The History & Importance Of Ambulatory Surgery Centers

Key Topics:

What is an Ambulatory Surgery Center?

Ambulatory Surgery Center or "ASC" means any distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization and in which the expected duration of services would not exceed 24 hours following an admission.
Source: Cornell Law School

History of Ambulatory Surgery Centers

The first ASC opened on February 12, 1970, in Phoenix, Arizona. It staffed five physicians and was approved to perform only five procedures. By the summer of 1970, the ASC garnered the support of more than 40 insurers and employed more than 200 surgeons.1

Not even a year later, the American Medical Association (AMA) endorsed the concept of outpatient surgery for selected procedures and patients in 1971. Two years later, the American Society of Anesthesiologists (ASA) released "Guidelines for Ambulatory Surgical Facilities" the first standards for ASCs.2

Expansion continued throughout the years:

Year # of Surgery Centers
1975 42
1976 67
1979 100+
1988 1,000+
2015 5,000+
2022 6,000+

Source: ASCA ASC Data

ASCs Today

Today, more than 80% of surgeries are now performed in an outpatient setting.

ASC Data provided key statistics on the Ambulatory Surgery Center industry for Q4 2021 Data Set:

  • Number of Medicare-Certified ASCs in the US: 6,053 (+26)
  • Total Number of ORs in ASCs across the US: 18,619 (+156)
  • Number of Single Specialty ASCs: 3,059 (+9)
  • Number of Multi-Specialty ASCs: 2,991 (+14)
  • Average Number of ORs in Multi-Specialty ASCs: 3.86 (↑)
  • Average Number of ORs in a Single Specialty ASCs: 2.31
  • Overall Average Number of ORs per ASC: 3.08 (↑)
ASC patients are less likely to be admitted to the hospital for post-surgery complications.

ASC Data predicts a growing demand in services at ASCs as the baby boomers continue to age with Americans 65 or older representing 24% of the U.S. population by the year 2060.

"As I think back to my start in this industry 21 years ago, while I am astounded by the growth, truthfully I am not surprised. Back then there were less than 500 ASCs and today, more than 6,000. Like any industry, ASCs have seen their ups and downs. At the end of the day, quality and affordable care will always win!"
— Chris Schriever, CEO of ASC Data


Historically, ASCs had a "90 minute/four-hour rule" which dictated a list of procedures that could be performed at surgery centers.

The procedure must take less than 90 minutes to perform and less than four hours for the patient to recover from.

This was a major difference between ASCs and hospitals, as hospital same-day surgery departments were not restricted to this list. Because of this "outpatient" style, ASCs are typically associated with lower rates of surgical site infections3 and reduced costs with greater scheduling flexibility.3

Of all the ways hospital and care facility leaders can lower costs and improve care, one of the most promising is the continued shift toward outpatient services.

With an increase to 23 hours or less, the definition of an ASC procedure remains the exact differentiator that separates them from a Hospital Outpatient Department (HOPDs) – HOPDs allow for an overnight observation on site, where an ASC is limited to 23 hours or less.

ASCs are designed to serve as an option for a simple procedure, while an HOPD is more suitable for more complex surgeries like a hysterectomy, which could require hospitalization or an overnight stay.4

U.S.-based ASCs state and federal organization reporting varies by region. One example provided is the state of New Jersey, which states if the ASC only has one operating room, then they do not have to hold a license by the state or submit reports on patient mortality or other events.5

ASCs are also not legally required to have the same emergency equipment and staffing levels as a hospital.

Even though ASCs are no longer required to report the use of a safe surgery checklist, it is still a good idea for facilities to continue using a checklist, as it ensures that the ASC has implemented safe surgery practices during each of the three critical perioperative periods.

Ownership of ASCs

Along with the economic benefits to physicians and hospitals, outpatient surgery continues to grow and expand because the industry is profitable.

Becker's Healthcare highlights the different types of ASC ownership structures with Physician-owned being the top ranking6:

ASC ownership structure breakdown:

  • Physician-only — 60%
  • Hospital-physician — 17%
  • Corporate-physician — 13%
  • Corporate-only — 5%
  • Hospital-only — 3%
  • Other — 2%

60% of ASCs are Physician-only Owned

Definitive Healthcare data shows that cataract surgeries, colonoscopies, and injections are the most common all-payor procedures at ASCs by volume.7

According to Avanza Healthcare Strategies8, the median case volume metric for ASCs is:

  • Annual surgical cases per operating room 1,104
  • Annual procedures per procedure room 1,357
  • Annual Orthopedic cases per room 800
  • Annual Ophthalmology cases per room 1,400
  • Annual Gastroenterology cases per room 1,500

ASCs in the U.S.

While most reports note 6,000+ ASCs, Definitive Healthcare states there are more than 9,280 active Ambulatory Surgery Centers in the U.S. on their platform.

They outline the top ten states based on volume of ASCs as9:

  1. Florida: 722
  2. Texas: 710
  3. Georgia: 514
  4. Maryland: 434
  5. New York: 333
  6. New Jersey: 323
  7. Ohio: 317
  8. Arizona: 263
  9. North Carolina: 253

Demand for ASCs

Besides the increase in demand by aging baby boomers, labor shortage are expected to continue to play a factor in our approach to provide accessible care.

"As there is a shortage and more physicians age, the one thing they want is efficiency. Time is of the essence. This is a time for ASCs to thrive."
— Timothy Kremchek, MD, of Cincinnati-based Beacon Orthopaedics & Sports Medicine

Reportlinker highlights another factor driving the demand – "a rising emphasis on healthcare costs and increased Medicare spending on ASCs." This increase is encouraging further expansion of services offered at ASCs10.

In addition, they outlined the following drivers for the Ambulatory Surgery Center market:

  • Increasing prevalence of chronic disease
  • Increase in the number of surgeries
  • Restrain – lack of skilled professionals

You can read more in their report found here.

The Impact of COVID

To limit the spread, federal and state governments mandated the cancellation of all nonurgent surgical cases to address surging hospital admissions and manage workforce and resource reallocation. During the pandemic surge, thousands of surgical cancellations have been required.
Source: Science Direct

While the pandemic caused interruption and created chaos to many industries, the surgery market may have been one of the most disrupted. Various government organizations throughout the world and throughout the pandemic called for complete halts, postponements, and delays of any "non-essential" medical treatment, including surgical procedures.

In the abstract, The COVID-19 and Orthodpaedics: Recovery After the Pandemic Surge, Brandon Petrone et. all, concluded:

The ramifications of this pandemic and the anticipated radical changes that it may cause in our health care system and our society are still not fully understood. The future remains unclear but it is obvious that the scope of our practice has been dramatically altered. Orthopaedic surgery and health care in general will evolve rapidly, and changes will be incorporated into our standards of care. Evidence-based protocols and innovative technology enable efficient identification of risk, resource use and minimization of exposure.
Source: Science Direct

Future of ASCs

Becker's Healthcare released a top ten prediction for ASCs in 2022 which took into consideration the impact of COVID-19 and labor shortages. A summation of their prediction is:

  1. Physicians Favoring ASCs
  2. Consolidation of Chains
  3. Commercial Insurer Demands
  4. Private Equity Increases
  5. Competition Between Hospitals & ASCs
  6. Value-based Care & Price Transparency Push
  7. Surgeon Retirement
  8. Nontraditional Drivers of Case Volume
  9. Vendors Developing ASCs Strategies
  10. Additional Financial Needs

The full list can be read here.

Vantage Market Research further highlights the expected growth:

The Global Ambulatory Surgical Center Market size is expected to reach over USD 7.53 Billion by 2028, exhibiting a Compound Annual Growth Rate (CAGR) of 27.6% during the forecast period. The Market stood at a revenue of USD 2.54 Billion in the year 2021.

They note the top market players worldwide as

By now, we hope you feel confident in the care being provided at Ambulatory Surgery Centers across the U.S. It is very apparent that their growth and popularity will continue to increase for years to come.

ActivePure Medical Resources

At ActivePure Medical, we have an in-house team of infection prevention experts, along with specialized outside distributors like Henry Schein. This month, in honor of Ambulatory Surgery Center Month (August 2022), we've teamed up with Henry Schein for their #ScheinChats.

Check out this episode from #ScheinChats titled Automating Your ASC for Optimal Infection Prevention featuring Erica Smith, MBA, Surgical Solutions Market Developer at Henry Schein Medical, and Caitlin Stowe, MPH, CPH, CIC, CPHQ, VA-BC, Vice President of Clinical Affairs and Medical Liaison at ActivePure Medical.

Other resources from ActivePure Medical like continuing education courses, webinars, articles and more can be found here. Other infection prevention updates, blogs, and press releases are highlighted in our news section.

National ASC Month

We've been fortunate enough to have Ambulatory Surgery Centers providing cost-efficient, high-quality surgeries for more than 50 years. Join us each August as we celebrate National ASC Month.

How to Celebrate National ASC Month

Whether you want to celebrate with your team or on social media, we encourage you to spread the word about the benefits of ASCs to our healthcare industry. A few actions you can take:

  • Educate lawmakers about the benefits of ASCs by hosting a facility tour and inviting state representatives
  • Host your community to highlight the benefits and procedures available at your
  • Join the Ambulatory Surgery Center Association (ASCA) — Membership Options
  • Join or contribute to the ASCAs's Political Action Committee (PAC) — Learn More

Other Resources

Founded in 1974, The Society of Freestanding Ambulatory Surgical Care was incorporated11. Later renamed, the Ambulatory Surgery Center Association (ASCA), the ASCA is the only national association dedicated to the ASC community12.

Mission: The Ambulatory Surgery Center Association (ASCA) assists Ambulatory Surgery Centers (ASCs) in delivering safe, high-quality, cost-effective patient care.

Below is a list of resources from their organization and others.

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