Ep. 111: A Comprehensive Look at ASC Data from 2024
Here’s what to expect on this week’s episode. 🎙️
HST CEO David Thawley recently joined ASCA’s podcast, Advancing Surgical Care, to discuss key data points and trends from HST’s State of the Industry Report.
With permission from ASCA, we’re excited to reshare their conversation on our own podcast platform. A few standout insights from the conversation:
• Cardiology is booming: OR time down 28%, revenue per OR minute up 30%
• Orthopedics continues to lead in profitability, bringing in roughly $6,400 per case
• Claim denials dropped from 8% to 4%—a win for clean claims and RCM tech
• 2-OR centers saw 22% growth, while the largest centers declined
• Partial payments are up—ASCs must rethink collection strategies
• Only 24% of cases completed required prior authorizations
• Patient deposit collection at time of service dropped from 55% to 51%
• Days to bill increased from 3.6 to 4.4—impacting cash flow
Check out ASCA’s podcast, Advancing Surgical Care: https://www.ascassociation.org/asca/news-and-publications/podcast.
Episode Transcript
[00:00:00] Welcome to this week in Surgery Centers. If you are in the ASC industry, then you are in the right place every week. We’ll start the episode off by sharing an interesting conversation we had with our featured guest, and then we’ll close the episode by recapping the latest news impacting surgery centers.
We’re excited to share with you what we have, so let’s get started and see what the industry’s been up to.
Erica Palmer: Hi everyone. Here’s what you can expect on today’s episode. David Hawley, H-S-C-C-E-O was a featured guest a few weeks ago on Ask A’s Podcast advancing surgical care. David sat down with Bill Prentice, ask a’s CEO to cover some of the key trends in A SC CARE in 2024, including specializations on the rise or efficiencies and revenue cycle management data that came from HSC State of the industry report.
I was so impressed with how the conversation went between David and Bill, that I asked ASCA if it would be okay [00:01:00] if we share the episode on our podcast platform as well. And thankfully they agreed. So after this recap is complete, this will transition right into David and Bill’s conversation, just an FYI that there is no video.
So if you’re watching on YouTube, you’ll just see a lovely photo of their faces and if you’re listening as a podcast, there won’t be any changes for you. But really quick before we switch to their conversation, the Ask a conference is this week. This episode comes out on Tuesday, April 29th, which means if you’re listening today, that HSC team is officially on site in Colorado and we can’t wait to see you all when the exhibit hall opens on Wednesday night.
HST will be at booth number 3 0 3 all week, right up front in the exhibit hall. So stop by to say hello. Grab a copy of the State of the industry report. Take a quiz for a chance to win a prize, and check out all of our latest solutions. This is always one of my favorite weeks in our industry. So if you are here in Colorado for the ASCA conference, I [00:02:00] hope you get the most of your time here, and please come by booth number 3 0 3.
And with that, I hope everyone enjoys the episode and hears what’s going on this week in surgery centers.
Bill Prentice: David, welcome to the podcast. Thank you for having me, bill.
Good to be here. So David, before we jump into some of the findings, could you take a couple of minutes to tell us about your methodology and the extent of the data you gathered for the report? I’m happy to bill.
David Thawley: And I guess before I get started, I just wanted to provide a shout out to to HSC. Pathways team members Will Evans and Eric Palmer, who led these efforts for HST.
And really the intention of this report is to take a wealth of data that we luckily have at HST and help share some insights to ultimately shine lights in areas that ASCs can potentially improve their performance and optimization. And just as a reference point, currently today, HST touches roughly 11% of the surgical [00:03:00] population in the United States.
We’re in over 1700 ASCs and all the way from the point of scheduling through post-service revenue cycle management. We’ve got a wealth of data that ultimately led to our ability to create some of this industry report and the benchmarking work. Specifically what we used in the industry report came from 590 surgery centers across 47 states and north of 3 million cases that were managed out of HST pathways.
And these are data points that we had explicit permission from our clients to use their DN identified data in order to to help create this report. The report itself is 50 chapters, more than 130 KPIs and over 35 charts with a lot of year over year trends to help give some insights as to how the a SC industry is evolving.
Bill Prentice: It is expansive, and I, I think it’s just a tremendous resource and something that I think, everyone in the a SC community will find some [00:04:00] really interesting information about. As head of the report, you highlight five a SC related trends that emerged from your data in 2024. Can you briefly touch on each of those?
David Thawley: Sure. So the first major trend that we’ve noticed is cardiology. And this is a specialty that is on the rise in the a SC space. And the cardiology trends in surgery centers between 2023 and 2024 ultimately reveal shifts that the average duration of operating time needed for these procedures decreased by impressive 28%.
And I that because. One of the things that obviously makes the a SC environment very attractive vis-a-vis the hospital environment is the efficiency which physicians can perform their procedures and cardio being a new specialty in the a SC space, we’re just seeing these impressive efficiency gains as cardio increases penetration in the a SC market.
So you, you combine this [00:05:00] improving efficiency with high net revenue per case, which we see data as $4,600 on average per case. And those two combine mean that we’re seeing very impressive improvements in overall revenue per minute of operating time in the a SC setting, where in 2024 it was just north of $132 per minute.
Which was about a 30% year over year increase of vis-a-vis 2023. And so this being one of the newest specialties in the A SC space, higher acuity, higher dollar procedures, and great level of efficiency for these physicians, we just think that this is gonna be a specialty that’s gonna do great things in the A SC space.
Bill Prentice: David, that, that’s fascinating information. And as you may know, cardiology is very much on our mind on the, on the advocacy front. And one of the things that we’re really looking to do with, with Medicare is obviously convince CMS that we can be safely performing many more of these procedures on [00:06:00] Medicare beneficiaries as well.
David Thawley: Great. Second major insight that we have and share in the report is that orthopedics achieved almost a 5% growth in net revenue per case. And Bill, as you’re aware, orthopedics continues to generate some of the highest net revenue per case within the A SC environment. And in 2024, this increased to $6,400 per case versus $6,100 per case in 2023.
And we really see this growth reflecting the demand for orthopedic procedures and potentially higher reimbursement rates of a greater mix of complex cases. And this consistent rise in revenue underscores how important orthopedics is from a surgical specialty perspective in the a SC market. And so yet again, this is another specialty alongside cardio that we expect to continue to see a high level of growth.
Bill Prentice: Yeah, and I think important for our listeners, particularly outside of the A SC community to understand is, we are [00:07:00] still providing tremendous efficiencies in savings by having those procedures being performed in the surgery center versus the hospital. So even though revenue might be going up still, when a case goes to the surgery center, the patient, the payer is saving an enormous amount of money almost all the time.
David Thawley: Absolutely. The third key insight, and this this one surprises me in the data, was a really impressive improvement in claim denial rates across ASCs. And it dropped from first submission denials of 8% to 4% in the as SC setting. And to us this trend really reflects more effective revenue cycle management, possibly due to better documentation and improved coding practices, and also the use of more technology and AI to to help ensure clean submission of claims, and obviously reducing denial rates by.
Half in this case allows surgery centers to capture more revenue and reduce the administrative [00:08:00] burden of resubmitting claims. So I think another key positive indicator of ASCs, understanding how to operate in this case as a business more effectively, submit claims more effectively and drive more positive differentiation via revenue cycle.
Bill Prentice: That’s a powerful data point. And to your point, I guess the more effort that’s put in on the front end of that claims process is paying off on the back end. And that’s where your data show
David Thawley: absolutely. On on our insight number four, it was that ASCs with two or saw the highest level of year over year growth.
And I’m sure all of our listeners know in this case that we’ll see ASCs from one to 20 operating rooms, but we typically see ASCs grow in the number of operating rooms that they have over time, and as they have more utilization of the existing operating rooms. Or they may bring in additional specialties into the a SC.
That’s where you see a [00:09:00] lot of that same a SC growth over time. But in the, in the case of two or facilities they saw, saw the highest level of revenue growth at 22% year over year. And so we think that this surge may indicate the smaller asds are becoming more efficient. Or better positioned to adapt to market demands.
And in contrast, larger ASCs with 15 plus ORs experienced an 8% decline. So there seems to be this level of sweet spot that I think at the end of the day comes down to how are you balancing your operating room utilization in a way that can drive. Greatest case volume, but efficiency of that case volume with a high level of utilization.
Bill Prentice: Again, just an amazingly interesting data point that I think that ASCs around the country are gonna really look to and think hard about.
David Thawley: Agreed. So the, the last insight, and I’ll try to be quite brief with this, is that partial payments increased while total payments decreased. Between 2023 and [00:10:00] 2024, ASCs experienced a shift in payment patterns and partial payments increase from 41.2% to 56.2%, indicating some patients are paying in installments and payers are reimbursing incomplete amounts.
Meanwhile, total payments decreased from 25.8% to 17%, suggesting that fewer patients are settling their bills in full. And this trend overall emphasizes the need for improved payment plans and financial assistance. Options and strategies to boost collections are, are really important facets for our ESC partners and facilities to get their hands around.
Bill Prentice: That’s also very fascinating and, and for the listener, we asked David to limit himself to five trends. He probably could have done 500 based upon just the immense amount of data that you have in your system and in this report. So thank you for those highlights. I wanna, your report also covers best practices for revenue cycle management and a [00:11:00] lot of detailed and payment information like you were just discussing.
Can you take a moment and focus on the effects we’re seeing from the increased demands for prior authorization? Sure.
David Thawley: So I’m gonna, I’m gonna go into a few different areas here, but on, on the, again, I guess as, as you think about some of the revenue cycle benchmarks broadly, pre-authorization is such a critical component when required in order to, to optimize the revenue cycle reimbursement rates and, and denial minimization.
We saw that in 2024, only 24% of cases completed preauthorization when it was required, meaning that three quarters of the time, even though we know a preauthorization is required, the facility was not submitting or completing that preauthorization that is up slightly from 2023 when only 21% of cases completed pre-authorization when it was required.
Obviously the [00:12:00] impact of that are delays in patient care, scheduling issues, claims, denials, and they also impact speed to revenue as well as patient satisfaction and administrative headaches. So these are, this is something very easy to improve and we feel in this case, the use of technology that integrates with your clearinghouse and payers to automate pre-authorization checks is really an intuitive way to help improve those statistics.
And a good practice management system or EHR can streamline these processes as well and reduce manual errors and alert your team of potential issues before they arise. That’s on the pre-authorization side. I’m not gonna go into like the full details across the, the rest of the board on those benchmarks, but we see some similar trends with patient deposit collections where in 2024, ASCs collected 51% of expected patient deposits at the time of service.
This was actually a decrease from [00:13:00] 55% of patient deposits at the time of service and patient bad debt is a challenge in the A SC environment. And Bill, as it can be confusing for patients who get a bill from the physician, from the A SC and the anesthesiologist. And that billing process and some of the lack of visibility into patient responsibility can ultimately impact patient deposit collections.
Then there’s some blocking and tackling aspects of revenue cycle management. A big piece of that being days to Bill. And in 2024, ASCs took 4.4 days to bill following the procedure. This was an increase in amount of time versus the average of 3.6 days. In 2023. I think some of that’s a reflection of ASCs, high level of growth and being busy.
But the longer billing cycles obviously impact cash flows. And so being very maniacal about the billing process is really important for the financial health of the business. [00:14:00] And, and then lastly on, on the claim denial rate, I already mentioned that there was a positive improvement of 4% denials versus 8% in 2023.
And this obviously is a big tailwind for the A SC clients, but really systematically breaking down the revenue cycle process, understanding how you perform versus some of these benchmarks, which is in the 150 page report. It’s available for free on our website. I think it can help really give. ASCs and listeners of this podcast and understanding of really how they’re doing versus a broad audience in the as SC space.
Bill Prentice: I think you’re exactly right. And, and the, the last few things you touched on, thinking like pre-authorization, there’s some really low hanging fruit for a lot of surgery centers to go improve their bottom lines in terms of their cash flow. Also prevents some patient frustration in terms of having to delay care because of not paying attention to those pre-authorization requirements.
So as I said, I think anyone would [00:15:00] benefit from reading this report. There’s so much more insightful information in the port than we have time to talk about. So again, I like you just did, I encourage our listeners to download a copy for themselves from the HST Pathways website. Any final thoughts you’d like to share before we wrap this up?
David Thawley: Briefly, I wanna share in, in, in observation more broadly now, participating in the a SC space for a period of time, and also having access to some of the data that we shared today. And Bill, that’s that. I think five to 10 years ago it was much easier to profitably operate in a SC, but with the really impressive growth of the a SC market and increasing competition and consolidation within the a SC space.
We’re seeing that the game is changing a bit and the world is really turning into the world of haves and have nots in terms of overall performance of ambulatory surgery centers, and something as simple as. [00:16:00] Increasing utilization of or time by 10 to 20% we see can have between a half a million dollars and two and a quarter million dollars in annual net revenue impact, depending on specialty mix.
And so really having a high level of, of focus on proactive operations is what’s allowing the best ASCs to perform at the highest level. And, and broadly what we’re seeing is that the ASCs that are being surgical with or utilization and case mix and they’re analyzing their case profitability alongside, try to automate manual processes including revenue cycle management.
It’s those centers that also benchmark everything to understand where they sit. Vis-a-vis the market and their competition and even within their own facilities. And then lastly, really forecasting the hiring needs and supply chain needs alongside optimizing the physician experience. It’s, it’s these different [00:17:00] components that are allowing some of the top decile ASCs to perform really at an elite level.
And so part of the intention of releasing the state of the industry report and sharing some of this rich data. With the market is to help guide ASCs as well as our partners into some of these best practices. And so we are all lucky to participate in such a beneficial and rapidly growing market as the a SC space.
And I think through focusing on some of these business operations and best practices, we can continue to see this higher level of performance and optimization of ASCs as more and more higher acuity procedures get approved into these facilities.
Bill Prentice: I couldn’t agree more. One of the things that we always trumpet about the A SC model is its efficiency.
And I think as you’ve rightly pointed out, it is harder and harder to be efficient because of all the challenges in headwinds that have come up over the last 10, [00:18:00] 15 years. And this report, I think, highlights that just the many different ways and many different, elements that you have to be pay close attention to if we wanna remain efficient and if we wanna remain that one little.
Rational place in healthcare that that kinda works, right? Provides, great care at a lower cost to, to, to the, the patients that need that care. So I wanna thank you once again for, for producing this amazing report and for your team. And for spending some time with me today and for HST Pathways continue support of ASCA and our members.
And I look forward to seeing you and your colleagues at ASCA 2025 in Denver at the end of April.
David Thawley: Thank you, bill, and appreciate the opportunity to, to be on the podcast today. And we equally thank you for all of the efforts in evangelism and support that ASCA provides to the a SC space. Thank you, David.[00:19:00]