Cataract surgery accounts for 18% of all ASC procedure volume and has generated more Medicare savings than any other single procedure in the ambulatory setting, but it took decades to get there.
Cardiac catheterization and percutaneous laminectomy are starting from near zero, but projections suggest they may follow the same curve in a fraction of the time.
New data from a KNG Health report published by the Ambulatory Surgery Center Association covering 2019 through 2034 puts numbers to what many in the industry have anticipated. The findings make the case that the ASC sector’s next era of savings growth could come from the cases getting ready to move.
The five procedures that have driven the bulk of ASC Medicare savings to date — cataract surgery, colonoscopy, total knee replacement, cardiac catheterization and percutaneous laminectomy — together account for 38% of total savings from 2019 through 2024, or $10.6 billion of the $27.9 billion generated over that period.
But the distribution is striking, with cataract surgery and colonoscopy carrying the volume. Cardiac catheterizations and percutaneous laminectomy each contributed just $0.06 billion in historical savings over that same five-year period.
Current ASC volume share confirms how early-stage this migration is. Total knee replacement, added to the ASC Covered Procedures List only in 2020, accounts for 0.6% of procedures performed in ASCs. Cardiac catheterization sits at 0.2%. Percutaneous laminectomy sits at 0.2%. Cataract surgery, for comparison, is at 18%.
The next decade looks materially different for ASCs. Cardiovascular savings are projected to grow from $390 million in 2025 to $1.57 billion in 2034, a 302% increase that makes it the fastest-growing CPT category in the analysis. Cardiac catheterization is projected to exceed a tenfold increase in savings over the 10-year period.
Percutaneous laminectomy numbers are similarly dramatic. The procedure grows from 77.6% of Category III Code savings in 2025 to 99.3% by 2034. Total Category III Code savings are projected to grow from $30 million in 2025 to $730 million in 2034.
The total knee replacement trajectory is the clearest analogy available. CMS added TKR to the ASC Covered Procedures List in 2020. Musculoskeletal savings jumped 75.7% from 2019 through 2024, growing from $400 million to $800 million as a direct result of that policy approval unlocking volume migration.
The pattern is consistent enough to function as a model: coverage approval, then rapid volume migration, then compounding savings. Cardiac catheterization and percutaneous laminectomy are at the earliest point on that curve, with 0.2% ASC volume share each and savings projections that assume the migration has barely started.
The cataract surgery comparison is useful not because cardiac catheterization will follow an identical path, but because it illustrates what procedure maturity looks like at scale. Getting from 0.2% to anything approaching 18% ASC volume share in cardiac cath would represent one of the largest site-of-care shifts in Medicare’s recent history.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.