Image by Paul from PixabayThe shift of surgical care into outpatient settings continues to reshape the U.S. health care landscape.
And a new set of rankings from U.S. News & World Report once again highlights which ambulatory surgery centers (ASCs) are leading the charge.
U.S. News on late Tuesday/early Wednesday (depending on where you live) released its “2026 Best Ambulatory Surgery Centers” ratings, evaluating 4,421 ASCs nationwide across four specialty areas. Those areas included colonoscopy and endoscopy, ophthalmology, orthopedics and spine, and urology.
Of those facilities, 911 centers – about 21% of the overall group – earned a “High Performing” designation, or the publication’s top rating under the project. The annual report is now in its third edition.
“With more and more patients receiving care in ASCs, we’ve produced these ratings to help them make data-driven decisions about where to seek care,” Ben Harder, managing editor and chief of health analysis at U.S. News & World Report, told ASC News in an email. “That’s our core consumer mission.”
“At the same time, the data and unique analysis we’ve performed offers highly granular insights into variation in outcomes, efficiency, volume, and quality – insights that provider organizations find helpful as they continue to reorient their services to meet consumer demand for same-day surgery and endoscopy care,” Harder continued.
Geographic concentration
The rankings show a notable geographic concentration of top-rated centers in several large states and metropolitan areas where outpatient surgical infrastructure has expanded rapidly.
California had the largest number of “Best ASC” facilities with 105, followed by Florida (81) and Texas (59). Other states with large numbers of highly rated centers included Maryland (48), Pennsylvania (43), Georgia (40) and New Jersey (40).
At the metro level, New York led with 52 Best ASCs, followed by Los Angeles (34), Atlanta (28) and Philadelphia (27). Baltimore and the Washington, D.C., region each had 24, while Phoenix (22) and Dallas-Fort Worth (21) also ranked among the largest clusters of high-performing centers.
The results reflect the broader growth of outpatient surgical care in densely populated markets where physician groups, health systems and national ASC operators have expanded networks of same-day surgical facilities.
Strong outcomes at top centers
Across specialties, ASCs receiving the “High Performing” designation consistently demonstrated lower complication rates than the national average.
Patients treated at top-rated colonoscopy and endoscopy centers experienced 26% fewer serious complications, while leading ophthalmology ASCs saw a 40% reduction in severity-weighted complications compared with the broader field of evaluated facilities.
Best ASCs in orthopedics and spine recorded 29% fewer complications, and top-rated urology centers had 31% lower complication rates.
These results reinforce the growing body of evidence that many procedures – including joint replacements and other complex surgeries – can be safely performed outside of hospital settings.
“I’d say the ongoing shift of so much surgical care from hospital-based to ambulatory settings is the most striking takeaway from our data analysis,” Harder said.
The majority of the ASCs analyzed were single-specialty providers. Still, more than one-quarter were multi-specialty ASCs.
How the rankings work
The rankings are based primarily on Medicare fee-for-service claims data from 2022 through 2024, analyzed by health care analytics firm Arcadia using data housed in the Centers for Medicare & Medicaid Services’ (CMS) Virtual Research Data Center.
“Other CMS data sets – the National Plan and Provider Enumeration System (NPPES) and ASC Quality Reporting (ASCQR) program – were used to identify facilities for inclusion in the analysis,” detailed a methodology section to the report.
U.S. News examined 17 types of procedures commonly performed in ASCs, grouping them into the four aforementioned specialties.
Performance was evaluated using multiple outcome measures tied to patient safety and complications. These include emergency department visits after procedures, hospital admissions, the cost of complications, mortality rates and post-acute care utilization.
ASCs are then categorized into one of three tiers within each specialty: “High Performing,” “As Expected,” or “Evaluated.” Facilities in the top 15% of composite scores receive the “High Performing” designation.
Specialty changes in 2026
As to be expected, there were changes in some areas and top performers year over year.
“Among the more than 4,000 ASCs in our analysis, we observed many that showed an improvement or decrement in their performance from last year’s ratings to this year’s ratings,” Harder said. “Those changes are important information for consumers who are choosing among the ASCs in their community, and they’re important for surgical administrators and ambulatory care leaders to understand, especially if their centers may have room for improvement.”
And the 2026 rankings also reflect the continued evolution of the outpatient surgery market.
For the first time, U.S. News included shoulder replacement surgery within its orthopedics and spine category, reflecting the growing number of ASCs performing advanced joint procedures that historically required hospital stays.
The change underscores how advances in surgical techniques, anesthesia and postoperative care are enabling more complex procedures to shift into ambulatory settings.
“[Overall], we found that ambulatory surgical care continues to be a very safe option for the vast majority of patients, even as utilization grows,” Harder continued. “That’s reassuring for patients and suggests that the ongoing shift of care from hospitals to ASCs is likely to continue and, if anything, gather steam.”
