Ambulatory Surgical Centers

Ambulatory Surgical Centers (ASCs) are medical facilities that specialize in performing outpatient surgical procedures. ASCs play a pivotal role in moving services into less expensive yet clinically appropriate settings. ASC-qualified procedures can be considered more intensive than those done in the average doctor's office but not so intensive as to require a hospital stay.

ASCs do not routinely provide emergency services to patients who have not been admitted to the ASC for another procedure. Procedures performed in ASCs are broad in scope. In the 1980s and 1990s, many procedures performed exclusively in hospitals began taking place in ambulatory surgery centers as well. Many knee, shoulder, eye, spine and other surgeries are currently performed in ASCs. In the United States today, more than 50% of colonoscopy services are performed in ambulatory surgery centers. (Source: ASC Association)

In the United States, more than 22 million surgeries a year are performed in more than 5,000 ASCs. ASCs are in all 50 states and can be found throughout the world. In the US, most ASCs are licensed, certified by Medicare and accredited by one of the major health care accrediting organizations.1

In general facilities range in size from as small as 4,000 sq. ft. for a one or two operating room (OR) center, to as large as 30,000-40,000 sq. ft. ASCs with up to twelve ORs and numerous special procedure rooms.

Large" ASCs can be interpreted as those with more than four ORs; "medium" ASCs as those with 3-4 ORs and "small" ASCs as those with 1-2 ORs.

ASCs with more than four ORs perform an average of 5,598 cases per year, over 3,000 more than their counterparts with 1-2 ORs. They bring in more revenue too, at $8,699 compared to $3,826. An ASC's level of revenue seems to correspond well with its size and number of cases; ASCs with 3-4 ORs sit comfortably in the middle of the spectrum, scheduling 3,540 cases and reporting $5,998 in net revenue.

ASCs with only 1-2 ORs concentrate the bulk of their efforts on GI/endoscopy, ophthalmology, urology and orthopedics, with GI making up 35 percent of case volume, ophthalmology consisting of 25 percent, orthopedics taking 21 percent and urology filling 23 percent.

ASCs with four or more ORs concentrate the bulk of their efforts on are ophthalmology (20 percent), GI/endoscopy (18 percent), pain management (15 percent) and orthopedics (13 percent). 2

The mean EBIDTA margin of ASCs depends greatly on the amount of total ASC revenues. For centers with revenues of between $5 million and $9 million, EBIDTA margins are on average in the 32 percent range. For centers at $3 million to $5 million in revenue, EBIDTA margins are on average in the 17 percent range. Above $9 million, average ebitda margins rise to close to 36.5 percent. The median ASC rental rate was approximately 27 dollars per square foot, costs inclusive of triple net costs were closer to 32 dollars per square foot.3


ASCs rarely have a single owner. Physicians partners who perform surgeries in the center will often own at least some part of the facility. Ownership percentages vary considerably, but most ASCs involve physician owners. For more information on how PCI can help you build, fund and develop an ASC L.P., please click here for more information.

ASCs are always licensed by the various state departments of health and are usually participants in the Medicare and Medicaid governmental programs. Although complications are very rare, ASCs are required by Medicare and the accreditation organizations to have a backup plan for the transference of patients to a hospital if the need arises.

References

  1. ASC Association
  2. Becker’s ASC Review “5 Ways an Ambulatory Surgery Center's Size Impacts its Business” April 11, 2011
  3. Becker's ASC Review "10 Benchmarking Statistics for Ambulatory Surgery Centers"



Accreditation

Accreditation organizations for ASCs provide standards of medical care, record keeping, and auditing. These audits will come every one to three years, depending on the accreditation organization and the circumstances of the surgery center. In an audit, a team of auditors visits the facility and examines the ASC's medical records, written policies, and compliance with industry standards.

The three main accreditors of ASCs are: