Trends in Ambulatory Surgery Centers: A Result of Myriad Forces

The first ambulatory surgery center (ASC) opened in 1970, and there are almost 5,500 Medicare-certified ASCs currently in the United States (Figure 1).^1,2  In 2009, the Centers for Medicare & Medicaid Services (CMS) established requirements for an ASC to be Medicare-certified, including criteria for facility design, operational organization and patient care.³  Alongside the growth in ASCs, the demand for outpatient surgeries has increased rapidly since 1981, when 19 percent of surgeries were performed in the outpatient setting compared to 60 percent in 2011.⁴  The growth in ASCs can be attributed to several factors, including: progress in the development and advancement of anesthesia and minimally invasive surgeries, economic and competitive pressures, enhanced patient experience and legislative changes.^4,5  For example, to encourage beneficiaries to use ASCs, the Part B deductible was...