In an interview with Same-Day Surgery, Justin Waters provides insight about the predictions and findings in HIDA’s recently published 2018 Ambulatory Surgery Center Market Report.

SDS: The 2018 market report notes that more than half of outpatient surgeries are performed in an ASC setting now, up from 32% in 2005, with predictions pointing to more market-shifting to ASCs.

What are the top five service lines that have experienced the largest patient volume increases in the ASC setting? Did your research offer any clues as to why these particular surgeries have shifted so rapidly to ASC settings?

Waters: Tracking the case volume by specialty, as a percent of total cases, the following added the greatest case volume growth from 2016 to 2017: gastroenterology, an increase of 25% to 29% of cases, [and] urology, an increase from 5% to 6% of cases. The remaining specialties decreased or remained the same as a share of total ASC cases.

While our research did not uncover a specific link between these specialties and their growth, urology cases are the fourth most profitable for ASCs. Gastroenterology is 11th. In our ASC provider survey, 48% of ASC [respondents] reported performing gastroenterology surgeries, and 38% [of respondents] reported performing urologic surgeries. Of those that do not currently perform surgeries in those specialties, 10% say they plan to provide gastro [by 2020], while 7% plan to provide urology.

SDS: In the HIDA report, commercial payers were calculated to account for 64% of the ASC payer mix in 2017, followed by Medicare at 19%. Also, worker’s compensation accounts for 10%, other pay is 8%, self-pay is 7%, and Medicaid at 6%. How has this division of the payer mix pie shifted over the past decade? For instance, was self-pay higher or lower in previous years? Have commercial insurance and Medicare also increased?

Waters: In 2016, commercial payers were estimated to be 52% of the ASC payer mix, Medicare 26%, Medicaid 6%, workers’ compensation 8%, and self-pay 4%. In 2012, commercial payers [were] 57%, Medicare/Medicaid combined 30%, and workers’ compensation 5%.1,2

SDS: The report also revealed that ASC nurses earned an average of $35.93 per hour in 2017, less than the $37.13 rate of 2016. Is that decline a one-time decrease, or is this a continuation of a downward wage trend? To what do you attribute the decline?

Waters: The overall trend in salaries is growth, and 2017 was a likely one-time shift. From 2011 to 2017, the average ASC nurse salary has increased from approximately $31 per hour to $36 per hour. We do not have data to definitively link this dip in wages to attempts to rein in operational expenses; however, our provider survey revealed that in 2017, labor was the largest expense for ASCs at 43% of the total. What may give insight into their thinking is that when speaking of supply chain strategies, ASC providers named “staying within budget” and “decreasing expenses” as top priorities.

SDS: Noting increasing deductibles, the HIDA report suggested that price transparency is beneficial to ASCs. Would you please explain some of the reasons why ASCs should market their procedure prices to consumers?

Waters: ASCs benefit from price transparency by having procedure prices that are often significantly lower than in an inpatient setting or a hospital outpatient department. Through ASC utilization, patients can reduce the overall cost and out-of-pocket costs for a procedure .... This makes ASCs highly competitive. In fact, a study by VMG Intellimarker revealed that when an ASC is added to a hospital service area, procedure rates for that hospital decline by an average of 500 per 10,000 Medicare beneficiaries. Advertising pricing would do more to shift this even further in favor of ASCs.3,4


  1. Dyrda L. 15 Statistics on ASC Payer Mix. Becker’s ASC Review, Jan. 8, 2015. Available to view online at: Accessed Dec. 19, 2018.
  2. Dyrda L. 18 Statistics on ASC Payer Mix in 2016. Becker’s ASC Review, Dec. 5, 2016. Available online at: Accessed Dec. 19, 2018.
  3. Healthcare Bluebook, Ambulatory Surgery Center Association, HealthSmart. Commercial Insurance Cost Savings In Ambulatory Surgery Centers. Available to view online at: Accessed Dec. 19, 2018.
  4. VMG Health.2017 Multi-Specialty ASC Benchmarking Study. Available at: Accessed Dec. 19, 2018.