Cardiology efficiency, orthopedic revenue surge as ASCs navigate growing complexity

Editor's Note

HST Pathways’ most recent industry report, discussed on the Advancing Surgical Care Podcast by HST CEO David Thawley and Bill Prentice, CEO of the Ambulatory Surgery Center Association (ASCA), offers insights into cardiology and orthopedic procedures done in ambulatory surgery centers (ASCs) in 2024, Ambulatory Surgery Center News March 24 reports. Other key insights include less claim denials, reported revenue shifts according to facility size, and partial payment shifts.

Notably, the number of cardiology procedures done in ASCs increased sharply, with OR times decreasing by about 28% compared with the previous year. Prentice highlighted the importance of this trend, pointing out the average net revenue per cardiology case now stands at about $4,600. He also underlined ASCA’s advocacy focus on cardiology, stressing that the data show the continued potential growth of high-acuity procedures in the ASC setting.

Beyond cardiology, orthopedics remains a strong revenue driver, with revenue per case rising from $6,100 to $6,400. Prentice emphasized that higher reimbursement for orthopedic procedures in ASCs than for some other specialties still represents a cost savings relative to similar hospital-based interventions.

Another positive development is the decline in first-submission claim denial rates, which fell from 8% to 4%. Thawley attributed this improvement to better documentation, coding practices, and the integration of more advanced technology—potentially including artificial intelligence—to streamline revenue cycle management. However, challenges remain: days to bill rose from 3.6 to 4.4, partly due to a significant gap in obtaining required preauthorizations. Only 24% of cases that needed preauthorization actually completed it, still leaving facilities vulnerable to claim denials and scheduling delays.

Examining facility size, ASCs with two ORs reported a 22% increase in revenue year over year, while larger centers with 15 or more ORs experienced an 8% decline. Thawley called this an “amazingly interesting data point” that highlights the importance of optimizing OR utilization.

Shifts in patient payment patterns further illustrate the evolving ASC environment. Partial payments grew from 41.2% to 56.2% of total payments, while total, one-time payments dropped from 25.8% to 17%, highlighting the need for clear payment plans and financial strategies.

Despite the operational hurdles, Prentice noted the inherent efficiencies of ASCs, and Thawley emphasized the considerable opportunity for growth as higher-acuity procedures move into these facilities.