ASCs are facing an increasing disparity between practice costs and reimbursements.
"Everything's getting more expensive," Elaina Turner, RN, administrator of New Albany, Ind.-based Commonwealth Pain and Spine, told Becker's. "The cost of every procedure is going up, and the reimbursements are matching that same rate. The net is going in the wrong direction."
Annual ASC operating budgets ticked up last year, according to a survey from OR Manager; the percentage of surgery centers with an operating budget of $3 million or more jumped to 43% in 2023, compared with 32% the previous year.
"The hard part is making sure that the bottom line still makes sense, staying in the black, keeping the doors open and still taking care of patients," Ms. Turner said.
There is also the disparity between hospital outpatient department and ASC reimbursements, she added.
Common medical procedures can cost more than twice as much when they take place in a hospital outpatient setting compared to a physician office or ASC, according to an analysis from the Blue Cross Blue Shield Association.
And consolidation is not helping. The vertical integration of physician groups and health systems is resulting in a push to procedures to HOPDs over ASCs, driving Medicare and patient out-of-pocket costs up.
This disparity will particularly affect small, privately owned ASCs, Ms. Turner said, because they "don't have a big conglomerate or corporation that can kind of back you."
"If you look at the giants like [United Surgical Partners International], they have hundreds of ASCs, so if one of them has a bad month it's not that great, but they've got all the other ASCs that are doing well," she said. "For smaller ASCs, with two or three in the group, if one does poorly, that's potentially a huge percentage of revenue and could be detrimental for the bottom line."
Smaller ASCs do not have that "safety net," she added, so a bad couple of months could make or break their business.
If this continues, Ms. Turner predicts ASCs could begin to get rid of procedures or service lines altogether.