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Six Emerging Trends Shaping ASC Performance
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Here's what to expect on this week's episode. 🎙️
We’re kicking off a short series called Trust the Data by sharing an excerpt from a recent webinar we hosted for our referral partners.
During the presentation, Ryan walks through findings from HST’s most recent State of the ASC Industry Report. The report brings together three years of benchmarking data from 682 surgery centers across 45 states and nearly 4.8 million cases.
The presentation explores six emerging trends shaping ASC performance, including uneven revenue cycle improvement, underused operating room capacity, patient collection leakage, gaps in accounts receivable follow-up, the efficiency of smaller centers, and the impact of specialty mix on growth and profitability.
After the presentation, Ryan covers CMS’s proposed 2.4% average ASC payment update for 2027 and explains why high-volume procedures could still receive lower reimbursement. He also looks at congressional proposals that could bring new price transparency requirements directly to surgery centers.
The episode closes with the uplifting story of three young heart transplant patients whose friendship helped carry them through nearly yearlong hospital stays.
Resources Mentioned:
2026 State of the ASC Industry Report:
https://www.hstpathways.com/resources/surgery-center-industry-report/
ASCA Analysis of the 2027 Proposed Payment Rule:
https://www.ascassociation.org/asca/news-and-publications/news/2026/2027-proposed-payment-rule
ASC Price Transparency Coverage:
https://www.beckersasc.com/asc-news/senate-committee-advances-price-transparency-bill/
Patients Deserve Price Tags Act:
https://www.congress.gov/bill/119th-congress/senate-bill/2355/text
House Energy and Commerce Committee Announcement:
https://energycommerce.house.gov/posts/the-house-committee-on-energy-and-commerce-advances-17-bills-to-the-full-house-of-representatives
The Power of Friendship Helps Three Young Patients Through Heart Transplants:
https://www.aha.org/tellingthehospitalstory/stories/power-friendship-helps-three-young-texas-childrens-hospital-patients-through-heart-transplants
Brought to you by HST Pathways.
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Transcript
Episode Introduction
00:00:00
Speaker
Welcome to This Week in Surgery Centers. If you're in the ASC industry, then you're in the right place. Every week, we'll start the episode off by sharing an interesting conversation we had with our featured guest, and then we'll close the episode by recapping the latest news impacting surgery centers.
00:00:16
Speaker
We're excited to share with you what we have, so let's get started and see what the industry's been up to.
Importance of Data for ASC Leaders
00:00:24
Speaker
Hi everyone, here's what you can expect on today's episode. This week we're kicking off a new short series called Trust the Data. Over the next couple of weeks we'll have some guests joining us to explore what ASC leaders can learn from industry data, how they can apply it to their own organizations, and why having the right information matters when making operational, financial, and strategic decisions.
00:00:46
Speaker
Before those conversations begin, though, we wanted to start the series off by sharing a short excerpt from a recent webinar we hosted for Aurora partners.
Emerging Trends in ASC Performance
00:00:54
Speaker
During the webinar, I presented findings from our most recent State of the ASC industry report, and the report included three years of benchmarking data from 682 surgery centers across states nearly million cases.
00:01:09
Speaker
In this presentation, I walk through the six emerging trends that are affecting ASC performance, including revenue cycle results, operating room utilization, patient collections, accounts receivable follow-up, and specialty makes.
00:01:24
Speaker
While the presentation was originally created for our partners, the data and takeaways are highly relevant for anyone working to improve the financial and operational performance of a surgery center.
00:01:36
Speaker
We felt it was the perfect way to kick off the Trust the Data series, and it also sets the stage for the conversations coming over the next few weeks. Then after the presentation, I'll be back to cover a few of the biggest developments from around the ASC industry this week, along with an uplifting healthcare story to close us out.
00:01:53
Speaker
I hope everyone enjoys the episode and here's what's going on this week in surgery centers.
Utility of the ASC Industry Report
00:02:05
Speaker
From those individual customer experiences, we can zoom out and look at what is happening across the broader ASC industry. And that's the purpose of our State of the ASC Industry Report.
00:02:16
Speaker
And this report brings together benchmarking data, best practices, KPIs across the the patient journey, and the recurring administrative work that's required to operate a surgery center.
00:02:27
Speaker
And it's designed to help ASC leaders understand where they're performing well, where they may be losing value, and which areas deserve a little bit more attention. And this gives you another useful resource that you can bring into your relationships rather than starting with a product conversation. you can start with the issues and performance trends that matter most to the center.
00:02:48
Speaker
And this report helps you create a more strategic discussion around improvement and growth and data and operational maturity. And this year's report is our most comprehensive version yet. It includes three full years of ASC data all the way from 2023 through 2025. That allows us to identify trends over time instead of looking at just a single year in isolation.
00:03:11
Speaker
includes 139 KPIs, 50 charts, 23 year-over-year comparisons, and six emerging trends, which is what we're going to reviewing in these next few slides. But the goal here is really to give ASC leaders something that they can use as an ongoing reference that we're going to continue updating on a year-by-year basis.
00:03:32
Speaker
And it's not just a report that they were read once and set aside. This is something that they can use to compare performance, and identify some gaps, ask better questions about the revenue cycle, and just compare themselves amongst their peers.
Scale and Sources of Report Data
00:03:45
Speaker
So who informed our insights? The scale behind this report is really what makes these insights especially meaningful in my eyes. The analysis represents 682 centers across 45 states and nearly 4.8 million cases.
00:03:59
Speaker
The information came from hst clients that granted us permission for their data to be included in this analysis. And that gives us a really broad view of what's happening across different types of surgery centers, including the differences by facility size, specialty workflow, operational maturity, OR rooms, you name it. It's pretty much all in this report. It's all freely available right now on our website. So again, we're going to be going through those six emerging trends that are shaping the ASC industry and ASC performance.
Revenue Cycle Performance Analysis
00:04:32
Speaker
These trends span revenue cycle management, scheduling, OR utilization, patient collections, accounts receivable follow-up, and specialty mix. And they're really intertwined and interconnected. If we think about it, unused OR time can... contribute to anesthesia pressure, weak patient collections can affect cash flow, inconsistent accounts receivable, follow-up can create additional revenue leakage, specialty mix can change how a center should think about growth and profitability.
00:05:03
Speaker
And really the the broader takeaway is that ASC performance can't be managed in separate silos. The strongest centers are connecting their clinical, operational, and financial data. So this first trend here is that revenue cycle performance is improving overall, but the improvement is uneven.
00:05:22
Speaker
Average net collection rates increased from 81% in to 87% in 2025, which is great. It's encouraging. However, that that specialty level data tells a little bit more of a complicated story.
00:05:36
Speaker
Pain and spine continued to lag with net collection rates of 54% and 73% respectively. And larger facilities with 10 to 14 operating rooms also had a net collection rate of approximately 73%.
00:05:53
Speaker
which means an improving industry average doesn't necessarily mean every center and specialty or facility size is performing well. So when you're speaking with a center, it can be helpful to move beyond the overall collection rates and ask where the gaps are occurring.
00:06:11
Speaker
Are there certain specialties that are underperforming for them? Are specific payers creating issues? Are larger volumes making it harder to maintain consistent follow-up?
00:06:21
Speaker
Those are the questions that can lead to a more meaningful discussion about workflow visibility and revenue cycle discipline. So this trend connects directly back to the anesthesia conversation, which is, our time is still one of the most underused assets in the ASC.
00:06:37
Speaker
And unused time creates pressure across scheduling, staffing, revenue, anesthesia, case flow, And our report found that OR block utilization ranges from 71% smaller centers to nearly 50% in larger centers.
00:06:55
Speaker
And cancellation rates also remain around 20%. In those gaps, they create holes in the schedule, and those holes, they make it harder for the entire organization to operate efficiently.
00:07:08
Speaker
And they can also make it more difficult for anesthesia groups to maintain back-to-back cases, which can contribute to additional subsidy requests. And when centers tell you that they need more capacity, they need more staff, or more OR space, one of the first questions may be whether they are fully using that capacity that they already have.
00:07:29
Speaker
Because better scheduling and stronger visibility into that open time can help centers increase volume without immediately adding more rooms. And if we go back to anesthesia conversation with Dr. Cohen and Lee in that podcast episode, Dr. Cohen was able to identify one of his centers. They were using five ORs and they really only needed four ORs.
00:07:54
Speaker
And by... basically shutting down one of the rooms, they were able to take a $50,000 subsidy and turn it into a $7,000 a month profit. So one small change like that can really make or break the difference for some of these centers.
00:08:09
Speaker
One of the more interesting findings is that two OR centers are often operating with a high level of efficiency. And in 2025, two OR ASCs had some of the highest OR block utilization and strong revenue cycle performance, including faster billing.
00:08:25
Speaker
Smaller centers you may benefit from having fewer variables to manage. It can be easier to coordinate schedules and maintain communication and keep cases moving when there are fewer rooms and workflows.
00:08:39
Speaker
And larger centers, they can um obviously handle much more total volume, but that scale also creates much more complexity. So more operating rooms and surgeons and staff and block time It can create additional opportunities for scheduling gaps and operational leakage. It all just can add on top of each other if it's not built right from the get-go.
00:09:01
Speaker
So the lesson here is not that smaller centers are always more efficient, but it's that growth requires visibility and discipline. And that's what it's all about.
Improving Patient Collections
00:09:10
Speaker
Awesome. So patient collections continue to be a significant source of revenue leakage for surgery centers. In 2025, the centers and the report expected to collect approximately $380 million dollars in patient deposits, but they collected only about $254 million, which means they collected about 67% of their expected amount.
00:09:32
Speaker
of their expected amount We also found that 47% of reimbursements were partial payments compared with only 26% that were paid in full.
00:09:43
Speaker
And as patient responsibility continues to grow, centers need to communicate financial expectations earlier and make it easier for patients to pay. This is really where patient estimates, patient payments, and broader financial clearance workflows become especially important. When centers are struggling with these patient collections, the the conversation shouldn't only be about collecting more aggressively after the procedure, it should really be about giving patients accurate information and convenient payment options before the day of service. They can walk into their day of service with a plan, with expectations, and they have they just know what to expect and have created a plan with the center.
00:10:27
Speaker
for how they can get this operation paid for. The next trend looks at what happens after an account enters accounts receivable. The report found that 92% of accounts are worked within the first 30 days.
00:10:40
Speaker
And after that point, follow-up drops to approximately 50% between 31 days and 120 days. And it drops, of course, even further as the account gets older.
00:10:52
Speaker
Some accounts, they sit untouched for as long as 87 And the longer an account sits, the harder it it becomes to recover the balance. And this isn't always the result of a lack of effort.
00:11:03
Speaker
Revenue cycle teams are often managing large volumes, payer issues, denials, patient balances, competing priorities. And the opportunity here is to give those teams better visibility and prioritization.
00:11:17
Speaker
reminders and automation so that the the accounts don't fall through the cracks. So when you hear a center talk about the staffing pressure or aging accounts receivable, the data right here in this report can definitely help them frame the issue as both a people challenge and a workflow challenge.
00:11:33
Speaker
Specialty mix has a major impact on how an ASC should think about volume and growth and profitability. Total Joint had the highest average net revenue per case in the report, around $14,709. And GI had the lowest average net revenue per case, about $1,400 and some change. But GI also averaged approximately 171 cases per month, making it one of the highest volume specialties.
00:12:01
Speaker
Orthopedics combined steady case volume with a 16% increase in revenue per case since 2023. And the point is that that case volume alone doesn't tell the whole story.
00:12:13
Speaker
Centers also need to understand the reimbursements and their supply costs and staffing requirements, the block utilization and profitability by specialty and procedure.
00:12:23
Speaker
So when speaking with centers that are evaluating new specialties or adding surgeons or planning for growth, this report gives you useful data to support
Healthcare Price Transparency Proposals
00:12:33
Speaker
that conversation. And it also reinforces the importance of having accurate reporting and case-level financial visibility so that they can actually plan for that growth effectively.
00:12:51
Speaker
Before we wrap up, let's look at two developments with direct implications for surgery centers. Then we'll close with an uplifting story from the broader healthcare care community. First, CMS has proposed 2.4 average payment increase for ASCs in 2027.
00:13:08
Speaker
At first glance, that sounds like good news, but the 2.4% update is an average across all covered procedures, not a forecast for what every surgery center or procedure will experience. According to ASCA's initial analysis, all 10 of the highest volume ASC codes would receive lower reimbursement under the proposed rates.
00:13:29
Speaker
This includes commonly performed ophthalmology, gastroenterology, and pain management procedures. This is a good example of why ASC leaders need to look beyond industry-wide averages.
00:13:42
Speaker
The impact on an individual center will depend on its actual procedure volume, specialty mix, local reimbursement rates, and case economics. A center could see the overall payment system increase while still facing lower reimbursement for the cases that account for most of its Medicare volume.
00:14:01
Speaker
For 2027 planning, centers should model the proposed rates against their own procedure-level data, and that will provide a much clearer foundation for forecasting, budgeting, contracting, and evaluating case profitability.
00:14:16
Speaker
The rule is still proposed, though, and comments are due August 31st. Our second story is another example of data becoming an increasingly important operational responsibility for ASEs. Two congressional committees recently advanced separate healthcare price transparency proposals with direct implications for surgery centers.
00:14:35
Speaker
The Senate Health, Education, Labor, and Pensions Committee advanced the Patients Deserve Price Tags Act. Under the proposal, certain ASCs with hospital ownership ties would be required to publish machine-readable, standard charges, and consumer-friendly pricing information beginning July 1, 2027.
00:14:52
Speaker
twenty twenty seven The House Energy and Commerce Committee also advanced the Lower Costs, More Transparency Act. That proposal would go further by extending transparency requirements to freestanding ASEs beginning 2028.
00:15:06
Speaker
Neither proposal has become law, and the details could change as legislation moves through Congress, but the direction is definitely worth watching. Price transparency isn't simply just a website project. Centers may need reliable processes for maintaining and communicating cash prices, payer-specific negotiated rates, procedure codes, patient estimates, and other consumer-facing financial information.
00:15:31
Speaker
That requires coordination across contracting, revenue cycle, compliance, reporting, and patient-facing teams. It also connects directly to the themes of our Trust the Data series. A surgery center can't confidently publish or explain its prices if the underlying financial information just isn't accurate, accessible, and consistently maintained.
00:15:53
Speaker
The operational work begins long before reporting deadline.
Heartwarming Story of Young Patients
00:15:56
Speaker
And finally, let's end with a story that's a little bit more uplifting. The American Hospital Association recently shared the story of three young patients at Texas Children's Hospital named Ahmed, Nasir, and Preston.
00:16:08
Speaker
The boys who are six and seven years old each spent nearly a year in the hospital waiting for a heart transplant. During that time, they became close friends and helped one another through an experience very few people their age could fully understand.
00:16:22
Speaker
Then in a remarkable turn of events, all three boys received donor matches within a period of just 10 days. As each boy recovered and was discharged, the hospital celebrated with a parade through the halls.
00:16:35
Speaker
Ahmed, who spent 351 days in the hospital, was the last of the three to go home with his friends and the hospital team there to cheer him on. All three of them are recovering well, and they've maintained the friendships that helped carry them through their time in the hospital.
00:16:50
Speaker
And after talking about reimbursement, reporting requirements, and operational performance, it's meaningful reminder of why the work happening across healthcare matters in the first place.
00:17:01
Speaker
And that feels like a good place to end this week. Thank you so much for listening to This Week in Surgery Centers. We'll be back next week with another episode in our Trust the Data series.