As a new year begins, leaders within the ambulatory surgery center (ASC) sector are bullish on growth and focused on the innovations needed to meet rising demand.
The needs and expectations of payers and patients are shaping the strategies that executives are pursuing, with the shift to more value-based reimbursement models and the aging population being major tailwinds propelling ASC growth.
But headwinds also are blowing, including challenges in attracting and retaining staff, difficulties in providing anesthesia services, and pressure on the bottom line related to cost increases.
The good news is that ASCs are rising to these challenges, including through technological and clinical innovations and creative dealmaking.
These ideas and more are reflected in the outlooks that five leaders shared with ASC News, as the calendar flips to 2025.
Geri Eaves, BSN, RN, CASC, CNOR, CEO/Administrator, Bone and Joint Institute of Tennessee Surgery Center:
We are seeing many trends coming our way in 2025 for ambulatory surgery centers (ASCs). These are going to include lots of emphasis on cost-effectiveness and patient-centered care.
Technology and innovation is going to drive an increase in cost and a change in the way we care for patients. The continued shift of procedures from hospitals to ASCs–driven by advances in minimally invasive techniques, patient preference and payer incentives–will expand demand, particularly in orthopedics, cardiology and spine surgeries. Bundled payments and value-based arrangements with large corporations will further highlight the efficiency and quality outcomes ASCs can deliver.
The challenges–such as staffing shortages, reimbursement pressures and supply chain disruptions–will continue to test our operational resilience. The tight labor market will demand competitive wages and improved work-life balance to attract and retain skilled staff. Focusing on patient experience through streamlined scheduling, follow-ups and quality of care is going to be impactful.
As aging demographics increase demand, ASCs must adapt to these trends and challenges, solidifying their role as a vital component of the healthcare ecosystem. I am very excited about 2025 and look forward to the amazing achievements ASCs will make!
Shakeel Ahmed, MD, CEO, Atlas Surgical Group:
In my opinion, there will be several key trends, challenges and opportunities shaping the ASC landscape in 2025.
One of the most significant shifts will be toward value-based care. All-inclusive, capitated models have been around for quite some time, but in the ASC industry, these are now starting to take shape and gain traction. The paradigm is shifting toward lower-cost, convenient outpatient care. Providers, insurers and patients all prefer a bundled payment option for the services provided. ASCs are well-positioned to meet many of these requirements and deliver high-quality care at a fraction of the cost of a hospital. More broadly, bundled payment models, capitated contracts and pay-for-performance agreements will become the new normal.
Another growth factor I see in the ASC business is the exponential migration of complex surgical procedures from inpatient settings to ASCs. We will continue to accommodate more complex procedures. Total joint replacements, complex spine surgeries and minimally invasive cardiac procedures are already on the horizon and are well on their way to becoming dominant in the outpatient environment. High-acuity cases will increasingly be performed in ASCs by 2025, as patients demand these services in a more convenient, lower-cost setting. Payers will also be incentivized and gain confidence in our setups.
Lastly, I would like to highlight the evolving role of artificial intelligence in the ASC industry. Innovative technologies–including robotic-assisted surgeries, AI-driven decision-making tools and improved imaging technologies–are transforming operations. Robotics, in particular, is expected to enhance surgical accuracy, shorten recovery times and improve various aspects of pre- and post-operative care for patients.
Wes Battiste, CEO and Founder, Destin Surgery Center:
In my 30-plus years in healthcare–which includes roles in and with ASCs as a clinician, a developer/owner/operator, and a consultant–I have found the ASC industry to be one of the most dynamic and exciting arenas, and I expect that trend to persist in 2025. The continued market expansion of outpatient surgery has created many opportunities for ASCs, along with challenges and new trends.
In our advisory work at Avanza, we are recognizing an upsurge in hospital-physician ASC joint ventures. A recent survey found that 90% of hospitals have strategic plans to grow their ASC portfolios.
In my consulting role, I am currently assisting in multiple hospital outpatient department (HOPD) conversions to ASCs, de novo hospital/physician joint-ventured ASCs, and hospital acquisitions of existing ASCs. The reasoning for these hospital initiatives is multi-factorial, including the need for increased surgical capacity; enhancing physician relationships along with recruitment, which seems to be a growing priority; and as a response to consumer- and payor-driven market demands. This new trend where many hospitals are seeking out ASC/physician JVs as part of their ambulatory strategy creates significant opportunities for ASC development, especially in certificate of need (CON) states where a large hospital system may have greater leverage to acquire the licensure for a new ASC.
McKinsey & Company recently predicted a 7% CAGR in the ASC market in 2025 and beyond. In other words, opportunities will abound. I expect the growth to exceed those predictions due to the continual pressure from payors to migrate cases to the ASC, along with the continued expansion of high-acuity allowable procedures in the ASC as we have seen with arthroplasties and most recently with cardiovascular procedures.
I am confident the ASC landscape in 2025 will continue to evolve and expand with more hospital interest in ASCs, payor- and consumer-driven demand for ASC utilization, and expansion of service lines offered in the ambulatory surgery setting.
Curtis K. Collins, COO, Palmetto Surgery Center:
- Much like other ASCs, we continue to see rising costs associated with anesthesia. Regional and state market studies on CRNA pay and reality do not align. At Palmetto Surgery Center, we perform ENT and dental procedures on a large pediatric population that has Medicaid. Unfortunately, in our state, anesthesia reimbursement per unit is only $14.99, which does not cover the cost of the CRNA/MDA per hour rates.
- Last year, our center was able to negotiate with three main payors for increases on grouper payments to include implant carve outs for otolaryngology specific implant surgeries. Every administrator should be reviewing this information throughout the year to ensure that reimbursement is aligned with both the surgeon time and the cost of the implants. Medicare Local Carrier Determinations (LCD) can exclude some implant procedures at an ASC because the reimbursement doesn’t cover the cost of the implant, much less the surgeon’s operating time.
- Recruiting talent from the hospital setting, where RNs are paid at a higher base rate, get shift differential pay, and work three 12-hour shifts is difficult to compete with. We do our best at providing a competitive salary, production bonus and work-life balance, but when three local competing hospital systems raise pay to attract talent in an already competitive market, we face challenges in recruitment and retainment.
- The cost of supplies and capital equipment purchases continue to rise, with certain supplies out of stock or being limited. Anticipate large capital expenses well in advance of equipment end-of-life, because manufacturer turn-around can be lengthy. We have experienced this over the last year with replacing sterilization equipment. We are still waiting on one large order that was placed over a year ago.
Todd Currier, Administrator, Bend Surgery Center:
There are several trends to watch for within the ambulatory surgery center industry for 2025. Some of those key areas will be focused around legislation, expected continued growth and anesthesia staffing challenges.
Advocacy
Over the last few years, we have seen a trend in potential legislation that would have both a positive impact and negative impact on our industry. For 2025, advocacy should be a major focus of our industry. We can no longer stand on the sidelines; all of us need to be active participants on moving our industry forward. Participate in the ASCAPAC to prevent negative legislation.
Opportunities
We will continue to see continued growth in most specialties within ambulatory surgery centers in 2025 and beyond. Aging demographics, cost efficiencies, commercial insurance preferred site of service, and ever-evolving clinical innovation allowing additional procedures to be safely performed within ASCs will continue to provide growth. Robotic assisted surgery and cardiac procedures should see a large growth in the coming year.
Challenges
Over the coming years we expect to continue to see a shortage of anesthesia providers within our communities. Collaboration and efficiency will be a necessity in our future years so that we can continue to grow. Today and into the future, we must work closely with our anesthesia service partners to ensure that we are prepared for the sustained growth that is projected.
