The latest U.S. News & World Report rankings of ambulatory surgery centers (ASCs) point to more than strong performance on routine outpatient cases.
The rankings also offer more evidence suggesting higher-acuity procedures are moving deeper into the ASC setting, with total shoulder replacement emerging as a prime example.
For its 2026 ratings, U.S. News & World Report added shoulder replacement to its “Orthopedics & Spine” category for the first time. The rankings specifically looked at 17 specialties, grouping them into four categories: colonoscopy and endoscopy, ophthalmology, orthopedics and spine, and urology.
That change – adding total shoulder replacement – may sound methodological on its face to some. In reality, though, it reflects a broader shift in the outpatient market. Procedures once treated as firmly hospital-based are increasingly being done in surgery centers.
“We’re now witnessing the same thing with shoulder replacement surgery – that used to be an inpatient-only procedure, and it is increasingly being performed in surgery centers,” Ben Harder, managing editor and chief of health analysis at U.S. News, said in a transcript shared with ASC News prior to the rankings coming out. “This is the first year we’ve evaluated surgery centers and shoulder replacement surgery because we now have enough of a sample size of that procedure being done in surgery centers that we can include it in our analysis.”
For ASC operators, that may be one of the clearest takeaways from this year’s rankings.
The report still spans the sector’s core service lines, but the shoulder addition suggests the next phase of outpatient growth is being driven not only by more volume, but by greater case complexity.
The shift, of course, has been building for years. The U.S. Centers for Medicare & Medicaid Services (CMS) finalized coverage of total shoulder arthroplasty in ASCs within its 2024 final payment rule, with the policy taking effect Jan. 1, 2024. At the time, it was somewhat of a surprise because total shoulder arthroplasty was not included in CMS’ proposed payment rule for 2024.
“We thank CMS for heeding our request to move additional surgical procedures – including total shoulder arthroplasty – onto the ASC payable list,” Bill Prentice, CEO of the Ambulatory Surgery Center Association (ASCA), said in November 2023. “Doing so benefits both Medicare beneficiaries, who now have a lower-cost choice for the care they need, and the Medicare program itself, which will save millions of dollars as volume moves to the high-quality surgery center site of service.”
The move followed earlier outpatient migration for knee and hip replacements and helped accelerate Medicare-backed adoption in the ASC setting.
Harder tied the broader migration trend to a mix of clinical, financial and regulatory forces.
“There are a number of factors that are driving a shift in care from hospitals to ambulatory surgery centers,” he said. “One of those is advances in medical care.”
Harder also pointed to “cost pressures.”
U.S. News added shoulder replacement to its Orthopedics & Spine analysis for 2026, but the released rankings do not identify which ASCs were top performers specifically for total shoulder replacement.
More broadly, the top metro areas by number of high-performing orthopedics and spine ASCs are New York (15), Chicago (8), and Atlanta, Baltimore and Phoenix (all with 7), according to an ASC News review of the rankings.
The top states in that category were California (24), Florida (20) and Maryland (15); New Jersey and Texas both had 13 high-performing orthopedics and spine ASCs.
