U.S. Ambulatory Surgical Centers Market Size, Share & COVID-19 Impact Analysis, By Type of Center (Single-specialty and Multi-specialty), By Ownership (Physician-owned, Hospital-owned, and Corporate-owned), By Application (Diagnostic Services and Surgical Services), and Forecast, 2021-2028

The U.S. ambulatory surgical centers market size was USD 34.73 billion in 2020 and is projected to grow from USD 36.96 billion in 2021 to USD 58.85 billion by 2028, at a CAGR of 6.9% in 2021-2028. Based on our analysis, the U.S. market exhibited a substandard growth of -5.7% in 2020 compared to the average year-on-year growth during 2017-2019. The COVID-19 pandemic negatively impacted the market due to the postponement and cancellation of most elective surgical procedures. The rise in CAGR is attributable to this market’s demand and growth, returning to pre-pandemic levels once the pandemic is over.  

Ambulatory surgical centers (ASCs) are modern outpatient healthcare facilities that provide same-day surgical services, including diagnostic and preventive services. These settings offer a convenient environment and cost-effective surgical services compared to most hospitals in the U.S. The typical specialties served in these settings include pain management, orthopedics, gastroenterology, ophthalmology, urology, and dermatology.

The market growth is mainly attributed to the increasing need for new solutions to cut down healthcare costs in the U.S. Moreover, the growing incidence of chronic diseases requiring surgeries is driving the market growth. In addition, rising investments and initiatives by governments and public health organizations, shifting preference of patients from hospitals to ambulatory surgical centers, and a favorable reimbursement scenario are propelling the market growth. The increasing number of ambulatory surgical centers over the last decade drives the market growth.

• For instance, according to the Medicare Payment Advisory Commission, the number of surgical procedures in ambulatory centers has increased rapidly over the last decade. In 2018, it was found to be around 23.0 million, compared to 15.6 million in 2010.


• According to the statistics by the Centers for Medicare & Medicaid Services (CMS), in 2020, the number of Medicare-certified ASCs in the U.S. was 5,935 compared to 5,105 in 2019.

Decline in Surgical Procedures amid COVID-19 to Hamper Market Growth  

The COVID-19 pandemic negatively impacted the market in 2020. Issues such as lack of workforce & staff, procedural prioritization, risk of transmission of COVID-19, and the limited number of surgical procedures across these healthcare settings posed as a roadblock for the market growth in 2020. These healthcare facilities across the U.S. witnessed a decline in the number of visits, thereby reducing the overall revenues generated in 2020. Moreover, operational restrictions such as mandates to stop or postpone elective surgeries during the COVID-19 pandemic negatively impacted the market.

• For instance, in April 2020, the Centers for Medicare & Medicaid Services (CMS) announced recommendations for postponing non-essential surgeries and other procedures with the help of a tiered framework in collaboration with medical societies and associations.  

Additionally, factors including the risk of rapid spread of COVID-19 through public gatherings and the need for conserving personal protective equipment and mechanical ventilators led to the postponement of elective surgical procedures in 2020. However, patients from hospitals are expected to migrate rapidly to ambulatory settings post-COVID-19.

LATEST TRENDS

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Strategic Initiatives to Boost the Market Growth

The companies operating in the U.S. ambulatory surgical centers market are constantly focusing on strategies such as mergers, acquisitions, and expansions to increase their revenue. For instance:

• In December 2020, T.H. Medical announced the acquisition of 45 ambulatory surgery centers from SurgCenter, a key developer of physician-owned centers.


• In April 2021, HCA Healthcare announced plans to open a new multi-specialty ASC, Willis Surgery Center, by 2022.  

Similarly, many market players are involved in developing new and innovative solutions in these healthcare settings are expected to boost the market growth.

DRIVING FACTORS

Shifting Preference Toward ASCs to Augment Market Growth

The shift from surgical procedures in hospitals to ambulatory settings is driving the market growth. The number of surgical procedures in ambulatory surgical centers has seen a significant increase over the past decade. A large number of patients prefer these healthcare facilities for various surgeries, owing to factors such as shorter stays, innovative technologies, cost-effective surgical procedures, and fewer risks of infections.

• For instance, according to the Medicare Payment Advisory Commission and VMG Health data, the outpatient surgical volume in ambulatory surgical centers has been increasing over the last decade. In 2019, approximately 60% of the outpatient surgical procedures were performed in ASCs compared to 48% in 2010.

Increasing government investments towards developing new ambulatory settings are expected to drive the market growth during the forecast period.

Positive Reimbursement Scenario to Boost Market Growth

The reimbursement is one of the critical drivers for market growth. Favorable reimbursement policies are increasing the focus of the Centers for Medicare & Medicaid Services (CMS) toward the extension of the list of surgical procedures that are allowed ASCs. Rising initiatives by commercial payers to encourage physicians to perform various surgical procedures in these facilities are expected to fuel the market in the upcoming years. Furthermore, CMS constantly focuses on reviewing the complications associated with the surgeries performed, thereby improving the patient’s safety who undergoes surgical procedures.

• For instance, as per the recent blog by the Advisory Board, in September 2018, CMS planned to review 38 procedures such as spine surgery, lumbar, and cervical spinal fusions to determine if they are safely performed in ambulatory settings.

Such intense focus of payers towards the safety of surgical procedures in these healthcare facilities will attract a larger patient pool across the U.S. Thus, the favorable reimbursement scenario for procedures performed in ambulatory settings coupled with the increased focus on the safety of procedures is expected to propel the market growth in the future.

RESTRAINING FACTORS

Disadvantages Associated With ASCs to Limit the Market Growth

A significant percentage of the patient population in the U.S. has preferred outpatient surgery centers for surgical procedures over the past decade. However, several disadvantages of ASCs are expected to limit the market growth during the forecast timeframe. These disadvantages include lack of overnight facilities, complications & emergencies during certain surgical procedures, and no plans for contingencies. Difficulties or complications during some surgical procedures may even require the transfer of patients from ambulatory surgical centers to nearby hospitals. Thus, some of the patients prefer hospitals for surgical procedures.

• For instance, as per a research article published by the National Center for Biotechnology Information (NCBI) in 2017, the rate of complications & adverse events of orthopedic surgeries at ASCs was between 0.05% and 20.0%.

The common complications during surgical procedures include pain & nausea, impaired healing, and infections. These disadvantages could hamper the market growth during the forecast period. 

SEGMENTATION

By Type of Center Analysis

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Strong Presence of Single-specialty Ambulatory Surgical Centers to Drive the Single-specialty Segment During 2021-2028

Based on type of center, the market is segmented into single-specialty and multi-specialty.

The single-specialty segment dominated the U.S. market in 2020 and is anticipated to continue to show similar trends during the forecast period. The dominance of the single-specialty settings is attributed to the growing incidence & prevalence of ophthalmic disorders and the strong presence of single-specialty ambulatory surgical centers in the U.S.

• According to the recently published data by the Medicare Payment Advisory Commission, in 2019, the number of single-specialty ambulatory surgical centers in the U.S. was more than 3,300.

The multi-specialty segment is projected to expand at a substantial CAGR during the forecast period. The surging number of surgical procedures related to ophthalmology, gastroenterology, and pain management are expected to boost the revenue of multi-specialty settings in the coming years.

By Ownership Analysis

Several Advantages of Physician-owned Centers to Boost the Physician-owned Segment During the Forecast Period

Based on ownership, the market is segmented into physician-owned, hospital-owned, and corporate-owned.

The physician-owned segment accounted for the largest market share in 2020 and is expected to expand at a substantial CAGR during the forecast period. Physician-owned ambulatory settings are the most common as doctors own 100% equity in these centers. The large share of this segment is also attributed to factors such as physicians’ convenience in scheduling surgical procedures, leading to increased preference for this type of ownership by in the U.S.

The hospital-owned segment is held the second-highest market share in 2020 and is projected to expand at a significant CAGR during the forecast period. Increasing employment of physician-owned practices by hospital-owned practices is expected to increase the revenue of hospital-owned centers in the future.

The corporate-owned segment is anticipated to expand at the highest CAGR during the 2021-2028. The high growth rate of this segment is attributed to the increasing focus of management companies and physicians toward the formation of a common joint venture. This ownership model is expected to boost the revenue of corporate-owned centers in the coming years as partnerships between corporate firms and physicians continue to emerge.

By Application Analysis

Increasing Number of Surgeries across the U.S. to Contribute to the Dominance of Surgical Services Segment during the Forecast Period

Based on application, the market is segmented into surgical services and diagnostic services.

The surgical services segment dominated the market in 2020 and is expected to expand at the highest CAGR during the forecast timeframe. This segment's large share and high growth rate are attributed to the increasing number of surgical procedures in ambulatory settings. These procedures majorly include surgeries related to ophthalmology, gastroenterology, pain management, and orthopedics.

• For instance, according to the Medicare Payment Advisory Commission, in 2019, cataract surgery accounted for around 18.5% of the total surgical procedures performed in ASCs in the U.S.

The diagnostics services segment is estimated to expand at a moderate CAGR during the forecast period. The growth of this segment is attributed to increasing patient population availing various diagnostic services which primarily include diagnostic colonoscopy and colorectal screening.  

KEY INDUSTRY PLAYERS

Companies with Largest Chains to Hold Key Market Share

This market is highly fragmented due to the presence of many companies offering ambulatory surgery services in the U.S. However, several key players, such as T.H. Medical, Surgery Partners, AMSURG (Kohlberg Kravis Roberts & Co. L.P.), SurgCenter, and Surgical Care Affiliates, held one-fourth of the market share in 2020. 

AMSURG (Kohlberg Kravis Roberts & Co. L.P.) dominated the market in 2020. Its dominance is due to the large number of ambulatory surgery centers owned and operated by the company. For instance, according to the recently published data by Becker’s ASC Review, in 2021, AmSurg (Kohlberg Kravis Roberts & Co. L.P.) owns and operates more than 250 ambulatory surgical centers.

Other companies, such as Constitution Surgery Alliance, ASD Management, and Medical Facilities Corporation, held substantial market shares due to their strong presence in the U.S. and the number of centers owned by them. Furthermore, strategic initiatives, such as mergers and acquisitions, are expected to increase their market share in the coming years.   

LIST OF KEY COMPANIES PROFILED:

• AMSURG (Kohlberg Kravis Roberts & Co. L.P.) (Nashville, U.S.)


• T.H. Medical (Dallas, U.S.)


• Surgery Partners (Nashville, U.S.)


• SurgCenter (Towson, U.S.)


• Surgical Care Affiliates (Deerfield, U.S.)


• HCA Healthcare (Nashville, U.S.)


• Physicians Endoscopy, LLC (Jamison, U.S.)


• Covenant Physician Partners, Inc. (Nashville, U.S.)


• Constitution Surgery Alliance (Avon, U.S.)


• ASD Management (Dallas, U.S.)


• Medical Facilities Corporation (Toronto, Canada)

KEY INDUSTRY DEVELOPMENTS:

• January 2021 – T.H. Medical announced plans to acquire up to 25 to 40 surgery centers in 2021. The company plans to spend an estimated USD 150 million on the acquisition of these surgery centers.


• January 2018 – Medical Facilities Corporation announced an agreement with NueHealth LLC to form a joint venture and acquire seven ambulatory surgical centers from Meridian Surgical Partners of Brentwood.

REPORT COVERAGE

An Infographic Representation of U.S. Ambulatory Surgical Centers Market

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The U.S. ambulatory surgical centers market research report provides a detailed industry analysis. It focuses on key aspects, such as leading companies, type of centers, ownerships, and application. Besides this, it offers insights into the market trends and highlights key industry developments. In addition to the factors mentioned above, the report includes the number of ambulatory surgery centers by key states, an overview of top surgical procedures, comparative analysis of average price & cost of selective procedures, company market share analysis in competitive landscape, and COVID-19 impact analysis on the market.

Report Scope & Segmentation