1. Overall trends fueling growth. Growth in ASCs is fueled by trends such as introduction of disease screening guidelines (such as for colorectal cancer), a shift of services away from the hospital outpatient setting, payor incentives for cost-effective care, demographic changes and the preferences of physicians and patients.
2. Technical changes behind growth. Technical improvements fostering ASC growth include safer anesthesia, drugs to treat post-operative pain and improved surgical techniques resulting in faster patient recovery times.
3. Demographics behind growth. Almost all of Medicare spending growth in ASCs was due to growth in number of services per beneficiary, with the remainder coming from growth in Medicare population and from price changes.
4. Where growth comes from. About 70 percent of growth in ASC volume per Medicare beneficiary from 2000-2007 comes from capturing market share from HOPDs, and the remaining 30 percent comes from new volume in outpatient surgical services at all settings.
5. What patients like. Patients appreciate lower co-payments, more convenient locations, shorter waiting times and easier scheduling than in other settings.
6. What physicians like. Physicians enjoy better control of staffing decisions, equipment selection decisions, and process and scheduling decisions.
7. What physicians gain. ASCs provide physicians with higher professional revenue due to improved efficiencies from their ability to better manage their work, shorted turnaround times and rely on a more specialized support staff.
8. Largest specialty. Eye procedures represent the largest share of Medicare spending for ASCs, but these services have experienced the slowest growth since 2000.
9. Specialty with greatest growth. Colonoscopy procedures have been growing at 15 percent per year. Colonoscopy and upper GI endoscopic procedures accounted for almost one-third of Medicare spending growth on ASCs from 2000-2007.
10. Reduction in price of procedures. The average price of ASC procedures fell by about 11 percent from 2000-2007, reflecting growth of less costly screening services.
Source: An Analysis of Recent Growth of Ambulatory Surgical Centers (pdf).
