2019 U.S. Ambulatory Surgery Center Market Report

The 2019 Ambulatory Surgery Center Market Report covers the industry-wide shift in surgical procedures from inpatient to outpatient settings.

• The U.S. ambulatory surgery center (ASC) market is estimated to grow to $52 - $55 billion by 2025
• ASCs are largely urban with 92.9% located in or near cities
• The top six ASC chains hold a combined 18.8% of total market share and manage 1,300 ASCs

Market At-A-Glance

The ambulatory surgery center (ASC) market is estimated to grow by up to $52-55 billion by 2025. ASC executives continue to rank improved surgical capabilities as the primary driver of growth; however, they also cite the aging U.S. population and increased surgical capacity as contributors.

In 2017, 5,603 Medicare-certified ASCs treated over 3.4 million Medicare fee-for-service (FFS) beneficiaries. The majority of ASCs (93.8%) are for profit, with 3.5% considered nonprofit and 2.7% government-owned.

Physicians Benefit From ASC Ownership

The majority of ASCs are physician-owned and report no affiliation with a hospital or health system. In 2018, these physicians reported ASC ownership as more appealing than being employed by a hospital. Reimbursement initiatives from private payers boost this perception. They are currently offering ASC physicians higher reimbursement rates, and are also offering bonuses for each patient that receives care in an ASC rather than an HOPD.

ASCs Expected To Receive Increased Volumes

ASCs continue to perform more than half of all U.S. outpatient surgical procedures and are expected to see greater volumes as the number of outpatient procedures increases by an estimated 15% by 2028. Though these increases will be experienced by both ASCs and hospital outpatient departments (HOPDs) alike, ASCs are poised to receive an outsized portion of volume growth. From 2015 to 2022, the proportion of outpatient cases performed in ASCs is expected to increase across most service lines with the largest jump (10%) to occur in spine procedures.

Among other factors, consumerism is set to play a major role in driving ASC volume increases, as procedures performed in ASCs cost an average of 58% less than the same procedure in an HOPD. Payers and patients alike, in an effort to reduce costs and increase value, are driving the shift in procedures from high-cost HOPDs to more cost-effective ASCs.

Efficiency Drives ASC Profit

While reimbursement continues to be lower in ASCs when compared to HOPDs, they are able to drive profits through efficiency. Lower average operating room turnover time and growing patient volumes bring in greater revenues. while lower operating expenses broaden margins. For the average ASC, 2018 operating expenses were 67% of net revenue; in hospital outpatient departments this figure was 97%.