SMART MOVE Health systems are partnering with freestanding surgery centers as patients and surgeons gravitate to more nimble ASCs.

An increasing number of hospitals and health systems plan to invest more money and resources into ambulatory surgery centers, according to a national survey of more than 100 senior healthcare executives and clinical leaders.

Avanza Healthcare Strategies with HealthLeaders Media conducted the survey at the beginning of 2020, before the coronavirus outbreak, but the pandemic has only reinforced the momentum in the direction of ASCs as the need to shift elective surgeries from hospital settings has grown due to COVID-19. Regardless of their size, the pollsters said, many hospitals and health systems are looking to build their own ASCs as well as convert hospital outpatient departments (HOPDs) to ASCs. Comparing survey data from 2019 and 2020, the surveyors found that systems planning to increase their investments in ASCs rose from 44% to 67%, and 76% of larger hospitals reported increasing their investments in ASCs.

The driving force behind this development points to consumer trends of payers and patients opting for less costly sites for outpatient surgeries. Hospitals have responded to this shift, as the number of hospitals owning or affiliating with more than one ASC jumped 17 percentage points in two years. In 2020, 75% of hospitals with 200-plus beds have more than one ASC, the report found.

"ASCs continue to be the model for providing high-quality, low-cost surgical care, and many hospitals are converting their outpatient departments or migrating cases to ASCs," said Joan Dentler, president and CEO of Avanza. "This was true before the pandemic reinforced the business case for every hospital having a freestanding ASC in its portfolio."

As a result of this strengthening trend, more health systems and hospitals are seeking to manage ASCs themselves as opposed to contracting third-party management companies, which have long held sway in the ASC world. In the 2018 survey, 44% of respondents said they contracted third parties to manage their ASCs; that figure plummeted to 16% in 2020. But as ASCs move closer to health systems, fewer physicians have ownership stakes in the facilities. The survey found only a third of hospitals allow employed physicians to invest in ASCs, the lowest number in three years.