The Future of Outpatient Ambulatory Surgery: A Business and Site of Care Transformation

Through this article, Mitchell emphasizes the rapid shift of surgical procedures from traditional hospital settings to ambulatory surgery centers (ASCs), highlighting their cost efficiency and the technological advancements positioning ASCs as the future of modern surgical care.

The healthcare industry is undergoing a fundamental shift as surgical procedures continue transitioning from traditional inpatient settings to ambulatory surgery centers (ASCs). This site-of-care transformation is driven by rising healthcare costs, technological advancements and evolving payer incentives that favor outpatient settings. As healthcare leaders search for innovative ways to improve efficiency and affordability, ASCs have emerged as a critical solution in modern surgical care.

Today, there are more than 6,000 ASCs across the United States, performing over 23 million procedures annually (MedPAC, 2023). These centers are not only reshaping how surgery is delivered but also expanding their capabilities to include more complex procedures, such as total joint replacements, spine surgeries and select cardiovascular interventions. With continued advances in surgical techniques, anesthesia and digital health, ASCs are positioned to become the dominant setting for many procedures traditionally performed in hospitals. The question is no longer whether outpatient surgery will continue growing, but rather how fast and how far the shift will go.

The Evolution of Outpatient Surgery

The concept of ambulatory surgery dates to the 1970s when physicians sought a more efficient and cost-effective alternative to hospital-based procedures. Over the decades, improvements in anesthesia, minimally invasive techniques and enhanced recovery protocols have allowed more procedures to be performed safely in outpatient settings (ASCA, 2023).

Initially, ASCs focused on low-acuity procedures, such as cataract surgeries and endoscopies. However, recent policy changes have enabled a broader range of surgeries to shift to ASCs. The Centers for Medicare & Medicaid Services (CMS) has expanded its list of ASC-approved procedures, including total knee arthroplasty, cardiac catheterization and select spine surgeries (CMS, 2024). These changes signal a growing recognition of ASCs’ ability to provide high-quality, cost-effective surgical care.

The increasing shift of surgeries from hospital operating rooms to ASCs is driven by multiple factors. Patients are seeking more convenient and affordable options, insurers are incentivizing cost-effective care settings and surgeons are looking for more control over their practice environments. The alignment of these interests has fueled the rapid expansion of ASCs and their role in the healthcare ecosystem.

The Business Case for ASCs

One of the most compelling reasons for the growth of ASCs is their cost efficiency. ASCs typically perform procedures at 30 to 50 percent lower costs than hospital outpatient departments (HOPDs), primarily due to lower facility fees, streamlined workflows and reduced administrative burdens (Health Affairs, 2022). These savings benefit not only payers and employers but also patients, who experience lower outof-pocket expenses.

Despite the cost advantages, ASCs have faced reimbursement challenges. Historically, CMS and private insurers have reimbursed ASCs at lower rates than hospital outpatient departments for the same procedures. Currently, ASCs receive approximately 80 percent of the reimbursement that hospitals receive for identical services (MedPAC, 2023). While policymakers are beginning to recognize the value that ASCs bring to the healthcare system, reimbursement disparities remain an ongoing concern.

Payer strategies are also evolving in ways that favor ASCs. Direct-to-employer contracts and bundled payment arrangements are gaining popularity as employers seek to control healthcare costs. By steering employees toward ASCs for procedures such as joint replacements and colonoscopies, employers can reduce expenses while maintaining high-quality care (KFF, 2023).

Expanding Surgical Specialties in ASCs

The range of procedures performed in ASCs continues to expand. Total joint replacements have become one of the fastest-growing areas in outpatient surgery, with a more than 200 percent increase in ASC-based procedures over the past five years (AAOS, 2023). Advances in minimally invasive techniques, improved pain management protocols and enhanced recovery after surgery (ERAS) programs have made it possible for patients to undergo joint replacements and return home the same day.

Spine surgery is another area experiencing significant growth in ASCs. Minimally invasive spine procedures, including microdiscectomies and fusions, are increasingly being performed in outpatient settings. The ability to manage post-operative pain effectively has been a key factor in this shift, allowing patients to recover in the comfort of their homes rather than spending extended time in hospitals (Becker’s ASC Review, 2023).

The cardiology field is also beginning to embrace outpatient surgery. With CMS now approving select cardiac procedures for ASCs, including percutaneous coronary interventions (PCI) and pacemaker placements, the potential for expansion in this specialty is substantial (CMS, 2024). As technology advances and reimbursement policies continue to evolve, cardiovascular interventions are likely to become a larger part of ASC services.

Technology and Innovation Driving ASC Growth

Technological advancements are playing a crucial role in the transformation of outpatient surgery. Robotics and minimally invasive surgical techniques are now being integrated into ASCs, improving precision, reducing recovery times and enhancing patient outcomes. While robotic-assisted surgery was once confined to large hospitals, it is increasingly being adopted in ASCs, particularly in orthopedic and spine procedures (Becker’s ASC Review, 2023).

Digital health solutions are also contributing to the growth of ASCs. Telehealth and remote patient monitoring are improving preoperative assessments and postoperative care, reducing complications and enhancing patient engagement. Wearable technology allows surgeons to track recovery metrics in real time, enabling early intervention if complications arise (Health Affairs, 2022).

Artificial intelligence (AI) is also beginning to shape decision-making in ASCs. AI-driven analytics help optimize patient selection, predict surgical risks and improve operating room efficiency. Machine learning algorithms are also being used to refine scheduling processes, reducing downtime and increasing case volumes (AMA, 2023).

The business of outpatient ambulatory surgery is at a critical inflection point. ASCs have proven their value in delivering efficient, high-quality and cost-effective care, and their role will only continue to grow. However, addressing challenges related to reimbursement, staffing and regulation will be essential to ensuring their long-term success.

As the healthcare industry moves further toward value-based care, ASCs will become the cornerstone of modern surgical delivery. Their ability to provide high-quality outcomes at lower costs makes them not just a preferred alternative to hospitals, but the future of surgical care itself.