For more than a decade, the ASC industry has absorbed one specialty after another that was once considered too complex for an outpatient setting, from total joint replacements to spine fusions and, more recently, cardiac electrophysiology procedures such as ablation. Now, ASC leaders say neurosurgery — long treated as the specialty most insulated from that migration — is positioning for the same shift.
Neurosurgery has lagged behind for numerous reasons. Cranial and complex spine procedures carry higher complication risk, require longer recovery monitoring and have historically demanded hospital-level anesthesia and imaging support that a typical ASC doesn’t have — but that may change in the coming years.
Michael Cournyea, CEO of University at Buffalo (N.Y.) Neurosurgery, offered a forecast that reaches well beyond his own specialty.
“I believe the ASC industry in 10 years will have moved most of the complex cases of all specialties to the ASC. I can see a scenario where independent ASCs, hospital/health system owned ASCs and those like SCA will have a step down unit to complement the ASC for these complex cases that require 24-48 hours of observation and care,” Mr. Cournyea told Becker’s.
That prediction lines up with what’s already underway inside neurosurgery specifically. Spine surgery moved into ASCs years ago, and the specialty’s own cost and outcomes data suggest cranial and neurovascular cases could be next.
The economics are pushing in the same direction. Commercial insurers paid 78% more for identical procedures performed in hospital outpatient departments than in ASCs, according to a 2025 Health Affairs analysis — an average of roughly $1,500 more per case with no difference in outcomes. Across specialties, ASCs show total costs 30% to 60% lower than hospital-based care, a gap drawing more attention from payers and from patients facing deductibles that can run $3,000 to $7,000.
Neurosurgery’s own outcomes data are backing up the economics. Large outpatient series of anterior cervical discectomy and fusion procedures, including one covering 1,000 consecutive cases, have posted 90-day readmission and reoperation rates under 5%, evidence that has already helped move lumbar decompression, one- and two-level ACDF and short-segment fusion into ASCs. Diagnostic cerebral angiography and other neurovascular interventions are next in line, following the same endovascular tools that transformed inpatient stroke care into outpatient settings for carefully selected cases.
Handling that additional acuity safely will require a more deliberate approach to matching patients to the right facility, ASC leaders say. Nick Schiavoni, MD, co-founder and CEO of Calder Health, said the industry is moving toward a system of graduated capability.
“Not all ASCs are created equal, and I think we’ll start to see a more formalized tiering of facilities, categorized by what they’re equipped to handle. Basic centers doing cataracts and colonoscopies on one end, and full surgical hospitals on the other. Then we can use big data and risk calculators to match the right patient to the right setting,” Dr. Schiavoni said.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
