ASC industry trends to watch heading into 2020 and beyond: Q&A with Cardinal Health's Marvella Thomas

Marvella Thomas, senior consultant for clinical operations at Cardinal Health, outlines the big trends for ASC administrators today.

Question: What are the most important trends you’re seeing in the ASC field today?

Marvella Thomas: In particular, I'm seeing ambulatory surgery centers handling more complex cases such as joint and spine procedures. By 2020, nearly 60 percent of outpatient surgeries will take place at ASCs, an increase of 46 percent since 2005.1 The trend toward physician-invested surgery centers continues as well.

Then, there are even broader trends such as increased government regulation, which requires physicians to do more administrative work to remain in compliance. Plus, there’s the continued challenge of value-based care, which links reimbursements to patient outcomes. And finally, healthcare consumerism will increase competition among ASCs, as patients take a greater role in making their own healthcare decisions — including where they choose to have surgery. As consumers continue to “shop” for the best value in healthcare, ASCs will need to become more creative in how they compete.

Q: What are the key challenges keeping ASC administrators up at night?

MT: As I mentioned earlier, a critical challenge that I’m seeing today is the migration of more complex procedures from acute to ambulatory surgery center settings. While ASC physicians are working hard to make this transition possible, there are still significant barriers to overcome. In a nutshell, the vast majority of ASCs don't have the appropriate resources to handle these more acute cases. For example, they typically lack the necessary space, instrumentation and other equipment to accommodate this level of acuity.

So, what can an ASC do to balance the desire for more acute cases with the ASC's available resources? Put another way, how can you do more with what you already have? As value-based care continues to drive care to lower cost settings, the opportunity for ASCs will continue to grow. And so will the challenge to handle these more acute cases.

Q: How do you see the ASC and outpatient surgery arena changing in the next 18 to 24 months? What is driving that change?

MT: A lot of change will be driven by the regulatory challenges facing the ASC community. Regulatory authorities such as the Joint Commission and the Centers for Medicare & Medicaid Services (CMS) are basing their requirements on an acute care model, and it's becoming more and more difficult for ambulatory surgery centers to meet them.

For example, many ASCs need to remodel because their facilities don't meet new regulatory requirements for processing instruments. Again, it’s a question of whether they have the resources to accommodate these more stringent regulations.

The regulatory challenge becomes even more pronounced as more complex procedures with higher acuity continue to migrate to the ASC space. Physician owners in particular will need to make informed decisions about which complex procedures are a good fit for their organization, based on available resources.


1. Advisory Board; LEK Consulting, Ambulatory Surgery Centers: Becoming Big Business (2017); Health Care Advisory Board interviews and analysis.

Ms. Thomas will share her expertise as a speaker at the Becker's ASC 26th Annual Meeting: The Business and Operations of ASCs, Oct. 24-26, 2019 in Chicago. To learn more and register, click here. For more information about exhibitor and sponsor opportunities, contact Maura Jodoin at 

More articles on surgery centers:
Ascension, orthopedic group to build ASC in Wisconsin
Moving cardiovascular services to ASCs
4 essential elements of an ASC total joint program

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