
The ambulatory surgery center (ASC) market has transformed dramatically since the 1990s.
Scott Fraser, founding partner of Fraser Healthcare Partners, has seen this evolution play out, with several factors playing important roles. He spoke about how the market has changed during a recent webinar hosted by Device Talks.
“I’ve spent about 30 years watching the overall market from its infancy in the early 90s to really now becoming a vital part of health care delivery,” he said.
As more complex procedures move into the outpatient setting, especially higher-acuity procedures like orthopedic total joints and cardiology, Fraser said he anticipates more operators will want to invest in robotic technology.
“It’s headed there because the major payers, [such as] CMS, are establishing codes to shift procedures to ambulatory centers, and they’re incentivizing … providers to shift their cases and to shift cases to ambulatory centers,” Fraser said. “You also have investors that are investing heavily, and this is both private equity and health systems.”
Historically, robotic surgical platforms have been designed for complex inpatient procedures, making them less accessible for smaller, leaner ASCs.
Yet surgical robotics companies are increasingly working on systems with the outpatient setting in mind, Lionel Flaction, VP of R&D at surgical robotics company Distalmotion, said during the webinar.
“[Our robotic system] is a very small, very agile platform, which you can easily bring into any OR,” Flaction said. “We don’t force the customer, the surgeon, to choose. … [They] remain the decision maker to choose their preferred stapling device, preferred visualization systems.”
As new surgery codes and commercial insurance agreements are opening doors for even more complex procedures, like cardiac ablations, to move into ASC settings, Flaction said he sees Distlamotion as well-positioned to ride the wave.
“We want to focus on outpatient, the ASC segment,” he said.
Historically, cost has been a prohibitive factor. Because ASCs are typically for-profit entities, their ownership and profitability structures shape their purchasing decisions, Fraser said. This drive for profitability means many ASC owners need to carefully consider investment in any technology, which can be expensive.
“Profit distributions, which could be monthly or quarterly, are incredibly important to making a decision on a technology,” Fraser said.
While younger physicians fresh out of fellowship often prefer certain implant technologies that they were trained on, they typically lack equity in the ambulatory surgery center, Fraser said.
“It’s really focusing the efforts not on the doctor that’s interested in the technology,” he said. “It’s on the doctors that are owners.”
Still, if a new device or service increases throughput, lowers labor costs, or attracts higher-reimbursement procedures, that can be a decisive factor in whether ASCs adopt that device, even if it is costly.
“What does the peer review look like for the technology, that is something especially important when shifting into an ambulatory center,” Fraser said. “But more importantly, [it’s important to ask] what is the value proposition of this technology for my ambulatory center’s KPIs and profitability?”
Making sure the med tech team operators are working with truly understand their business is also key, Fraser said.
“When you sit in a boardroom with ASC owners and you have a team from med tech come in and talk all about the clinical benefits of a technology, it becomes very clear that they don’t understand your business and don’t understand your needs as a business owner,” he said.
Labor cost inflation is another key factor to consider.
“Wage inflation from 2024 to 2025 is projected to be 10%,” he said.
With labor as the largest expenditure, operators should look for technologies that streamline workflows and reduce full-time employee hours in the OR, Fraser said.
“If you have a technology that enables that, like some of the surgical robot platforms, that is very meaningful to the overall profit distribution in the center,” he said.
By limiting the need for certain in-room staff or reducing turnover time, new devices can have an impact on efficiency, he added.
“If you’re able to reduce an OR suite by one or potentially two [full-time employees], that becomes very, very meaningful,” he said.
Flaction agreed, adding that Distalmotion specifically focused on combining simplicity and adaptability to integrate into existing ASC workflows.
“We decided to focus on solving dexterity, solving the ergonomics, nothing else,” he said. “And we focused on providing a solution that will adapt to any OR.”