Most, least desirable states to open ASCs 

The Southern ASC market has been a hotspot for years — ASCs in that region earn the most revenue and perform the most cases of any region in the country. 

Southern states like Texas and Florida have huge numbers of ASCs, and states like South Carolina and North Carolina are seeing rapid population growth paired with an influx of ASCs.  

In January, personal finance website WalletHub assessed which states are the best and worst places to start a business across three dimensions — business environment, access to resources and business costs. 

Alaska was WalletHub's pick for the worst place to start a business, followed by Connecticut and West Virginia. Of the 183 new ASCs that Becker's reported on in 2022, none was opened in those three states. 

The best states — Utah, Florida and Texas — saw a flurry of ASCs openings. Texas and Florida are great states to open ASCs because of their loose certificate-of-need laws. 

"Physician-owned or operated ASCs in Oklahoma, Texas, Kansas and Arkansas have been the result of robust entrepreneurial growth over the years coupled with very little restraints of certificate of need statutes and regulatory oversight," Stewart Burchett, executive director of Oklahoma Lithotripter Associates and Oklahoma Kidney Stone Center in Oklahoma City, told Becker's last year. "The result early on was a plethora of ASCs as outpatient surgery grew in popularity, and many physician-owned entities were built in areas one would never have imagined."

The best states to open a business, according to WalletHub:

  1. Utah
  2. Florida
  3. Texas
  4. Colorado
  5. Idaho
  6. Georgia
  7. Arizona
  8. Nevada
  9. Oklahoma
  10. California

The worst states to open a business:

  1. Alaska
  2. Connecticut
  3. West Virginia
  4. New Jersey
  5. Rhode Island
  6. Wyoming
  7. Pennsylvania
  8. North Dakota
  9. Virginia
  10. Maryland

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