As the ASC space continues to develop and respond to an increasing demand for healthcare services, these frontiers may present major opportunities for practice growth:
Cardiology: Cardiology has been a major target of private equity investment in the ASC space and a driver of ASC growth for the last several years.
Cardiology procedures received the highest estimated Medicare payment increases in 2021, making it the fastest-growing ASC specialty, according to Avanza's "2022 Key ASC Benchmarks and Industry Figures" report.
Becker's also reported on at least 10 cardiology practices that have opened this year alone.
"As a new rural cardiovascular ASC with a robust office practice, the growth potential in our space is endless. We are set to 'go live; with our streaming option, in which family members can watch our cases and one of our trained staff members can guide them as the procedure progresses," Amanda Ryan, DO, owner and physician at Advanced ASC in Carlsbad, N.M., told Becker's.
ASC chains are also eyeing cardiology for growth. Optum's ASC arm, Deerfield, Ill.-based SCA Health, quietly purchased at least two cardiovascular providers in 2023, National Cardiovascular Partners and Pivotal Healthcare.
Direct-pay models: Declining reimbursement rates have weighed heavily on ASC growth over the years, pushing some ASCs to shift to direct-pay models to bypass payer obstacles.
David Bailie, MD, president of Scottsdale-based Arizona Institute for Sports Knees and Shoulders, has spent a decade building a practice on his reputation as a physician, with no ancillary revenue streams and limited insurance contracts.
He previously worked for a large group that was purchased by a hospital system, but cut ties with large insurer contracts after going into independent practice.
"Be fair and transparent — don't price gouge," he told Becker's. "If you've been in practice long enough, you know what you're getting paid from insurance, and you know what you think is fair. So for rotator tear costs, I have a small, medium, large and massive fee schedule. If I get into a medium-sized tear and I already charged the patient, and it's way worse, I don't change the [price]. That's my risk for not being able to figure that out ahead of time. I'm fair and transparent with everything. I turn a lot of people away from surgery who are willing to pay because I don't think they need it … Over time, that reputation gets even stronger."
Non-traditional consolidation: Despite being a historically fragmented industry, ASCs have caught the eyes of private equity, hospitals and ASC chains who want to acquire surgery centers to drive growth amid the migration of procedures to the outpatient setting.
Some ASC leaders are taking note of the downsides of consolidation in other healthcare sectors — including loss of autonomy, rising costs and potential declines in care quality — and are looking to alternative models to reach economies of scale.
Longtime ASC owner-operators Mark Quigley and John Webb, along with developer Woodrow Moore and analyst Arjun Gangakhedkar, created Ker Leader Medical earlier this year. The new ASC operates under an ownership-focused model and was created to disrupt current corporate investment trends. The new structure puts physicians in leadership positions and provides them with the option of an exit strategy.
"The future of medicine should not be doctors being directed to the benefit of the hospitals, insurance companies and Wall Street firms, rather we offer the opportunity for physicians to build long term value for their patients and communities independently," Mr. Moore said.