Certificate-of-need laws, which regulate the development of healthcare facilities, continue to shape the development of ASCs differently in each state, according to L.E.K. Consulting's "2024 ASC Insights Study."
Here are five takeaways from the study:
1. The compound annual growth rate of Medicare-certified ASCs between 2019 and 2023 was highest — at least 4% — in Arizona, Mississippi and South Carolina, according to the report. South Carolina is the only state that has repealed its ASC-specific CON law since 2020.
2. The next-highest bracket of CAGR for ASCs was between 2% and 4%, which also correlated somewhat with a lack of CON regulation. Montana, Wyoming, Utah, Colorado, Kansas, New Mexico, Texas, Louisiana, Indiana and Michigan all fell into this growth bracket. None of these states have ASC-specific CON regulation.
3. The CON states with between 2% and 4% CAGR were Iowa, North Carolina, Virginia and New York.
4. These dynamics could change as states continue to evaluate their CON laws. North Carolina, for example, will lift CON requirements for ASCs in counties with less than 125,000 people, effective Nov. 1, 2025. Exempt ASCs will still need to satisfy certain charity care and reporting requirements annually.
5. On Dec 1, 2027, Tennessee will lift CON requirements for ASCs. The Tennessee Health Facilities Commission is also creating a six-year plan to study the impact of CON reform, which will shape future regulation in the state.