Ambulatory surgery center payment models: current trends and future directions

The total health care expenditure in 2017 was $3.5 trillion dollars—an increase of 3.9% over the previous year and up from $2.6 trillion in 2010 (1,2). With these numbers predicted to grow at an annual rate of 5.5%, the Centers for Medicare and Medicaid Services (CMS) have been piloting new programs and payment systems to reduce costs and incentivize physicians and healthcare organizations to provide cost-effective care (2-4). In 1983, medicare introduced the inpatient prospective payment system in the hopes that hospitals and physicians would start to provide more patient care in the outpatient setting. Since then, the number of surgeries performed as outpatient procedures has increased dramatically from 3.7 million in 1981 to over 32.0 million in 2005 (5). In 2017, more than 50% of all outpatient surgeries were conducted in ambulatory surgery centers (ASCs)—a market which is projected to reach $40 billion in 2020 (6).