As the healthcare landscape evolves, ASCs are navigating a complex mix of financial, operational and competitive pressures that threaten their independence and profitability.
Here are three market pressures shaping ASCs today:
1. Payment disparities between ASCs and HOPDs
ASCs are facing obstacles in the “lack of equity in contracting and payment” between hospital outpatient departments and ASCs, according to Sally Wright, CFO of Puyallup, Wash.-based Meridian Surgery Center.
ASCs are reimbursed significantly less than hospitals for performing the same procedures. A Blue Health Intelligence analysis found that procedures performed in HOPDs can cost up to 58% more than those in ASCs or physician offices. For example, colonoscopies cost 32% more in hospital settings compared to ASCs.
These disparities affect more than just reimbursement rates. They also limit ASCs’ negotiating power with payers and restrict their ability to invest in technology, staffing and new service lines.
Meanwhile, as ASCs grow in popularity, competition from HOPDs is also intensifying.
“Independent ASCs are exactly that — independent. They have fewer restrictions, and they can almost pick and choose which surgeons and anesthesia providers they work with,” Alejandro Badia, MD, founder and CMO at Miami-based Badia Hand to Shoulder Center, told Becker’s. “In a hospital outpatient department, the surgery center that’s affiliated with a hospital — they’re a little more encumbered in terms of who they can have there.”
2. Rising patient expectations
As consumers bear a greater share of healthcare costs, patient expectations are rapidly evolving. A report from Sage Growth Partners found that 49% of hospitals and health systems ranked improving patient experience as their top strategic initiative for the next two years, up from just 14% in 2020.
“Patients expect ASCs to be easy, transparent and comfortable — more like a service business,” Kristen Owens, MSN, RN, ASC manager at Morgantown, N.C.-based Carolina Digestive Care, told Becker’s. “Without a good experience, you risk losing referrals and patients.”
Patients increasingly prioritize convenience, digital access and communication transparency when deciding where to receive care. For ASCs, meeting those expectations requires balancing high-quality clinical outcomes with a streamlined, patient-centered experience, often without the deep administrative or financial resources of large hospital systems.
3. Consolidation
Although the ASC industry remains relatively fragmented — with about 66.5% of centers still independently owned as of 2024 — consolidation is accelerating. Health systems, private equity firms and payer-aligned entities are acquiring or partnering with independent centers at a steady pace.
ASC leaders now face difficult strategic decisions: remain independent, pursue a partnership or sell to survive.
According to an October 2024 survey from VMG Health, 59% of independent ASCs would consider a strategic partnership rather than a full sale. Among those open to partnerships, 71% would consider working with a health system, 31% with a management company and 29% with a private equity group.
While consolidation can bring financial stability and access to capital, it also raises questions about physician autonomy and the long-term sustainability of the independent ASC model.
