Ambulatory surgery centers: A 2012 to 2018 analysis on growth in number of centers, utilization, Medicare services, and Medicare reimbursements.

Background: Given declining reimbursements and potential financial conflicts of interest in ownership, it is important to continually assess ambulatory surgery center role and growth. The objective of this study is to evaluate scope of practice, number of patients served, number of procedures performed, and revenue of ambulatory surgery centers within a Medicare fee-for-service population.

Methods: This retrospective study includes data from Medicare Part B: Provider Utilization and Payment Datafiles (2012-2018). In addition to total number and geographic distribution, sums and medians were gathered for Medicare reimbursements, services performed, number of patients, and unique current procedural terminology codes used.

Results: The number of Medicare fee-for-service-serving ambulatory surgery centers grew 7.0% from 4,886 to 5,227 between 2012 and 2018. A total of 8,169,288 Medicare fee-for-service services were performed on 3,910,434 patients in 2018, an increase of 10.8% and 6.5% since 2012, respectively. At the median, each ambulatory surgery center performed 1,050 services in 2018, which was slightly less than in 2012 (median: 1,094). Ambulatory surgery centers collected $5.1 billion in payments in 2018, compared to $3.6 billion in 2012 (29.1% inflation-adjusted growth).

Conclusion: Total inflation-adjusted allowed Medicare fee-for-service payments have increased 29.1% between 2012 and 2018, despite just 7% growth in number of ambulatory surgery centers and 10.8% increase in total number of services. The 16.5% increase in inflation-adjusted revenue generated per service may indicate that the increased use of complex procedures with higher reimbursement, previously only performed in an inpatient setting, are now offered more readily in ambulatory surgery centers.