Neurosurgery is following a familiar path: just as orthopedics and cardiology moved key procedures to ambulatory surgery centers (ASCs), spine and neurovascular surgeons now have the technology and data to safely shift high-value cases out of hospitals. The question is no longer whether ASCs are safe, but how quickly organizations can realign site-of-care strategy to capture the value.
“For many elective neurosurgical procedures, keeping care in the hospital is now the premium option without a premium outcome.”
Reason 1: ASCs Cut Costs Without Cutting Corners
Across multiple services, the same CPT-coded neurosurgical procedure is meaningfully cheaper in an ASC than in a hospital outpatient department (HOPD), even when the surgeon’s professional fee is identical. In spine surgery, comparative analyses of decompression, fusion, and kyphoplasty cases show consistently lower facility and technical fees in ASCs.
A 2025 Health Affairs analysis found commercial insurers paid on average 78 percent more for identical procedures performed in HOPDs than in ASCs, translating to roughly 1,500 dollars in additional payments per case with no gain in outcomes. MedPAC and commercial claims data likewise suggest 30–60 percent lower total costs for ASC-based procedures across specialties, a pattern that extends to neurosurgical cases with implants and advanced imaging.
Illustrative facility cost differences
| Procedure | Site of care | Outcome difference |
|---|---|---|
| Lumbar decompression | ASC | No difference in 90-day ED visits, readmissions, reoperations. |
| Lumbar decompression | HOPD | No improvement in outcomes versus ASC. |
| ACDF (1 level) | ASC | Similar or lower readmission/complication rates vs inpatient. |
Reason 2: Site of Care Is Now a Financial Determinant for Patients
In a world of 3,000–7,000 dollar deductibles, the choice between hospital and ASC can be the difference between getting surgery now or deferring it indefinitely. The same lumbar decompression that essentially wipes out a working patient’s annual deductible in the HOPD may be delivered at a fraction of that cost in an ASC due to lower negotiated facility rates.
Surveys show over one in three insured Americans postponed needed care in the past year because of out-of-pocket costs, a burden magnified in high-ticket specialties such as neurosurgery. For small employers operating under ERISA, rising premiums and cost-sharing have pushed many toward narrower networks and higher deductibles, further increasing the stakes of site-of-care decisions for elective surgery.
Reason 3: ASCs Restore Control Over OR Access and Workflow
Hospital ORs are under constant pressure from emergency volume, nursing shortages, and post-acute bottlenecks, and elective neurosurgical cases are often first on the chopping block when capacity tightens. Repeated cancellations are not just a scheduling nuisance; they are documented drivers of lower patient satisfaction and eroded staff morale.
By contrast, neurosurgeon-led ASCs provide controlled elective blocks, specialty-trained teams, and fewer last-minute disruptions. For spine surgeons, migration of appropriate cases to ASCs has been associated with more predictable schedules, shorter length of stay, and streamlined teams that can execute standardized, high-reliability care pathways.
“Every canceled elective case is a hit to patient trust and surgeon morale, ASC governance lets neurosurgeons design around that reality.”
Reason 4: Safety Data Have Caught Up With Innovation
Historical concerns that spine and cervical procedures were “too risky” for ASCs have been overtaken by contemporary data. In Medicare beneficiaries undergoing lumbar laminectomy, there were no differences in 90-day ED visits, readmissions, one-year reoperations, or one-year utilization between ASCs and HOPDs after risk adjustment.
Systematic reviews of ambulatory spine surgery report similar or lower reoperation and readmission rates for outpatient ACDF and lumbar procedures when compared to inpatient or hospital-based outpatient surgery. Large ASC ACDF series in Medicare-eligible patients show low 30- and 90-day adverse events, no intra-op deaths, and readmission and reoperation rates well under 5 percent, even in older adults.
Selected outcome comparisons
| Procedure & population | Site of care | 90-day readmission | Major complications |
|---|---|---|---|
| Lumbar laminectomy, Medicare | ASC | Comparable to HOPD | Comparable to HOPD. |
| ACDF, 1-level, mixed adult | ASC | <5% in large series | No intra-op deaths, no immediate transfers. |
Beyond spine, early neurosurgical endovascular data show diagnostic cerebral angiography in outpatient centers can be performed with near-zero periprocedural complications and very high patient satisfaction.
Reason 5: Physician Ownership Can Enhance Ethics and Accountability
Policy debates often assume any physician financial interest in a facility drives overuse and conflicts of interest. Yet neurosurgeons now practice under intense utilization management—prior authorization, narrow networks, and coverage rules that limit inappropriate procedures regardless of site.
Systematic reviews in orthopedic and spine settings show no increase in complications or inappropriate surgeries at physician-owned entities when compared with hospital-owned facilities. Instead, ownership often accelerates adoption of modern technology, gives neurosurgeons real influence over capital spending, and tightens accountability for outcomes and patient experience.
“In an era of high deductibles and prior authorization, the ethical risk is not physician-owned ASCs-it is clinging to hospital-centric models that cost more and deliver the same results.”
For payers, employers, and health systems under pressure to demonstrate value, neurosurgical ASCs offer a scalable way to lower total cost of care while preserving or improving outcomes—and to do it in a governance structure that puts surgeons and patients at the center of decision making.
