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Ambulatory surgery centers (ASCs) play a crucial role in the U.S. health care landscape.

There are over 6,000 Medicare-certified ASCs in the country, and this number is rapidly increasing due to several factors, including shifting payer and patient preferences for non-hospital alternatives. For ASC operators, all that growth raises an important question: How do you capitalize on that demand and expand in a strategic, safe and impactful manner?

And there isn’t a one-size-fits-all answer to that question, ASC leaders told Ambulatory Surgery Center News.

“Patients, providers and payers recognize ASCs for the high-quality, efficient, low-cost care they provide,” Dr. Peter Bravos, Sutter Surgery Division chief medical officer, told ASC News.

Based in Sacramento, California, Sutter Health provides care to over 3.5 million patients each year. Sutter ASCs conduct approximately 180,000 surgeries and procedures annually across 18 surgical specialties.

The organization also performed 1,700 total joint replacements in 2023, representing a 51% increase since 2017.

“More complex procedures are being performed in ASCs than ever before,” Bravos said.

The need for more extensive, state-of-the-art facilities, particularly in underserved areas, is also growing with the rising demand for ASC services.

The development of the Millennium Surgery Center in Greenville, South Carolina, is a recent example of this trend.

A collaboration between Bon Secours Mercy Health, Compass Surgical Partners and Greenville physicians, this 20,000-square-foot center specializes in same-day orthopedic surgeries, otolaryngology interventions and pain management procedures. One of the center’s chief goals: eliminating hospital stays for patients in its market.

Compass Surgical Partners, known for its development and management of ASCs, has been involved in over 250 ASCs nationwide in joint ventures with health systems and physicians.

As part of Bon Secours Mercy Health, Bon Secours St. Francis is among the top 20 largest health systems in the U.S., providing care through a network of 1,200 care sites and 49 hospitals across several states and Ireland.

Historically, South Carolina has fewer ASCs relative to its population than most states.

“Greenville is one of the fastest growing cities in the U.S.,” Maureen Richmond, vice president of external and merger-and-acquisitions communications at Bon Secours Mercy Health, told ASC News. “Millennium’s opening brings convenient ambulatory surgical care to people in the region as well as advanced surgical equipment and specialized surgical staff.”

Bon Secours Mercy Health and Compass previously opened three other facilities jointly.

The organizations plan to open multiple ASCs in 2024 and beyond, showcasing their commitment to patient care.

Build a well-managed growth strategy

The adaptability of ASCs during the COVID-19 pandemic has been evident, with some segments transitioning to digital. Telehealth has emerged as a significant development, enabling virtual consultations and surgeries in ASCs, further reducing the need for hospital visits.

Factors such as the increasing aged population, lifestyle changes, obesity and chronic conditions are contributing to a rise in the number of surgeries conducted, prompting some ASCs to become single-specialty providers to attract patients looking for specialized care.

While a higher volume of surgeries does not always equate to higher profits, a well-planned and strategically executed expansion can lead to significant financial success.

Complete buy-in from staff and a clear understanding of how, why and when to grow are essential for a successful expansion, sources told ASC News. Additionally, growth should be embedded into an ASC’s business strategy, focusing on physician recruitment, specialty additions and service line expansions.

“The ASC’s governing body should be involved in any service line expansion discussions,” Compass Market President Tommy Kline told ASC News. “The administrator, the director of nursing, and members of Compass’s team ranging from managed care to clinical quality to operations also play key roles in determining the feasibility of service line expansion.”

“Our partnership trusts and works closely with our physician partners to guide us on clinical aspects and patient needs,” Kline said. “Scheduling analytics also signal that an expansion would be beneficial.”

Another signal for ASC operators that expansion should be on the table comes from market trends among ASC competitors in a given market.

If hospitals in a market are seeing a large number of surgeries that could readily be shifted into the ASC setting, that’s an important clue it’s time to grow.

“We also consider whether the expansion would benefit patients currently having the same services performed in hospital outpatient departments,” Kline said. “If a percentage of this patient population is eligible for the same procedure to be performed in the ASC, that is a sign that expansion is a good idea.”

Conversely, if clinical trends indicate that a service could become less common in the coming years, expansion probably isn’t a good idea.

“It is imperative to consider the financial viability of ASCs,” Kline counseled. “We rely on the reimbursement rates provided by the payers, and if reimbursement rates for a certain service are insufficient to make that service financially viable, we would likely not add that service to the ASC.”