Why Texas' ASC market is booming — 4 center leaders elaborate

Texas was among the states that experienced the most ASC growth in 2019. Here, representatives of the Texas Ambulatory Surgery Center Society explored what makes the state great for ASCs and offered insights into the future of the market.

Note: Responses have been edited for style and content.

Question: Why is Texas a good place to start a surgery center?

Susan Cheek, TASCS president, administrator of Dallas Endoscopy Center: Texas is a non-certificate-of-need state and is very friendly to physician ownership. Taxes are lower in Texas for individuals to live here as well.

Christina McDonald, TASCS board member, CEO of Texas Health Surgery Center Rockwall: In Texas, there are over 430 ASCs that have an estimated economic impact of nearly $1.7 billion. The state has a long history in this industry since the Texas Ambulatory Surgical Center Licensing Act was enacted in 1985 by the 69th Texas Legislature. Texas is a non-CON state and promotes business ownership through lower taxes and less regulation.

Q: I know it varies by region, but do you have an average caseload by center?

SC: Our average [caseload] is more than 15,000 procedures per year.

CM: Volume at ASCs varies by region as well as individual centers due to specialty mix and capacity. For example, a single-specialty ophthalmology or gastroenterology center in Dallas will perform on average 15,000 procedures annually, while a multispecialty practice may only perform 5,000.

Q: Are there any concerns about oversaturation of surgery centers leading to a correction? Why or why not?

SC: No, because Texas is a free marketplace. [Centers need to] do [their] homework for need before opening, then provide excellent service.

CM: With over 28 million residents, Texas is growing substantially with a 14.1 percent increase from 2010-18, according to the U.S. Census Bureau. The state is appealing to people because of booming job markets and affordable housing. The growth in the state, along with technique and technological medical advances, will lead to more ASCs. Some areas may be more saturated than others, but as a whole, there is a lot of new opportunity.

James McClung, BSN, RN, TASCS board member, administrator of Center for Specialty Surgery of Austin: Average volume per center encompasses a lot of variables, especially in independents. We have averaged a 20-30 percent growth in volume each year. However, our main specialties are high-volume specialties. We are still a young center with four rooms and a decent location [and have] performed close to 5,000 cases in 2019.

Q: What does TASCS view as the biggest threat to surgery centers in the region?

SC: Consolidation of health systems.

CM: TASCS serves over 250 ASCs by providing state and federal legislative and regulatory advocacy. Ensuring legislation on regulation, reimbursement and compliance is our priority. One of the challenges ASCs are facing is the narrowing of networks with hospitals and insurance companies, including the employment of primary care physicians and specialists by big organizations. Another challenge we face is payer negotiations; as supplies, implants, and salary/wages expenses increase, some contracted reimbursements are not meeting those increases.

JM: Legislation being created per ASC reimbursement, growth, billing [and] compliance without proper ASC representation.

Q: How does TASCS advocate for centers in the region?

SC: Advocate with the state Legislature to shape legislation that is friendly to ASCs.

CM: TASCS has an active presence in [the] state capital and Washington, D.C.

We prepare, support and defend legislation related to healthcare and surgery centers. During legislative sessions, TASCS proactively sponsors legislation, ensures that bills are supportive of the Texas surgery center industry and do not adversely impact ASCs. TASCS and its members also testify before committee hearings and take formal positions on bills that may impact Texas ASCs.

Out of session, TASCS monitors and responds to comments during the rule-writing phase after new laws have been passed. TASCS also works closely with regulatory agencies such as [the Texas Department of Insurance] and [Texas Department of State Health Services] to ensure its members are up to date with the government organizations that regulate them. The society also provides news, reports and data to help member facilities stay compliant and competitive.

JM: Center visits, consolidating competitive centers for the betterment of the industry, networking and support.

Amy Kyle, senior director of managed care at Addison, Texas-based United Surgical Partners International: My Texas ASCs average 6,000 cases/year. The one thing TASCS does that no one else does is to advocate with the state Legislature to shape legislation that is friendly to ASCs.

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