10 predictions for ASCs in 2022

Consolidation, payer policies, nurse shortages and COVID-19 will continue to loom large for ASCs over the next 12 months.

Here are 10 predictions:

1. Physicians will have more power and be driven to develop new ASCs or join an existing center as a highly efficient site of care. "As there is a shortage and more physicians age, the one thing they want is efficiency. Time is of the essence. This is a time for ASCs to thrive. Multiple rooms for surgeons and efficient use of staff and the rooms will allow more cases to be done and still allow the surgeon more time away. Surgeons will pull away from the slow-moving bureaucratic hospital as they can find more of the things professionally they want to do in a far easier, efficient, streamlined system — the ASC," Timothy Kremchek, MD, of Cincinnati-based Beacon Orthopaedics & Sports Medicine, told Becker's.

2. Large ASC chains will further consolidate, with even the largest chains needing new ways to spur quick growth through acquisitions and health system partnerships. There will likely be more acquisitions like Dallas-based United Surgical Partners International's $1.2 billion deal for SurgCenter Development finalized earlier this month.

3. Commercial insurers will try to drive more cases to the ASC by narrowing guidelines for outpatient procedures. However, the potential higher volume won't guarantee sustainable pay rates for procedures. Prior authorizations will also be big roadblocks for ASCs, especially as more complex cases come into the centers.

4. Private equity will make more inroads with midsize physician groups and large ASC chains. "A majority of ASCs are owned by physicians. Private equity and venture capital groups are assessing deploying major capital investments in ASCs, especially as insurers and CMS are transitioning their more complex, high-cost surgical procedures to ASCs due to cost savings with safe, convenient and quality results," said Joe Peluso, administrator of Aestique Surgery Center in Greensburg, Pa.

5. The relationship between hospitals and physician-owned ASCs in many communities will grow more contentious as the two facilities compete for physicians, outpatient surgeries and nurses. The nursing shortage nationally compelled many health systems to pay large bonuses for new nurses, or high rates for traveling nurses, luring nurses away from the ASC. However, long hours at the hospital and pandemic-related burnout also drives nurses to the outpatient setting, where they have a more reliable schedule and do not treat COVID-19 patients.

6. Surgery centers will be required to collect more clinical and cost data as the industry pushes for value-based care and price transparency. ASCs with the right technology and infrastructure to provide this information quickly and use it to promote their services will be in the best position to succeed.

7. Surgeon owners nearing retirement may decide to take the plunge early instead of facing new challenges from COVID-19 and payer policies. "These surgeons see inconsistent payer practice from CMS and commercial with restrictive prior authorizations and then the removal of the 258 CPT codes from the ASC. It's so hard to decide where to go with this information. Do we invest in more, or do we retire? Additionally, COVID-19 and all of the variants and the expense and changes that come with this. If they are close to retirement, this might be the tipping point for the physician. Can the new surgeon afford to buy into a center?" said Christine Blackburn, administrator of South Kansas City SurgiCenter in Overland Park.

8. There will be more nontraditional methods for driving case volume, including direct-to-employer contracting and digital marketing to the consumer. Surgery centers will also invest more resources in boosting the patient, and surgeon, experience.

9. Vendors will increasingly devise ASC-specific strategies to target independent surgery centers, which still comprise the majority of ASCs in the U.S. Success with the ASC strategy will be key for orthopedic device companies in particular as more total joint replacements and spine surgeries are performed in ASCs.

10. Surgery center owners are investing in growth and expansion, and will need additional financing. "Our partners have made significant sacrifices over the past two years to keep our staff on board, and we need to get as close to normal as possible. Because of the major investments we plan to make, we will be relying on financing options more heavily than in the past," said Alfonso del Granado, administrator of Covenant High Plains Surgery Center in Lubbock, Texas.

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