ASCs have spent decades perfecting high-volume, low-acuity procedures. But as reimbursement models shift, technology advances and patients increasingly prefer outpatient settings, industry leaders say ASCs are failing to capitalize on a significant and growing opportunity in higher-acuity care.
ASCs that aren’t using higher-acuity procedures are leaving opportunity on the table, Sean Gipson, CEO and division president of ASCs for Hurst, Texas-based Remedy Surgery Centers, told Becker’s.
“ASCs have traditionally focused on low-risk, high-volume cases (e.g., endoscopy, ophthalmology), but advances in anesthesia, minimally invasive techniques, and post-op care now make it possible to safely perform more complex procedures in outpatient settings,” he said.
In particular, opportunity is being missed in spine procedures, total joint replacements and cardiovascular procedures, particularly with select catheterization lab and electrophysiology cases.
A scientific statement published by the Journal of the American College of Cardiology in November describes electrophysiology as the next specialty poised for site-of-care migration, similar to interventional cardiology’s path before CMS expanded ASC coverage for cardiac catheterization and percutaneous coronary intervention in 2020.
“Hospitals still dominate these higher-revenue procedures, even when ASCs could perform them at lower cost with similar outcomes,” he said. “Reimbursement models (including CMS approvals of outpatient procedure lists) are increasingly supportive of shifting cases to ASCs. Patients prefer ASCs due to convenience, lower infection risk and faster discharge.”
Luke Mitchell, executive director of Green Bay, Wis.-based Prevea Health, told Becker’s that he believes the ASC industry is “leaving a lot of opportunity on the table” amid the site of care migration, particularly in orthopedics.
“We have made progress, but we still are nowhere near where we should be,” he said. “There is a pretty large gap between what we can safely do in an ASC today and what is actually being done. Total joints, spine and other higher acuity cases are still lagging more than they should.”
According to Mr. Mitchell, this comes down to payer policies, misaligned incentives and occasional internal resistance.
“At the same time, I think we undersell ourselves as an industry,” he said. “ASCs are not just a lower-cost option, but in many cases, they are a better setting for patients. More efficient, more predictable, and often a better overall experience. The systems that really lean into this, aligning physicians, effectively directing care pathways, and pushing the appropriate migration, are going to separate themselves pretty quickly if they have not already.”
Other leaders agree, particularly when it comes to cardiovascular procedures.
Krishna Jain, MD, CEO of National Surgical Ventures and Limb Preservation Centers of America, told Becker’s that cardiovascular ASCs not offering management of peripheral arterial disease are leaving opportunity on the table. Those that do offer PAD should also add wound care centers to provide limb preservation services.
“This addition increases revenue significantly and improves care,” he said.
According to Mr. Gipson, what’s holding ASCs back is physician alignment issues, capital investment barriers, payer contracting limitations and risk tolerance.
According to Mr. Gipson, what’s holding ASCs back is a combination of physician alignment issues, capital investment barriers, payer contracting limitations and risk tolerance. He added that other notable missed opportunities include ancillary revenue streams such as imaging, physical therapy and pharmacy integration.
Not all leaders believe the opportunity lies exclusively in higher-acuity care, however.
Harel Deutsch, MD, associate professor at Chicago-based Rush University and co-director of Rush Spine Center, told Becker’s that ASCs may also be overlooking lower-acuity procedures.
“ASCs are too focused on fusions and big surgeries and are not paying attention to less invasive procedures and possible out-of-pocket procedures and alternative medicine,” he said.
Colonoscopies are one example, particularly amid rising demand. Benjamin Levy III, MD, gastroenterologist at University of Chicago Medicine, told Becker’s that boosting colonoscopy volume at ASCs should be a national priority.
ASCs are seeing a surge in colonoscopy demand as CRC rates rise, especially among adults under 50. Updated screening guidelines that lowered the recommended starting age from 50 to 45 have added millions of newly eligible patients, driving a steady increase in screening volume. Practices report noticeable jumps in patient inquiries and referrals since the guideline change.
“Nationally, we should help ASCs increase the number of colonoscopy procedures performed each week,” Dr. Levy told Becker’s. “We should increase the number of available gastroenterology rooms at ASCs to dramatically boost colonoscopy screening rates in America.”
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