The global ASC market is projected to hit $130.6 billion by 2031, increasing at a 3.9 percent compound annual growth rate, and seven ASC leaders joined Becker's to discuss emerging opportunities that will continue to fuel growth.
Question: What emerging trends or opportunities do you see driving growth for ASCs in the next few years?
Editor's note: This response was edited lightly for clarity and length.
Traci Albers, CEO of Surgical Management Professionals (Sioux Falls, S.D.):
I do not believe these are new trends or opportunities, but I foresee these continuing to drive growth for ASCs:
- Joint replacements: It is hard to believe that all physicians are not performing appropriate joint replacements in ASCs; however, we go into some markets and are still seeing joint replacements performed exclusively in hospitals. I believe joint replacements will continue transitioning to ASCs. For those ASCs that have been performing them for many years, they are continuing to perfect care delivery and cost management, which helps as reimbursement continues to tighten.
- Cardiology: Cardiology continues to be a growth area in some markets.
- Spine: Much like joint replacements, there is still significant opportunity to move spine cases to ASCs.
- Employer-directed healthcare: In markets with high healthcare costs where employers are getting involved, we are seeing unique opportunities for ASCs to partner with self-funded employers to help drive down the cost of healthcare. Employers are designing their benefit plans around ASCs to direct their patients.
Will Brancamp, ASC Administrator, Infirmary Health System:
- The growth of hospital systems doing joint venture ASCs. This includes hospital systems, physicians, and ASC management groups, as many hospital systems do not have ASC experience.
- Private equity companies pushing for more ancillary services, particularly ASCs.
- Growth of procedures that are acceptable in an ASC setting.
- Development of new procedures in hospital system surgery departments.
Jennifer Boese, Director of Healthcare Policy at CliftonLarsonAllen:
- Shifting sites of service for procedures is propelling growth and volumes in ASCs. This shift has been occurring for years, with procedures moving from higher-cost settings (like hospitals) to more cost-efficient settings, such as ASCs.
- Volume opportunities may increase if more procedures are covered under Medicare. I’m watching what the incoming administration might do with the Medicare ASC-covered procedures list. (Remember, the first Trump administration wanted to add hundreds of procedures to the list.)
- Opportunities to assess and participate in joint ventures with hospitals. By participating in ASC ownership through JVs, hospitals can capture revenues they are losing as outpatient procedures move to ASCs.
- Demographics, especially individuals aging into Medicare eligibility, are a long-term trend to watch.
- Consumers and employers are becoming more cost-conscious, potentially turning to ASCs for better value.
Vance Chunn, CEO of Cardiology Associates (Mobile, Ala.): There are a number of trends driving growth for ASCs. One includes the continued shift of cardiac procedures from the hospital inpatient and outpatient setting to ASCs. Additionally, CMS has approved numerous cardiac related procedures that can now be performed in the ambulatory surgery setting, and other payers are coming along as well. However, this transition is moving slower than previously presumed. Many hospitals are reluctant to see these procedures move out of the hospital setting. Cardiac procedures account for a significant portion of a hospital’s revenues. Because of this, only those hospitals that see the importance of an early and aggressive ambulatory strategy are focusing on current development of cardiac specific ASCs or muti-specialty ASCs that are expanding to accommodate cardiac procedures. Many hospitals will have to give up revenue by seeing procedures exit the inpatient and outpatient setting. Additionally, they will also, in many cases, have to share revenue with physicians by including them in joint ventures or other ownership in ASCs.
Another trend is the push by some payers to lower the cost of procedures. Again, this too is a mixed experience. That is, some payers have been slow on the uptake of pricing and paying for ASC procedures. Gastroenterology, ENT, ophthalmology and general surgery procedures are more mature and stable, but orthopedics and now cardiology are still considered relatively new to the space. On the other hand, other payers are pushing to get procedures into a lower-cost setting.
Additionally, patients are looking for alternatives to the hospital setting and are becoming more and more accepting of the convenience and satisfaction associated with the ambulatory surgery environment. The concern about quality in ASCs is minimal and, in some cases, educated patients understand there are potential quality benefits for having procedures in that arena.
Another trend is the rapid growth in involvement of private equity in ASCs and physician practices that could shift procedures to ASCs. This is especially true in non-CON states. Private equity has recently more rapidly become involved with cardiology because of the enormous potential to shift cardiac procedures out of the hospital. Private equity companies see this as a way to increase revenues to practices they become involved in owning and an opportunity for them to participate in the ownership and management of ASCs.
Daniel Hatef, MD, Plastic Surgeon (Nashville, Tenn.): Plastic surgeons working in office-based surgery suites will begin to partner to create multi-location mini-ASC management organizations. These ORs are typically financial losses, offering a boutique experience and allowing surgeons to control their schedules and perioperative care. Economies of scale, access to big data, and professional management will reduce overhead and turn these OR suites into moneymakers for participating surgeons.
Carina Topf, RN, Director of Nursing at Riverview Surgical Center (Sioux City, Iowa):
Same-day endoscopic back procedures and total shoulder replacements are becoming more popular. The cost of lengthy hospital stays is very expensive, and an ASC is more attractive to patients as they will have less out-of-pocket costs. With same-day procedures for bigger cases such as backs, and total joints patients have the capability to finish recovery in the comfort of their own home. As insurance companies add these CPT codes to their list of covered procedures at an ASC, I feel that in the long run most of these procedures will eventually be done in an ASC setting.
Kathy Weihman, Administrator of Genesis Surgery Center (Fowlerville, Mich.):
I definitely see growth in some of the higher-dollar cases, such as orthopedics. I also think we need to watch emerging AI technologies to see how they can improve how we do business and enhance patient care.