The ASC industry is undergoing significant shifts in performance, efficiency and patient payment patterns, according to HST Pathways’ latest State of the Industry Report.
The report, which analyzes data from 590 ASCs in 47 states, highlights five key trends shaping the future of outpatient surgery:
1. Cardiology is booming, but revenue per case is slipping
Cardiology continues to gain traction in ASCs. Between 2023 and 2024, the average operating room time for cardiology cases fell by 28%, dropping from 48 minutes to 34.7. The report credits this efficiency to improved workflows and greater use of technology.
However, streamlined procedures haven’t led to higher earnings per case. Average net revenue dropped 8%, from $5,014 to $4,611. Still, revenue per OR minute rose sharply — from $104.46 to $132.88 — a 27% gain.
“These changes highlight the balance between operational efficiency and financial performance, the report said. “Influences such as payer reimbursement policies, shifts in case volume and technological advancements may impact procedure times and revenue outcomes.”
Cardiology is now the fastest-growing ASC specialty, according to Avanza’s “2022 Key ASC Benchmarks and Industry Figures” report.
“Cardiology is now the big hot ticket for ASCs,” Bruce Feldman, administrator of Eastern Orange Ambulatory Surgery Center in Cornwall, N.Y., told Becker’s. “A lot of centers are beginning to do cardiac procedures, vascular stenting, ICD implants, etc.”
2. Orthopedics holds steady as a top-performing specialty
Orthopedics continues to lead in profitability, with the highest average net revenue per case among ASC specialties. That figure increased from $6,141 in 2023 to $6,419 in 2024, a 4.5% bump, according to the report.
“As technological advancements continue, we expect the volume of higher-acuity orthopedic procedures to migrate to ASCs in 2025,” Andrew Lovewell, CEO of Columbia (Mo.) Orthopedic Group, told Becker’s. “Total joint replacements, particularly knee and hip replacements, will remain a primary growth driver in most orthopedic/[musculoskeletal]-focused ASCs. Shoulder replacements will grow more in the ASC space as well since we have a year of data demonstrating the excellent outcomes that ASCs produce on this procedure.”
3. Claim denial rates cut in half
ASCs are making major gains in revenue cycle management. Claim denial rates dropped from 8% in 2023 to just 4% in 2024 — a notable contrast to broader industry trends. Experian Health’s “2024 State of Claims” survey found that nearly 75% of providers reported rising claim denials, a 31% increase since 2022.
The report attributes the ASC improvement to more accurate documentation, better coding and potentially early adoption of AI tools.
4. Smaller ASCs outperform larger ones
ASCs with just two operating rooms saw 22% year-over-year growth — the highest of any group. In contrast, centers with 15 or more ORs saw an 8% decline.
“These trends suggest a shifting dynamic in ASC performance, with smaller centers thriving while larger ones face headwinds,” the report said.
This may also reflect differences between single-specialty and multispecialty centers, according to many industry leaders.
“A lot of the larger surgery centers, many of them are broad, multispecialty centers, which I think is a significant flaw in some respects, because when you’re trying to get ahead, it’s all about routine,” Benjamin Stein, MD, an orthopedic surgeon who co-founded and chairman of ASC development group Capital Surgical Solutions, told Becker’s last year. “If you look at it from a clinical perspective, catering to the clinical deployment of a single specialty means your staff — your sterilization departments, both operating room and recovery staff, anesthesia staff — will all be much more knowledgeable, efficient and targeted in the care they provide if they can focus on one specialty.
5. . Surge in partial payments
ASCs are seeing a shift in how patients and payers settle bills. Between 2023 and 2024, partial payments rose from 41.2% to 56.2%, while total payments dropped from 25.8% to 17%.
“This trend emphasizes the need for improved payment plans, financial assistance options and strategies to boost collections,” the report said. “Collecting payments pre-DOS is critical, with some ASCs going as far as implementing policies where surgeries are not performed unless the patient has paid in full.”
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