arthroscopy patients say they are comfortable post-discharge in the ASC.
77. 100 percent of knee arthroscopy patients report little or no discomfort during the procedure and 98 percent would recommend it to others
Low back injections
The following is based on a benchmarking study from AAAHC on clinical findings for low back pain in ambulatory care settings based on data from 31 organizations that perform a combined total of more than 45,728 low back injections annually. The data was collected between January and June 2017.
78. Pre-procedure time for low back injections is 49 minutes, and organizations with the shortest pre-procedure times attribute results to involving the physician, either in scheduling or keeping the physician up-to-date on patient arrival.
79. Procedure time is six minutes for low back injections in the surgery center.
80. Discharge time after low back injections in the ASC is 20 minutes, with a range of seven to 52 minutes.
81. 94 percent of patient wait less than a month from scheduling their low back injection to undergoing the procedure in the ASC.
82. 96 percent of patients say they are able to schedule their low back injections in an ASC within a "reasonable" period to time.
83. 89 percent of patients report returning to daily activities after undergoing low back injections in ASCs.
84. 82 percent of patients say they experienced less pain after the low back injections, and 47 percent reduced pain medications after the procedure.
YAG laser posterior capsulotomy
The following is based on a benchmarking study from AAAHC on clinical findings for YAG laser posterior capsulotomy in the ASC based on data from 28 organizations that perform a combined total of 15,509 YAG laser posterior capsulotomy procedures annually. The study was conducted between January and June 2017.
85. 94 percent of patients wait less than one month after scheduling YAG laser posterior capsulotomy surgery before undergoing the procedure.
86. 96 percent of patients are able to schedule their YAG laser posterior capsulotomy surgery at their desired time in the ASC.
87. 100 percent of patients resume daily living within a week of undergoing YAG laser posterior capsulotomy surgery.
88. 88 percent of patients reported improved vision after YAG laser posterior capsulotomy surgery in an ASC; 96 percent of patients reported that their physician rated their eyesight as better after the procedure.
89. 99.6 percent of patients say they're comfortable while undergoing YAG laser posterior capsulotomy surgery in the ASC and 98 percent are comfortable after discharge.
90. 98 percent of patients report they would recommend YAG laser posterior capsulotomy surgery after undergoing the procedure in an ASC.
91. Pre-procedure time is 42 minutes for YAG laser posterior capsulotomy surgeries.
92. Procedure time for YAG laser posterior capsulotomy surgeries in ASCs is two minutes.
Case volume & revenue
The following statistics are based on VMG Health’s Intellimarker Ambulatory Surgical Centers Financial & Operational Benchmarking Study 2017 report. The study includes an analysis of more than 278 licensed freestanding ASC covering more than 1.3 million cases.
93. Case volume mix as a percentage of total cases:
• Gastroenterology: 29 percent
• Ophthalmology: 20 percent
• Orthopedics: 16 percent
• Pain management: 16 percent
• Otolaryngology: 8 percent
• General surgery: 7 percent
• Oral surgery: 7 percent
• Urology: 6 percent
• Obstetrics and gynecology: 4 percent
• Plastic surgery: 4 percent
• Podiatry: 3 percent
94. Net revenue per case:
• Orthopedics: $3,133
• Otolaryngology: $2,591
• Podiatry: $2,506
• Urology: $2,368
• Obstetrics and gynecology: $2,344
• General surgery: $2,156
• Plastic surgery: $1,797
• Ophthalmology: $1,434
• Oral surgery: $1,217
• Pain management: $1,074
• Gastroenterology: $1,004
Operating expense
The following statistics are based on VMG Health’s Intellimarker Ambulatory Surgical Centers Financial & Operational Benchmarking Study 2017 report. The study includes an analysis of more than 278 licensed freestanding ASC covering more than 1.3 million cases.
95. All facilities
• Employee salaries and wages: $412
• Taxes and benefits: $94
• Occupancy costs: $114
• Drugs and medical supplies: $456
• Other medical costs: $7
• Insurance: $11
• General and administrative: $305
• Total operating expenses: $1,400
96. Atlantic:
• Employee salaries and wages: $362
• Taxes and benefits: $91
• Occupancy costs: $97
• Drugs and medical supplies: $391
• Other medical costs: $6
• Insurance: $13
• General and administrative: $272
• Total operating expenses: $1,232
97. Midwest:
• Employee salaries and wages: $357
• Taxes and benefits: $83
• Occupancy costs: $108
• Drugs and medical supplies: $463
• Other medical costs: $9
• Insurance: $17
• General and administrative: $336
• Total operating expenses: $1,374
98. Mountain:
• Employee salaries and wages: $449
• Taxes and benefits: $102
• Occupancy costs: $122
• Drugs and medical supplies: $463
• Other medical costs: $7
• Insurance: $8
• General and administrative: $289
• Total operating expenses: $1,405
99. Northeast:
• Employee salaries and wages: $393
• Taxes and benefits: $87
• Occupancy costs: $118
• Drugs and medical supplies: $425
• Other medical costs: $15
• Insurance: $11
• General and administrative: $253
• Total operating expenses: $1,302
100. Pacific:
• Employee salaries and wages: $516
• Taxes and benefits: $132
• Occupancy costs: $124
• Drugs and medical supplies: $492
• Other medical costs: $9
• Insurance: $15
• General and administrative: $325
• Total operating expenses: $1,612
101. South:
• Employee salaries and wages: $393
• Taxes and benefits: $93
• Occupancy costs: $120
• Drugs and medical supplies: $486
• Other medical costs: $6
• Insurance: $9
• General and administrative: $333
• Total operating expenses: $1,440