From emergent technologies and changing market dynamics to an aging population, a slew of trends could shape ASCs' survival and growth over the next five years.
ASC leaders gathered at Becker's 30th Annual Business and Operations of ASCs Meeting in Chicago to discuss the trends they're watching over the next five years.
HOPD vs. ASC reimbursement disparity
Procedures performed in hospitals can cost 58% more than the same procedures performed in an ASC, according to a 2023 analysis by Blue Health Intelligence, the Blue Cross Blue Shield Association's data analytics company.
Medicare hospital pay also increased by 70% between 2001 and 2023, whereas physician payment only increased by 9% over the same period, according to the American Medical Association. CMS also recently finalized a 2.83% cut to physician payments for 2025, further widening the gap between ASC and hospital payments.
"Predictions in the ASC market in the next five years… I see it growing and if there's legislation that changes the reimbursement where there's parity or closer to parity between hospital outpatient and ASC," said John Prunskis, MD, medical director and principal of Chicago-based DxTx Pain & Spine.
While ASC leaders want their rates to be closer to parity with hospitals, there is doubt that this will materialize in the next five years.
"Obviously the ongoing viable success is perhaps going to [mean] leveling the playing field a little bit in terms of the reimbursement," said Michael Redler, MD, an orthopedic surgeon at Connecticut Orthopaedics in Camden. "But I'm going to predict to you that in an ideal world, the ASC wants to get very close to those hospital outpatient rates, but you may not want to completely get them because that would be complete parity. And why? Because one of the calling cards of an ASC is a high-quality, lower-cost alternative. And that's one of the things that also will drive patients and also insurers to the market."
More high acuity procedures
A key factor in the growth of ASCs will be the continued migration of high-acuity procedures from HOPDs, which relies on ASCs maintaining their key selling point as a venue for high-acuity procedures at a lower cost.
"How can we do these higher acuity cases? Well, you need to have great anesthesia, you need to have great regional blocks," Dr. Redler said.
This could be particularly important for orthopedic centers. In the last quarter, Dallas-based United Surgical Partners International, the largest ASC chain in the U.S., saw a 7.6% increase in net revenue per case, driven by high-acuity procedures and a favorable payer mix. The company's ASCs experienced a 19% increase in total joint replacements compared to last year, and USPI recently partnered with San Diego-based Synergy Orthopedics to develop the largest musculoskeletal ASC in San Diego.
Continued focus on patient comfort and experience
Both physicians predicted that the relatively hassle-free experience of ASCs compared to that of hospitals will continue to forge the path for sustained growth in the industry as the demand for surgical procedures increases.
"[Patients] don't have to park their car 600 yards away and spend all day and the case gets delayed. And infection rates are generally lower in ASCs in a hospital setting," Dr. Prunskis said.
According to a February 2024 report by SCA Health, infection rates are six times lower in ASCs than in hospital outpatient departments. ASC patient experience scores also hit a five-year high in 2023, according to a June report from Press Ganey.
"No matter what we're doing with ASCs, [as long as] our number one goal is patient care, patient comfort and patient outcome, then everything else along the way builds upon that," Dr. Redler said.
One way that Dr. Redler's ASC is achieving this goal is through bridging the "efficacy gap," through emerging technologies in anesthesia and pain management that will allow patients to enter the neuromodulation phase of recovery sooner and from their own homes.
"And if you can get that in a surgical center-type setting, you're going to have a winning situation. The patients can actually take their iPhone to control the neuromodulation," he said. "Not only are they comfortable in real-time, but you then have real-time data of how they've been affected. That's the next wave, when that comfortable patient with higher acuity is home, it's going to be a win-win situation. And with that kind of methodology, you're going to have a great future for ASCs."