In 2019, ASCs that were certified by Medicare treated 3.5 million beneficiaries. The data in this list comes from the MedPAC 2021 Report to Congress, Avanza and VMG Health Intellimarker.
1. Number of ASCs in 2019: 5,816
2. States with the most ASCs per 100,000 Medicare beneficiaries
- Maryland: 38
- Georgia: 23
- Alaska: 19
- New Jersey: 18
3. Single-specialty ASC breakdown:
- Gastroenterology-driven ASCs: 1,082 (21 percent of ASCs)
- Ophthalmology-driven ASCs: 1,057 (21 percent of ASCs)
- Pain management ASCs: 619 (12 percent of ASCs)
- Dermatology-driven ASCs: 209 (4 percent of ASCs)
- Urology-driven ASCs: 134 (3 percent of ASCs)
- Cardiology-driven ASCs: 88 (2 percent of ASCs)
- Podiatry-driven ASCs: 83 (2 percent of ASCs)
- Orthopedics-driven ASCs: 32 (1 percent of ASCs)
- Respiratory-driven ASCs: 26 (1 percent of ASCs)
4. Number of single specialty ASCs: 3,356 (65 percent of all ASCs)
5. Number of multispecialty ASCs: 1,787 (35 percent of ASCs)
6. The volume of services per 1,000 CMS beneficiaries increased by 2.7 percent in 2019, compared to the average of 2.1 percent per year from 2014-18.
7. Most common ASC procedures:
- Cataract with intraocular lens insert, one stage: 18.5 percent
- Upper GI endoscopy, biopsy: 7.8 percent
- Colonoscopy and biopsy: 6.8 percent
- Lesion removal colonoscopy (snare technique): 6.5 percent
- Inject foramen epidural: lumbar, sacral: 4.6 percent
- After cataract laser surgery: 4.1 percent
- Inject paravertebral: lumbar, sacral: 3.4 percent
- Injection spine: lumbar, sacral (caudal): 2.5 percent
- Colorectal screen, high-risk individual: 2.1 percent
- Destroy lumbar/sacral facet joint: 1.7 percent.
8. Number of ASCs in largest companies in 2020:
- USPI (Dallas): 310
- AmSurg (Nashville, Tenn.): 250
- Surgical Care Affiliates (Deerfield, Ill.): 230
- SurgCenter Development (Towson, Md.): 155
- Surgery Partners (Brentwood, Tenn.): 180
9. Approximately 72 percent of ASC facilities remained independent in 2020.
10. The number of hospitals and health systems planning to increase their investments in ASCs rose from 44 percent to 67 percent from 2019-20.
11. In the same time frame, 76 percent of larger hospitals reported increasing their ASC investments.
12. The number of hospitals owning or affiliating with more than one ASC shot up 17 percentage points from 2019-20.
Key Insights:
Matthew Ewasko. Administrator of Physicians Alliance Surgery Center (Cape Girardeau, Mo.): Over the past year we have become much more forward-looking in our [decision-making] approach. Prior to the pandemic, we looked more at historical trends and possible one to two months in the future when considering decisions for the facility. Now we are looking at least three months, if not more, in the future when we are considering changes or purchases.
Steven Jascewsky. Administrator of Wellspring Pain Solutions (Columbus, Ind.): The smartest thing we did [in the past year] was to not furlough any employees who didn't need to be furloughed. We also decided, rather than furlough them, to expand my staff's responsibilities to become more actively involved in our upcoming EMR transition, which will pay dividends in not only buy-in but efficiency when we roll out.
Suzi Cunningham. Administrator of Advanced Ambulatory Surgery Center (Redlands, Calif.): I believe the future is bright for ASCs. We have proven to be a vital resource for patients and providers in many specialties. Our facility, in addition to hundreds of others, have been able to provide much-needed care to patients when hospitals weren't able [during the pandemic].
Marie Yarborough. Administrator of Skyway Surgery Center (Chico, Calif.): I feel that the payer landscape is improving for ASCs. We have big insurance companies finally realizing the ASC's cost effectiveness, lower infection rate and better quality outcomes, thus passing new policies to cover procedures in surgery centers.
Julie Nelson, BSN, RN. Executive Director of Elmhurst (Ill.) Outpatient Surgery Center: Commercial payers are changing their policies to drive more cases to the ASC. I believe that private payers are starting to address this by providing reimbursement incentives to physicians to move their care to an ASC.Because patients are so reliant on their physician to determine location of care, I believe that physician reimbursement models will have more of an impact on location of care than price transparency.