As the migration of procedures from hospitals to ASCs accelerates, some health systems are struggling to accept what many leaders already see as the inevitable shift outpatient.
With lower costs, leaner operations and high patient satisfaction, ASCs are increasingly performing complex procedures that were once the domain of hospitals. Amid this progress, friction is growing, and Janet Carlson, executive director of ASCs at Commonwealth Pain & Spine, joined Becker’s to discuss ways tension is starting to boil over.
“Hospitals are resisting the migration of higher acuity cases to ASCs, even though we perform them successfully with great outcomes at much lesser cost to the payer and patient,” Ms. Carlson said. “Resistance is futile. It’s going to happen — with or without their collaboration.”
The migration of orthopedic, spine, cardiovascular and vascular procedures to ASCs represents a major financial shift. While orthopedics has been shifting to ASCs for years, cardiology is a newer “gold rush” for ASCs — the specialty is now the fastest-growing ASC specialty, according to Avanza’s “2022 Key ASC Benchmarks and Industry Figures” report.
In response, Ms. Carlson told Becker’s she has witnessed subtle retaliation against physicians seeking more efficient sites of care, such as removing dedicated block time for ASC-aligned surgeons, creating scheduling chaos and reducing incentive for further migration.
Despite hospital resistance, ASCs continue to gain momentum as a cost-effective, patient-preferred alternative. A Blue Health Intelligence analysis revealed procedures performed in HOPDs can cost up to 58% more than in ASCs or physician offices. For example, colonoscopies cost 32% more in hospital settings compared to ASCs.
Physicians are also interested in the ASC setting. In addition to safety and savings, ASCs offer a uniquely collaborative culture.
“Surgeons love working in ASCs — they’re lean and efficient. We clean the rooms ourselves — we don’t wait for environmental services,” Ms. Carlson said. “Everyone pitches in, including the anesthesiologist and the surgeon.”
Ms. Carlson argues that forward-thinking health systems are already adjusting their strategies, many through joint ventures or shared-ownership models, to capitalize on ASC efficiency without compromising their financial goals.
“If they’re smart, they’ll allow physicians to share opportunities,” she said. “If success is measured through RVUs, there should be a model that rewards using the lower-cost site of service.”
Many health systems are seeing success with a forward-thinking approach to ASC development. Outpatient surgery was the top service line for joint venture partnerships in 2024 according to a VMG Health survey of health system executives. Survey results have been backed up by news of multiple health systems partnering with one of the many ASC chains vying for market growth.
Last year, Altamonte Springs, Fla.-based AdventHealth East Florida partnered with two major physician groups to build not just an ASC, but a joint-venture medical office building housed in the same facility.. In the first syndication wave, 15 physicians invested, and there’s already a waitlist for the next round.
Giving physicians true ownership and a seat at the table has been a “game-changer,” Shyroll Morris, senior vice president and chief strategy officer of AdventHealth’s East Florida division, told Becker’s.
“It creates alignment. It doesn’t feel like ‘us versus them,’” she said. “It’s very collaborative. Not every patient belongs in an ASC, and not every patient belongs in a hospital. Having both options ensures the right care in the right setting, and that helps everyone grow.”
The partnership has also improved hospital throughput. Instead of competing for cases, the ASC handles lower-acuity procedures, freeing up hospital capacity for higher-acuity patients.
