1. More dermatology focused ASCs. "Dermatologists have grown more prolific and come on stronger as ASCs expanded services to incorporate the need for dermatology ASCs and are now building more ASCs for themselves and their specialties," Mr. Fox says.
2. More gastrointestinal ASCs. "GI ASCs started growing about five years ago and continues to grow despite the drop in reimbursements in that specialty," he says.
3. Bigger, rather than smaller ASCs. "We’re seeing physicians building bigger buildings, in spite of the economy," he says. "We’re particularly seeing that in smaller markets where they have captive audiences. A physician in Rollins, Wyo., doesn’t face the same kind of competition that a doctor in Dallas does. We’ve seen a ton of these in small communities around the country at the same time physicians in big markets are trying to consolidate."
4. More ASCs built within Certificate of Need (CON) states with a single specialty. "About half the remaining states that have CONs do allow physician groups to build single specialty (ASCs)," Mr. Fox says, citing Pennsylvania and Washington as two states seeing a lot of ASC construction activity. "That’s a way for CON boards to bridge the gap. They’re not trying to be hospitals."
5. Fewer pain management ASCs. "Pain management as a specialty has taken a beating over last few years," Mr. Fox says. "It’s not going away, but the reimbursements have fallen and that component [has become] smaller and is less of a cash cow than it used to be."
6. More spine-focused ASCs. "As more orthopedic surgeons and neurologists perform more arthroscopic procedures, they will grow more comfortable doing them in outpatient settings such as ASCs," says Mr. Fox, who said that reimbursement and technology will also drive the migration. "Spinal procedures in surgery centers will explode in the next few years in ASCs and I think we’ll see the same thing with knees and hips."
7. Improved aesthetics. "We’re seeing more user-friendly and patient-friendly new products coming out, new flooring and cabinetry that make ASCs look homier," he says. "You can build an ASC now that looks like somebody’s living room, still with commercial grade materials, but looking much more residential and less institutional We expect that to grow."
Mr. Fox says the actual flow and design of ASCs haven’t changed much since he entered the business 31 years ago. "They might vary by specialty and types of surgery performed," he says. "And the lights and surgical equipment may have improved. They are power users and there’s strong need for filtration. The plumbing, electrical and mechanical systems are so large and based on capacity that it seems to be going in the opposite direction of the green movement. So much of it is dictated by building code, which necessitates using more energy. It’s not a place where you can incorporate a lot of energy conservation."
Raymond Fox (ray@raymondfox.com) is a medical architect whose San Diego-based firm, Raymond Fox & Associates, has designed more than 600 ASCs.
