Ambulatory Surgery Centers (ASCs) have long offered a cost-effective, efficient alternative to traditional hospital settings, providing critical outpatient care and filling gaps within the healthcare system. 

However, as market dynamics shift, the ASC sector faces significant challenges that should be closely monitored by medical real estate brokers and investors. 

The following 10 statistics shed light on some key financial, operational, and workforce concerns affecting ASCs. Understanding these metrics will help you make more informed decisions and identify potential risks and opportunities in the market.

1. 55% Facility Fee Difference for Colonoscopies

According to a study by JAMA Health Forum, facility fees for colonoscopy procedures at hospitals are 55% higher than those at ASCs. This stark contrast underscores the inherent cost advantages that ASCs offer for outpatient procedures. However, it also highlights the financial pressure on ASCs as rising healthcare costs may push more patients towards higher-cost hospital settings, driven by insurance reimbursements and hospital acquisitions of ASCs. 

Brokers should be aware that this differential could impact the competitive positioning of ASCs in the market, potentially affecting leasing demand and future property values.

2. 43% of ASCs Have Budgets Over $3 Million

In 2023, 43% of ASCs reported operating budgets exceeding $3 million, up from 32% in 2022, according to a survey from OR Manager. This budget expansion reflects the increasing costs ASCs are incurring, from supply chain inflation to labor shortages. 

For real estate stakeholders, this trend could influence the types of facilities ASCs need, potentially driving demand for larger or more adaptable spaces that can accommodate higher patient volumes and complex services. With growing budgets, ASCs may seek new spaces or retrofits to optimize operations, but these spaces must be carefully planned to support financial sustainability.

3. 47% Reported Budget Increases, Only 12% Saw a Decrease

Nearly half (47%) of ASCs surveyed reported an increase in their operating budget, while only 12% saw a decrease. This upward trend signals ongoing cost pressures, which can strain an ASC’s profitability. 

For real estate brokers, this shift may mean that tenants in the ASC space will seek longer lease terms to stabilize their cost base or explore lease agreements with flexible terms to offset rising expenses. Understanding how budget changes are affecting ASCs can help you create lease structures that appeal to this sector while meeting both the tenant’s and landlord’s financial goals.

4. Medicare Hospital Payments Increased by 70% Since 2001, Physician Payments by 9%

Between 2001 and 2023, Medicare payments to hospitals rose by 70%, while Medicare payments to physicians only increased by 9%, according to the American Medical Association. This disparity underscores a systemic payment gap that disproportionately affects ASCs, which rely heavily on physician services. 

This limited reimbursement growth for physicians impacts ASC operators and, by extension, could influence lease renewals or expansions as they manage tighter margins. Real estate brokers should consider these factors, as ASC operators might look for cost-effective leasing options to balance their operational budgets.

5. 6.8 Percentage Point Increase in Hospital Outpatient Department Use for Colonoscopies

A recent study published in Science Direct found a 6.8 percentage point increase in the use of hospital outpatient departments over ASCs for colonoscopies. This shift is largely attributed to vertical integration, as hospitals acquire more ASCs and steer patients toward their facilities.

 For investors and brokers, this trend may reduce demand for independent ASCs in certain areas, potentially leading to vacancies or even closures. It’s essential to monitor the competitive landscape, particularly in regions with active hospital acquisition of ASCs, to understand how these changes may influence property demand.

6. 52 ASCs Partnered with National Operators from 2021 to 2022

As of 2021–2022, 52 ASCs moved from being independently operated to partnerships with national operators, according to a report from VMG Health. These partnerships are becoming increasingly necessary for ASCs to survive, as costs rise and economies of scale become critical. 

Brokers should note that national operators often have more stringent facility requirements and preferences, which could impact property specifications and leasing structures. ASCs under national ownership might also prefer multi-year leases with property upgrades to support scalable operations.

7. 2,872 Anesthesiologists Left the Workforce in 2021–2022

Definitive Healthcare reports that 2,872 anesthesiologists left the workforce between 2021 and 2022. Given the essential role of anesthesiologists in surgical procedures, their departure contributes to staffing shortages that impact ASC operations. 

Brokers may want to assess whether their prospective ASC clients face staffing challenges and explore creative lease terms or partnerships that support flexibility. Workforce shortages might also encourage ASCs to implement tech-driven solutions like telemedicine, which could reduce space needs or alter layout requirements.

8. 82% Increase in Medical and Surgical Supply Costs Per Full-Time Physician

According to the Medical Group Management Association, ASCs have experienced an 82% increase in medical and surgical supply costs per full-time physician from 2022 to 2023. As supply costs become a larger part of the budget, ASC operators might seek properties that offer built-in storage, efficient layout options, and possibly shared supply chain infrastructure. 

Real estate brokers can capitalize on this by emphasizing adaptable spaces that accommodate high supply volumes and align with ASC operational demands.

9. Over 108,700 Physicians Left Private Practice for Employment from 2019 to 2021

A report by Avalere indicates that over 108,700 physicians left private practice for employment opportunities between 2019 and 2021. This migration toward employed positions within larger healthcare systems impacts the ASC industry, as physicians often move to hospital-owned settings that don’t have the same cost-saving emphasis as independent ASCs. 

This trend could reduce the number of independent ASCs, affecting demand for standalone ASC real estate. Investors may need to adapt by seeking opportunities in mixed-use medical facilities or diversifying their tenant portfolios to include larger healthcare organizations.

10. 47,724 Nurse Practitioners and Physician Assistants Left the Workforce from 2021 to 2022

The healthcare workforce shortage extends to nurse practitioners and physician assistants, with 47,724 exiting the field between 2021 and 2022, according to Definitive Healthcare’s report on staffing shortages. This trend is particularly relevant for ASCs, which often rely on these providers for both surgical support and patient care. 

Brokers should consider how this shortage might influence an ASC’s space and resource requirements, possibly driving demand for smaller, more specialized facilities that don’t require as large a support staff.

What These Trends Mean for ASC Real Estate

As these statistics show, ASCs face significant challenges that extend beyond rising costs and workforce shortages. For medical real estate brokers and investors, understanding these dynamics can help you make more strategic decisions. From designing spaces that meet new budget constraints to anticipating demand shifts due to workforce challenges, brokers can play a pivotal role in helping ASCs navigate these turbulent times. 

By aligning your property offerings with the needs and concerns of ASCs, you position yourself as a valuable partner in their efforts to provide efficient, cost-effective care while sustaining profitability in a challenging market.