The migration of surgical procedures from hospitals to ambulatory surgery centers (ASCs) continues to accelerate, driven by technological advancements, evolving reimbursement models and patient demand for cost-effective, convenient care.
A recent analysis by Definitive Healthcare highlights the top 10 service lines experiencing the most significant shifts from hospitals to ASCs between 2016 and 2024.
Orthopedic procedures, particularly joint replacements, are among the procedures leading the hospital-to-ASC migration.
Advancements in minimally invasive techniques and anesthesia have made it feasible to perform total knee and hip replacements in outpatient settings, reducing recovery times and costs. While not featured on Definitive Healthcare’s list, more ASCs are starting to perform total shoulder replacements as well.
Gastrointestinal endoscopies and ophthalmologic surgeries, such as cataract removals, have long been staples in ASCs. But the data indicates a growing volume of these procedures migrating from hospital outpatient departments to freestanding ASCs, further underscoring the broader shift in care settings.
“Colonoscopies and esophagogastroduodenoscopies (EGD) top the list, reflecting an ongoing trend of patients opting for minimally invasive, outpatient procedures,” Definitive wrote.
The specific list of the 10 service lines and sub-service lines moving out of hospitals and into ASCs the fastest, according to Definitive’s data, are:
– Colonoscopy
– Esophagogastroduodenoscopy
– Other surgery, ortho (trigger finger release, tenodesis, and others)
– Lens & cataract procedures
– Arthroplasty, knee
– Arthroscopy, knee
– Incision & drainage
– Arthroplasty, hip
– Excision, skin
– Peripheral nerve decompression
Several factors contribute to the hospital-to-ASC shift, Definitive pointed out when releasing the data.
The Centers for Medicare & Medicaid Services (CMS) has expanded the list of procedures eligible for reimbursement in ASCs, incentivizing providers to consider these settings.
Additionally, value-based care models and bundled payment arrangements encourage cost-effective care delivery, aligning with the efficiencies offered by ASCs.
Patient preferences also play a role. ASCs often provide shorter wait times, streamlined scheduling and reduced exposure to hospital-acquired infections. These benefits, coupled with lower out-of-pocket costs, make ASCs an attractive option for many patients.
“This shift is reshaping the landscape of outpatient care, with ASCs increasingly becoming the go-to destination for various surgical services, especially in high-demand, low-risk procedures,” Definitive wrote.
Looking ahead, the hospital-to-ASC shift is expected to continue – and accelerate. Health care providers and systems are investing in ASC infrastructure, and policymakers are likely to support the expansion of services in these settings to control costs and improve access.
Many higher-acuity procedures are likely headed for ASCs as well, with cardiovascular procedures and complex spine procedures being prime examples.
