Healthcare Insights
Top 10 ambulatory surgery center service line shifts from hospitals
Ambulatory surgery centers (ASCs) provide an alternative site for physicians to perform elective procedures in an outpatient care setting. According to the Ambulatory Surgery Center Association, more than 80% of surgeries are now performed at ASCs.
Some procedures and service lines are more conducive to an ambulatory care setting, such as gastroenterology and ophthalmology. Others, such as cardiology and vascular surgery, are still largely performed in a hospital setting. These surgeries tend to be more complex and require extensive monitoring, specialized equipment, or prolonged recovery times. However, we may start to see a shift in some of these surgeries to ASCs as the Centers for Medicare and Medicaid (CMS) adds additional cardiovascular procedures to their ASC-covered procedure list (CPL).
Using data from the Definitive Healthcare Atlas All-Payor Claims Dataset, we created this list of the top 10 service lines that have experienced the highest shift in services from hospitals to ASCs from 2016-2022.
| Rank | Service line | Percent of surgeries that shifted from hospital to ASC | Explore dataset |
|---|---|---|---|
| 1 | Nephrology | 12.2% | Explore |
| 2 | Ophthalmology | 11.7% | Explore |
| 3 | Hand surgery | 8.1% | Explore |
| 4 | Reproductive endocrinology | 6.9% | Explore |
| 5 | Orthopedic surgery | 6.9% | Explore |
| 6 | Gastroenterology/endoscopy | 5.2% | Explore |
| 7 | Allergy/immunology | 4.0% | Explore |
| 8 | Colorectal surgery | 4.0% | Explore |
| 9 | Interventional cardiology | 3.6% | Explore |
| 10 | Urology | 2.7% | Explore |
Fig. 1. Data is from the Definitive Healthcare Atlas All-Payor Claims Dataset. Claims data is sourced from multiple medical claims clearinghouses in the United States and updated monthly. Accessed May 2023.
What service lines are experiencing the highest shifts to ASCs?
Nephrology holds the top spot for service lines that have shifted care to ASCs, with 12.2% of total nephrology surgeries shifting from hospitals to ASCs during the period of 2016-2022. Nephrology focuses on the diagnosis, treatment, and management of diseases and conditions related to the kidneys.
Ophthalmology has also seen a large shift in care to an ASC setting, with 11.7% of procedures shifting from hospitals to ASCs during this timeframe. Ophthalmology focuses on managing disorders and diseases related to the eyes and the visual system.
Hand surgery is third on the list, with 8.1% more procedures performed in an ASC setting in 2022 than in 2016. As the name implies, hand surgeons focus on the diagnosis, treatment, and management of conditions and injuries affecting the hand, wrist, and forearm.
What has led to service lines shifting to ASCs?
Several factors have led to this shift from hospitals to ASCs. Many of the procedures performed at ASCs are more affordable than in hospital outpatient departments, which means lower costs for both payors and patients. According to cost data from medicare.gov’s procedure price lookup, the most common procedures performed at ASCs are more affordable than in hospital outpatient departments.
Part of the shift is also due to ACA-imposed regulations where physicians have lost ownership at hospitals. Over half of ASCs are now physician-owned, while another 21% are jointly owned by physicians and hospitals. The implementation of shared ownership models in outpatient care financially incentivizes physicians to promote the shift towards non-hospital procedures. By becoming equity owners in ambulatory sites, doctors are motivated and given the chance to direct their patients toward procedures conducted outside of hospital settings.
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