Most, least desirable states to open ASCs

Texas is potentially the best state to open an ASC, while New Jersey and other states fall short.

The Southern ASC market has been a hot spot for growth. They earn the most revenue in the country and perform the most cases annually.

"Physician-owned or operated ASCs in Oklahoma, Texas, Kansas and Arkansas have been the result of robust entrepreneurial growth over the years coupled with very little restraints of certificate of need statutes and regulatory oversight," Stewart Burchett, executive director of Oklahoma Lithotripter Associates and Oklahoma Kidney Stone Center in Oklahoma City, told Becker's on March 29. "The result early on was a plethora of ASCs as outpatient surgery grew in popularity, and many physician-owned entities were built in areas one would never have imagined."

In July, personal finance website WalletHub assessed which states are the best and worst places to start a business. It compared each state's business environment, access to resources and business cost using 28 metrics.

WalletHub indicated Texas is the best state to start a business. Three other Southern states — Georgia, Florida and North Carolina — were in the top 10 in the same category.

The Northeastern market faces a variety of challenges hindering ASC growth. Most of the region's states have certificate of need policies, which require physicians and owners to obtain approval to open or expand ASCs.

"The New England market for ASCs is a little bit of a mixed bag. Most of the New England states have a certificate of need or determination of need requirement to open an ASC. Though this is not different from some other markets nationally, the regulations have led to fewer ASCs per capita than anywhere else in the country," Prashanth Bala, vice president of ASC operations at Shields Health Care Group in Quincy, Mass., told Becker's on March 29. "Additionally, most commercial payers are still learning the clinical and economic benefits of ASCs for patients. The payer landscape is restricted with a number of the national payers having limited covered lives in the area."

New Jersey was WalletHub's pick for the worst place to start a business. Three other Northeastern states — Connecticut, Rhode Island and Delaware — were also considered some of the worst states for that purpose.

The best states to open a business, according to WalletHub:

1. Texas
2. Georgia
3. California
4. Florida
5. Idaho
6. Utah
7. Colorado
8. North Dakota
9. North Carolina
10. Massachusetts

The worst states to open a business:

1. New Jersey
2. Connecticut
3. Rhode Island
4. West Virginia
5. Wyoming
6. Alaska
7. Missouri
8. Pennsylvania
9. Delaware
10. Virginia

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