Avanza Intelligence 2021-2022 Hospital Leadership ASC Survey Reveals Increased Investments in ASCs

The latest national survey commissioned by Avanza Healthcare Strategies, a leading expert on ambulatory surgery centers (ASCs) and outpatient services, found most hospitals and health systems are planning to increase their investments in ASCs. This fourth annual survey of senior healthcare executives and clinical leaders provides valuable insights into hospital-owned and hospital-physician joint venture ASC trends. 

According to the survey, more than 6 out of 10 hospitals and health systems intend to increase their investments in ASCs, as senior executives and clinical leaders at hospitals and health systems across the country were polled. The survey demonstrates the growing importance of ASCs to hospital systems and is attributable to a multitude of factors, including the ongoing shift of non-urgent surgical procedures into the outpatient setting, growing competition for physicians and surgical cases, and the movement toward value-based care.

Hospitals and health systems of all sizes are expanding their ASC portfolios, and many are converting hospital outpatient departments to ASCs. The percentage of hospital systems with ASCs continues to increase. More than 60% of hospitals and health systems are planning to grow their investments in ASCs going forward.

Avanza Founder and President Joan Dentler notes, “It comes as no surprise to see our new survey indicate that hospitals and health systems are pursuing a variety of ASC initiatives — often in partnership with physicians — that will allow them to broaden their surgery center and outpatient portfolios. As surgical care continues its migration out of the inpatient setting, hospital systems are recognizing the need for at least one ASC — and increasingly multiple centers — in their portfolios.”

More than 80% of hospitals and health systems surveyed have one or more of their ASCs as joint ventures with physicians. From 2020-2021, the percentage of ASCs with 100% hospital and health system ownership declined while hospital and health system majority ownership in ASCs increased during that same period. More than half of hospitals and health systems are allowing their employed physicians to invest in their ASCs.

Hospitals and health systems of all sizes are expanding their ASC portfolios…

Dentler points to several trends that may be contributing to such changes, including hospitals and health systems recognizing the value of physician investment in their ASCs. 

“When physicians are ownership partners, they are more likely to support cost-conscious activities that can drive profitability and help hospital systems better maximize the revenue from their value-based contracts. Meanwhile, physicians financially benefit not only through their ownership shares but also the access they get to their partners’ payer and group purchasing contracts that further boost the bottom line,” she notes.

Continuing a downward trend, outsourcing ASC management functions dropped from 23% in 2019 to 15% in this latest survey. In addition, the percentage of hospitals and health systems with ASCs that permit third-party equity partners also continued to decline, dropping from 44% in 2018 to 27% in the survey.

Dentler points to the maturity of the ASC industry that’s now more than 50 years old. “In the early days of ASCs, outside management services were often a necessity to running a viable surgery center. But thanks to the proliferation of support services and technologies for the industry and increase in seasoned professionals with ASC experience, the need to give up valuable equity and enter expensive management agreements is no longer a requisite for ASC success.”