Policy shifts, technology, patient expectations and payer incentives are aligning to push more musculoskeletal procedures into ambulatory surgery centers.
Here’s more on five of the biggest factors driving the migration:
1. Regulatory and reimbursement changes expand eligibility: Following the removal of orthopedic procedures from Medicare’s inpatient-only list, case volumes have steadily moved into ASCs.
In late 2023, the volume of orthopedic procedures in the outpatient setting was 33 times higher than that of inpatient procedures.
2. Minimally invasive techniques make outpatient care safer: Smaller incisions, better imaging and improved anesthesia protocols have enabled complex cases to shift outpatient.
“Orthopedics lends itself nicely to outpatient care in general,” Brett Shore, MD, president and CEO of Shore Orthopedics and an orthopedic surgeon with DISC Sports and Spine Center, told Becker’s. “As minimally invasive surgery becomes more widespread and as we’re able to use products such as tranexamic acid to reduce blood loss, orthopedics is in some ways, going to be a leader and a pioneer in bringing the majority of surgeries into the ambulatory setting.”
3. Patient preferences accelerate demand: Patients are increasingly choosing outpatient settings over hospitals as payer pressure and minimally invasive techniques make same-day recovery safer and more accessible.
“Payer pressure will continue to push cases to ASCs, and patients increasingly prefer outpatient settings over hospitals,” Brian Curtin, MD, orthopedic surgeon at Charlotte, N.C.-based OrthoCarolina, told Becker’s.
4. Payers and providers align around value: Outpatient orthopedics aligns closely with value-based care by delivering high-quality outcomes at lower costs. Physician leaders say reimbursement policy will determine how quickly the shift accelerates.
“The big thing that we’re following now is if the payers go to a site-neutral payment,” Jonathan Foret, MD, orthopedic surgeon at Baton Rouge (La.) Orthopaedic Clinic, told Becker’s. “If those payments become equal, then you’ll see [total joint] patients that were being seen in a hospital driven out into the ambulatory setting.”
5. Growth projections reinforce momentum: The outpatient orthopedics/ASC market is showing steady, sustainable growth as health systems commit more resources to meet rising demand. Projections indicate that orthopedic ASCs will grow by about 6% annually through 2030, driven by minimally invasive techniques, enhanced anesthesia protocols and payer pressure to shift cases outside hospitals.
