Image by Oleksandr Pidvalnyi from PixabayHospital and health system ownership of ambulatory surgery centers (ASCs) is reaching new heights.
That’s according to the recently released 6th Avanza Intelligence Hospital Leadership ASC Survey.
“Hospital systems were faced with a choice,” explained a report based on the survey. “They chose ASCs.”
The accelerated hospital and health system interest in ASCs comes as organizations continue to prioritize outpatient surgery as a strategic imperative tied to patient, payer and physicians preferences.
How serious is that interest? More than 80% of the hospital and health system leaders that participated in Avanza’s survey said their organizations now owned at least one ASC. That figure is more than double from just 41% in 2019 and also up significantly from 48% in 2023, according to Avanza.
“While COVID-19 delayed some ASC development due to hospitals and health systems needing to focus efforts elsewhere, most organizations have now made up for the lost time by aggressively pursuing ASC opportunities,” detailed the report. “The pressure to add ASCs to their outpatient surgery portfolio – and the potential risks of waiting to do so – is too great to postpone investments.”
Beyond a COVID-19 lag, the accelerated interest is tied to multiple converging pressures.
Health systems are seeking to meet growing patient demand for high-quality, lower-cost surgical care outside of traditional inpatient settings. Additionally, payers are increasingly pushing for outpatient migration to curb costs.
Meanwhile, physicians continue to favor ASC environments for the efficiency, autonomy and financial alignment they offer.
Specifically, 63% of hospital and health system leaders surveyed by Avanza said they were experiencing direct pressure from commercial payers to provide ASC options for appropriate procedures.
Additionally, 66% cited increasing outpatient surgical capacity as a top reason for ASC ownership or affiliation, while 65% pointed to enhancing physician relationships as a major driver.
Consumer trends, cost containment and surgeon retention were also among the key motivating factors.
Surgeon recruitment is another critical consideration, with 93% of surveyed hospital and health system leaders saying ASC ownership helps attract top surgical talent.
“The pressure for hospitals and health systems to add one or more ASCs is especially intense in markets with rival systems and in states with revised or pending changes to certificate of need (CON) laws, making delays increasingly risky,” the report continued. “Delaying action is neither a viable option nor a strategic choice.”
What’s more, ASC ownership structures also continue to evolve.
Roughly 75% of hospital and health systems are utilizing joint venture models, sharing ownership with physicians, according to the report. Most systems prefer to maintain operational control, with 67% of respondents indicating they seek at least a 50% stake in ASC partnerships, up from 64% in 2023.
“Physician financial investment in the surgery center may serve to motivate physicians to be more engaged and cost-conscious, thus helping drive profitability,” the report said. “Physicians are still interested in joint ventures where they are the minority owners because they want to leverage contracts such as those from payers and group purchasing organizations that are only accessible if the hospital demonstrates control.”
Internal management of ASCs is gaining favor, too, according to Avanza.
More than half of respondents reported using in-house teams to oversee ASC operations rather than outsourcing to third-party management companies.
“Internal ASC teams can often adapt more quickly to industry changes and patient and physician needs,” the report explained.
While the overwhelming majority of hospitals now own or are planning to own ASCs, a small portion of systems remain on the sidelines. For these holdouts, regulatory hurdles such as CON laws, a lack of sufficient outpatient surgical volume, or other organizational priorities are often cited as reasons for delay.
The 6th Avanza Intelligence Hospital Leadership ASC Survey included responses from a wide range of hospital and health system leaders, including CEOs, financial executives, operations leaders and clinical leadership, with a mix of for-profit and nonprofit organizations across various regions of the country.
