Fifteen trends and observations on the ASC industry.
1. There are nearly 5,600-plus Medicare certified ASCs. There has been growth in the total number of ASCs, increasing 1.5 percent from 2013 to 2017. The number of ASCs jumped 2.6 percent from 2017 to 2018 with 224 new ASCs opening in 2018 and 78 closing or merging, according to the MedPAC 2020 report.
2. ASCs are largely rebounding well from the pandemic. There has been slower growth in high-volume procedures, such as cataracts, aimed at elderly patients, but overall volumes are rebounding well.
3. The big four specialties are ophthalmology, GI, orthopedics and pain. About 36 percent of ASCs include orthopedics, 36 percent include ophthalmology, 34 percent include pain management and 32 percent include endoscopy, according to the Ambulatory Surgery Center Association.
4. The number of total joints, spine and cardiovascular procedures performed in ASCs is growing.
5. About 33 percent-plus of ASCs have a hospital partner or management partner.
6. The top 10 or so ASC chains own interests in around 1,500 ASCs, according to the VMG Health Intellimarker.
7. Many ASCs are essentially small businesses reporting $3 million to $7 million in revenues.
8. ASCs are largely paid by Medicare — about 50 percent of what hospital outpatient departments are paid.
9. The majority of ASCs are physician-owned.
10. There is growth in outpatient versus inpatient surgery, but not all growth goes to ASCs.
11. There are a few thousand non-Medicare certified ASCs, primarily providing cosmetics and some pain services.
12. Private equity firms are buying into practices and trying to invest and grow ASCs and other ancillary services. HealthCare Appraisers' 2020 ASC valuation and benchmarking survey named orthopedics, radiology, gastroenterology, urology, cardiology and podiatry have strong PE interest.
13. The growth in joint-venture ASCs with hospitals is slow currently.
14. The Ambulatory Surgery Center Association, or ASCA, in Washington, D.C., represents ASCs.
15. CMS under the Trump administration has largely been friendly towards ASCs. In the past four years, CMS has added more complex procedures, including total knee replacements, on the ASC payable list and proposed abolishing the inpatient only list.