How certificate-of-need laws are impacting HCA's ASC growth 

Nashville, Tenn.-based HCA Healthcare faces challenges expanding its ASC network in states with certificate-of-need laws, CFO Mike Marks said during the health system's Jan. 24 earnings call.

Certificate-of-need laws, which regulate the establishment and expansion of healthcare facilities, are designed to control costs and prevent unnecessary duplication of services. However, they have been a source of debate, with critics arguing that they stifle competition and hinder access to care.

Mr. Marks noted that HCA can expand its outpatient network "much more quickly and aggressively" in states without CON laws. In contrast, regulations in states such as Georgia, Virginia and North Carolina create barriers that slow or limit the company's ability to develop new ASCs.

Several states are considering changes to their CON laws this year. North Carolina, for example, will ease regulations by eliminating CON requirements for ASCs in counties with fewer than 125,000 residents, effective Nov. 1, 2025. ASCs in these areas will still be required to meet charity care obligations and comply with annual reporting requirements.

Despite the regulatory hurdles in certain states, HCA remains committed to its ASC strategy. In regions where CON laws are not a factor, the company maintains a robust outpatient network.

"Where we have control over our own destiny, if you will, we're fairly consistent with a large outpatient network, including ASCs per hospital," Mr. Marks said.

HCA Healthcare is one of the largest ASC operators in the U.S., managing its surgery centers under the Surgery Ventures division. By the end of 2024, the organization operated 124 ASCs, averaging approximately 14 outpatient facilities per hospital, according to Mr. Marks.

"We feel good about our ambulatory surgery center network," he added. "They are an important part of our overall network and the markets we serve, and they will continue to be a key component of our network development and optimization strategy in 2025 and beyond."

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