2024 was defined by a marked increase in cardiology procedures, with OR times for these procedures decreasing by about 28% compared to the previous year.
This has big implications for ambulatory surgery center (ASC) operators.
“You combine this improving efficiency with high net revenue per case, which we see as $4,600 on average per case, and those two combined mean that we’re seeing very impressive improvements in overall revenue per minute of operating time,” Bill Prentice, CEO of the Ambulatory Surgery Center Association (ASCA), recently said on the Advancing Surgical Care Podcast.
““[Cardiology is] very much on our mind, on the advocacy front,” he added.
Prentice was joined on the podcast by HST Pathways CEO David Thawley. Together, the two ASC market leaders discussed HST’s most recent industry report, which drew from more than 3 million cases with data collected at 590 ASCs across 47 states.
“Currently, today, HST touches roughly 11% of the surgical population in the United States,” Thawley said. “We’re in over 1,700 ASCs, and all the way from the point of scheduling through post-service revenue cycle management. We’ve got a wealth of data that ultimately led to our ability to create some of this industry report in the benchmark.”
Orthopedics also remained a strong revenue driver in 2024, with HST data showing revenue per case rising from $6,100 to $6,400. And higher ASC reimbursement for orthopedics still translates into lower overall costs compared to hospital-based procedures, Prentice said.
“We’re still providing tremendous efficiencies in savings by having those procedures being performed in the surgery center versus the hospital,” he said.
Another data takeaway from 2024: an encouraging decline in first submission claim denial rates, which dropped from 8% to 4%.
“[There is] a more effective revenue cycle management, possibly due to better documentation and improved coding practices, and also the use of more technology and AI to help ensure clean submission of claims,” Thawley said.
Yet another trend was that ASCs with two operating rooms saw a 22% rise in revenue year over year, while larger facilities with 15 or more ORs experienced an 8% decline.
“There seems to be this level of sweet spot that I think at the end of the day comes down to, how are you balancing your operating room utilization in a way that can drive greatest case volume,” He said. “ … Just an amazingly interesting data point that I think that ASCs around the country are going to really look to and think hard about.”
Patient payment patterns are also evolving, according to HST data, with partial payments increasing from 41.2% to 56.2% of total payments, while total payments dropped from 25.8% to 17%.
“This trend overall emphasizes the need for improved payment plans and financial assistance options and strategies to boost collections are really important facets for our ASC partners and facilities to get their hands around,” Thawley said.
The report also called attention to billing turnaround times and the difficulty of obtaining preauthorizations. According to the report, days to bill increased from 3.6 to 4.4, which can have a direct impact on cash flow, Thawley said.
“We saw that in 2024, only 24% of cases completed preauthorization when it was required, meaning that three-quarters of the time, even though we know a preauthorization is required, the facility was not submitting or completing that preauthorization,” he said.
This gap can lead to greater claim denials, scheduling delays and patient frustration, he added.
Thawley suggested that technology integrating with clearinghouses and payers can reduce manual errors and alert administrative teams of issues before they arise.
“The longer billing cycles obviously impact cash flows,” he said, adding that delays hurt both the ASC’s bottom line and the patient experience.
While operational challenges are growing more complex, there is a continuing advantage of ASCs, Prentice said.
“We always trumpet the ASC model’s efficiency, though it is harder and harder to be efficient because of all the challenges and headwinds that have come up,” he said.
Despite challenges, Thawley said the opportunities outweigh the disadvantages.
“We are all lucky to participate in such a beneficial and rapidly growing market as the ASC space,” he said. “I think through focusing on some of these business operations and best practices, we can continue to see this higher level of performance and optimization of ASCs as more and more higher-acuity procedures get approved into these facilities.”
