Episode Overview

Podcast: Becker’s Healthcare Podcast
Host: Scott Becker
Episode: "12 Trends We Are Watching in the Surgery Center Space"
Date: August 19, 2025

This episode features Scott Becker discussing the top 12 key trends impacting the ambulatory surgery center (ASC) space in 2025. Becker provides insights into the evolving healthcare landscape, highlighting the challenges and shifts that both shape and challenge ASCs, as well as broader implications for US healthcare.

Key Discussion Points & Insights

1. Growing Supply and Demand Imbalance

• [00:19] There’s an "increasing supply and demand problem in healthcare," especially as the US population of 345 million outpaces the number of available physicians.
• Impact on ASCs: Surgery centers are particularly vulnerable because they depend heavily on the availability of surgeons.

2. Payer Dominance and Market Power

• [01:05] The "four biggest payers—United, Aetna, Cigna, Anthem/Elevance—have tremendous power compared to providers."
• These payers rank among the top-20 US companies by revenue, dramatically outscaling even the largest ASC chains.

3. Limitations of Payment System Reforms

• [02:01] "There’s this content in this narrative that a failure-based care system is a panacea. We just don’t see that."
• Key Insight: Supply-demand problems and administrative costs are more critical issues than just switching between value-based care and fee-for-service.
• Becker emphasizes that payment system reform alone won’t resolve the underlying challenges.

4. The Myth of Technological and Preventive Panaceas

• [02:52] While technology and preventive care are vital, "ultimately labor and doctors to go with the technology, the prevention and more" are indispensable for sustainable healthcare improvements.

5. ASC Growth Numbers

• [03:13] There are "about 6,300 Medicare certified surgery centers in the country," and while the number has grown, that growth has not been dramatic — counter to popular perception.

6. Shift Toward Outpatient Procedures

• [03:37] There is "more migration of procedures to surgery centers and to outpatient," but "relatively slow growth in the total number of ambulatory surgery centers."

7. Rising Expenses and Reimbursement Pressures

• [03:56] Surgery centers now face "rising expenses and reimbursement pressure, more and more government pay as a percent of total pay, [and] harder and harder to recruit independent physicians."
• Decline in independent physicians is troubling, though core surgical specialty numbers are holding up for now.

8. Challenges Recruiting Independent Physicians

• [04:29] Fewer independent physicians available, making recruitment for ASCs progressively harder. Independent physicians remain "the lifeblood" of surgery centers.

9. Key Surgical Specialties Powering ASCs

• [04:50]
  • Ophthalmology: 30% of procedures
  • Gastroenterology (GI): 12%
  • Orthopedics: 50%
  • Pain Management: 10%
• These specialties "remain very, very important to surgery centers."

10. Independence of Specialists is Critical

• [05:10] Independence among specialists is "the lifeblood of ASCs." Although these numbers are declining, it’s "not disastrous yet."

11. Anesthesia Shortages

• [05:33] "Anesthesia shortages...remain very critical in many markets." Ongoing shortages challenge the functioning and scheduling of ASCs.

12. Biggest Surgery Center Chains

• [05:46] The three largest ASC chains are:
  • USPI (a part of Tenet Healthcare)
  • SCA Health (part of Optum)
  • Amsurg (now part of Ascension)
• Honorable mention: Surgery Partners and HCA also operate large numbers of centers.

Notable Quotes & Memorable Moments

• On power dynamics:

  • "The four largest payers earn the four largest 20 companies in the US by revenue. That just gives you one data point as to their differences in power between that and let’s say an individual surgery center or even a surgery center chain." — Scott Becker [01:18]

• On supply-demand issues:

  • "We think it’s going to be really need to fix the supply and demand problem and how we deliver care, not the payment system." — Scott Becker [02:30]

• On slow ASC growth:

  • "That number has grown some over the years, but it’s not grown dramatically at all, notwithstanding all the discussion out there, but the growth in outpatient surgery." — Scott Becker [03:19]

Timestamps for Important Segments

• 00:19 — Introduction: Supply and demand imbalance
• 01:05 — Market power of major payers
• 02:01 — Payment system reform limitations
• 02:52 — Role of technology and prevention
• 03:13 — Medicare-certified ASC numbers
• 03:37 — Growth and shift in outpatient procedures
• 03:56 — Rising expenses and reimbursement pressure
• 04:29 — The recruitment challenge for independent physicians
• 04:50 — Key specialities (ophthalmology, orthopedics, GI, pain management)
• 05:10 — Importance of independent specialists
• 05:33 — Anesthesia staffing shortages
• 05:46 — Largest ASC chains

Summary & Takeaways

Scott Becker offers a concise yet profound list of 12 trends shaping the ASC landscape, highlighting the tension between payer and provider power, stagnating growth in new centers despite procedure migration, and increasing operational challenges like staffing and reimbursement. The "lifeblood" of ASCs—independent physicians and certain essential specialties—remains under stress, and technology, while helpful, won’t fix structural supply-and-demand mismatches.

This episode serves as a "pulse check" for anyone involved in ambulatory surgery centers or healthcare delivery, with actionable awareness of the major forces influencing the present and future of outpatient surgical care.