Common Ambulatory Surgery Center (ASC) Challenges in 2019

April 1, 2021
April 1, 2021

The Ambulatory Surgery Center (ASC) is a common healthcare environment that has only existed in recent decades—“the first ASC was established in Phoenix, Arizona in 1970 by two physicians who wanted to provide timely, convenient and comfortable surgical services to patients in their community, avoiding more impersonal venues like regular hospitals” (ASCA, n.d.).  Now in widespread use, Ambulatory Surgery Centers “are modern health care facilities focused on providing same-day surgical care, including diagnostic and preventive procedures” (ASCA, n.d.). They have become very popular among care providers and patients as an alternative to hospital-based procedures that can often offer higher care quality, lower costs, and better outcomes.

Continued ASC Growth

Multiple indicators identified in a recent ASC-focused market report show just how positive the outlook for this sector of the U.S. healthcare market continues to be:

  • “The ambulatory surgery center (ASC) market was estimated to reach $36 billion in 2018, and is projected to increase to $40 billion by 2020.”
  • “As of 2017, more than half of outpatient surgeries were performed in an ASC setting, up from 32% in 2005.”
  • “Based solely on population growth forecasts, outpatient procedure volumes are predicted to increase 14% from 2016 to 2026. However, analysts predict this number will be higher (16%) due to the growing shift in surgical procedures from inpatient to outpatient settings” (BusinessWire, 2018).

ASC Challenges in 2019

Despite the vigor of the Ambulatory Surgery Center market, this care sector is facing some significant challenges in the years ahead, like much of the rest of healthcare. During a recent expert roundtable organized by Becker’s ASC Review, ASC leaders from across the country talked about some of the specific issues they are addressing. These challenges include:

Recruiting New Independent Surgeons – In our current healthcare environment, surgeons are more likely than ever to be employees of hospitals or large practice groups. And, many of them get recruited to be employees right out of medical school. ASCs have to compete fiercely for their attention. Having long-term relationships with recruiting and marketing firms is a proposed solution.

Technology Limitations – Some ASCs are challenged by scheduling and maintaining high utilization in the absence of EMRs and other applications with this express purpose. It is important to be creative about finding solutions for managing providers’ availability and schedules.

Reduced Care Volumes – One reason for this decline in some areas is that many hospitals will not allow their doctors to perform procedures at ASCs. Another is the retirement of highly productive providers, who are often replaced by younger practitioners with different needs in terms of work-life balance. A respondent suggests performing more high complexity procedures, which can involve more time and higher billing amounts, as a substitute for quantity.

Expansion Demands – CMS keeps expanding the list of ASC-qualified procedures, and demographics alone mean more patients are going to need ASC procedures in the years to come. Getting larger involves a great deal of planning and hiring.

Financial Pressures – Though ASCs can help insurance companies save money as a lower cost provider, they have some of the same fixed costs—salaries, equipment, and supplies—as hospitals. Getting payers to understand the need for greater parity in fees is essential. (Dyrda, 2018)

Providing Effective Training – Impediments to training success include finding time for training, ensuring all employees are trained, and retaining trainees’ attention (Popa, 2018). Using a training resource with expanded functionality is one solution.

Learn more about HealthStream Care Continuum solutions for the Ambulatory Surgery Center environment.


Ambulatory Surgery Center Association, “History,” (n.d.) Retrieved at

Ambulatory Surgery Center Association, “What Is an ASC?,” (n.d.),

BusinessWire, “2018 Ambulatory Surgery Center (ASC) Market: Projected to Increase from $36 Billion in 2018, to $40 Billion by 2020 -,” October 11, 2018, Retrieved at

Dyrda, Laura, “Top challenges for 6 ASCs Today,” June 19, 2018, Becker’s ASC Review, Retrieved at

Popa, Rachel, “5 challenges ASCs face when providing effective infection control training,” Becker’s Clinical Leadership & Infection Control, October 15, 2018, Retrieved at