Who’s on Your Schedule? Exploring Demographic Data for ASCs

Ep. 128: Will Evans – Who’s on Your Schedule? Exploring Demographic Data for ASCs

Here’s what to expect on this week’s episode. 🎙️

On this week’s podcast episode, we welcome Will Evans, Head of Data Science & Insights at HST Pathways, to break down our latest report. We analyzed 5.3M cases across 635 ASCs over 5.5 years to understand how patient demographics shape case mix, OR minutes, and payments by specialty. We talk about what we learned, and what ASC leaders can actually do with this data. 

Highlights include: 

• Two distinct patient profiles suggest two operational playbooks: pediatric (ENT & Dental) cases tend to be shorter and highly predictable, while older-adult cases (Orthopedics, Ophthalmology, Total Joint) drive longer in-room time and a larger share of payments. 

• Total Joint requires deliberate capacity planning: even with a smaller case share, OR minutes and dollars concentrate here — plan blocks, equipment, and staffing accordingly. 

• Seasonality is real and predictable: a reliable Q4 volume lift shows up year after year — tighten scheduling, extend block availability, and align staff to meet demand. 

• PLUS: 4 benchmarks to track at your center to make this data actionable. 

Also in this episode: a quick news roundup on funding, ambulatory strategy shifts, cybersecurity pressures, and an encouraging FDA development to help Alzheimer’s assessments. 

Watch the episode on YouTube or listen to the full discussion on your favorite podcast platform.

Episode Transcript

Alex Larralde: Hi everyone. Here’s what you can expect on today’s episode. I’m joined by Will Evans, our head of data science & insights here at HST, to unpack our latest report on how patient demographics shape case volume, payments, and OR minutes across specialties. Will makes it simple to understand and navigate the data, and that’s a good thing, because there’s actually a lot of it there in the report, and we run you through the metrics that you can track at your center to make this data actionable.

Then in our news segment, we’ll talk about Oath Surgical’s $24 million series A round that they just raised to help grow its footprint; a recent report from University of Pittsburgh Medical Center and KLAS that indicates that health systems are increasingly reorganizing around ambulatory care with more investment flowing to outpatient virtual and at-home; recent findings from three studies that show that cybersecurity remains a pressure point for organizations with attacks that can disrupt care and even lead to increased mortality rates.

But then we’re going to close on a hopeful note with the breaking news that the FDA has cleared a blood test that can help rule out Alzheimer’s, offering a faster and less invasive path to answers for many, many families.

I hope everyone enjoys this episode and here’s what’s going on this week in surgery centers.

Alex Larralde: Joining us today is Will Evans, our head of Data Science and Insights here at HST Pathways to talk about our most recent data report, which is benchmarking patient demographic patterns in case volume, payments, and OR minutes across specialties.

And if that sounds complex. Don’t worry, Will is actually here to help us break it down. So, Will, I would love it if you could share a little bit more about the work that you do here at HST and then help explain in simple terms what we actually looked at in this data set.

Will Evans: Sure. Thanks Alex. Happy to be on the podcast again.

So, for anyone who hasn’t met me yet, my name’s Will Evans and I help lead the analytics team here at HST. As part of that responsibility, I’m also involved with creating a lot of the data products that we have and basically helping our customers essentially make better decisions with a lot of the data that’s going through their HST systems.

As part of that, I get to help out with a lot of marketing stuff. That’s the fun part of my job, where I get to work with people like Alex, and analyze a lot of the data, create a lot of the content that you see in these benchmarking reports.

Alex Larralde: So, in this particular report we were curious, you know, what can demographic data really tell us about the typical patient at a surgery center, and how does that vary between specialties and are there any insights there that we can derive and share with our listeners?

So, what did we see when we looked at this data? What did we analyze here?

Will Evans: So, this report was a little bit different than, uh, a lot of our previous ones.

Previously, we’ve kind of looked at revenue cycle metrics and a lot of the benchmarking around how does the population of HST centers perform on revenue cycle? This one, we wanted to look at something a little different where it’s a lot more focused on demographics and what’s actually going through centers.

And to get a full view, we wanted to take a big step back and we looked at a much more longitudinal timeframe for this study. And so, we looked at almost 5.3 million cases across 635 centers essentially over the past five years. So, we went all the way back to the first quarter of 2020, I think. So, it’s just around five and a half years’ worth of data and we really wanted to try to understand what are all the shifts that we can see, or we can pull out of the data over time. And we are starting off kind of, uh, just looking at a handful of measures. So, things like cases payments are basically the.

Total cash received per case, um, as well as, or minutes by specialty. And we wanted to break this down in a couple different ways where we’re not just looking at what’s the count of things as it’s going through the ASC, but we wanted to break it down by patient age groups and as well as biological sex.

And kind of the overall goal for us here was we wanted to start generating descriptive benchmarks and, to make sure, like this isn’t really clinical guidance. I think centers have a sense of some of the implications around what do different populations need. But we really wanted to help paint that picture of what procedures are different populations having, and what does that look like for an ASC? And so, as we go through this report, you’ll hear a couple of different measures. And just to make sure everyone’s on the same page when we talk about a case, we’re referring to basically a unique surgical encounter.

And then when you start hearing things around case share or payment share or minute share, that’s really that segment’s, percent of that total. Payments, as I mentioned, you’re going to be hearing that that’s really the total dollars collected. And then there’s two more I’ll touch on, which is or time, and that is the wheels in to, wheels out. So basically, we’re excluding some of the turnover time around when procedures are starting and ending. And then the sex, in our system, it’s what’s recorded at registration. So not necessarily indicative of gender identity.

Alex Larralde: That’s super helpful context as we start to get into these charts, and I’ll just let everybody listening know that the report is on our website.

Again, it’s called Who’s on Your Schedule? Demographic Trends and Benchmarks. We will be talking about the graphs. I suggest that you look at them, go pull them up and navigate around the report yourself because there’s a lot there. So, we won’t be going into really granular detail on every chart on the podcast today, but we’ll be talking about the trends and themes that we want you to take away from the data.

So, let’s get into that. Will, what was the first pattern that jumped out at you once you started looking at this data? Like you said, we’ve got five and a half years of data here and there’s some pretty clear patterns year over year. What did you find?

Will Evans: There were some things that, I’m not going to lie, were kind of surprising to me. And then a lot of other things, which I think you expected to see, but it was still interesting to see it quantified and broken down within the context of everything that happens within our ASC population.

But I would say there’s kind of two things that were the main pieces that jumped out. The first one was that there’s really two populations that, dominate, and I think we’re going to talk about that a little bit next. But then the other piece which was kind of one of the, the things where I think I knew it and I kind of felt it having worked in the ASC industry for a while, but when we broke it down and we showed it graphically it really started to tell the story and that is that orthopedics is really anchoring OR minutes. And similarly, we hear a lot about it in the industry, but really the impact that Total Joints has had on OR utilization really starting in 2023 and you can really see the impact that just growth in case volume has had.

Alex Larralde: Yeah, absolutely. I would agree. That was one of the things that jumped out to me first as well, was the proportion of payments for Total Joint relative to the case volume was quite significant and definitely something that people should pay attention to and that we’ll talk about a little bit more as we go through the report.

But yeah, let’s talk about this idea of two populations. Who are those populations and what is the data telling us about what they’re doing?

Will Evans: Sure. It’s a great question.

The first one that honestly jumped out at us, I think was really within the ear, nose and throat and the dental specialties, and really seeing the disproportionate volume of under 21 patients for those two specialties. And then, once we identified that and we took a step back and were like.

This is kind of surprising to see, when we start diving into some more of like the procedure mix and OR utilization. We started to see that a lot of those cases are more short duration predictable window cases where we don’t see tons of variation in terms of, how long the procedures are taking.

Rather they’re very reliable, shorter, quicker turnaround, especially as compared to something like orthopedics where, uh, those are going to be longer duration cases. The second piece that I think was almost the flip side of that was, how older adults, and by older adults we mean the age range between 61 and 80, uh, those are really dominating ophthalmology and the orthopedics and total joint specialties. And really when you look at ortho and total joint, that’s where that age group within those specialties is really driving, the bulk of, OR minutes and oftentimes payments associated with those procedures.

And when you step back and you look at what does that mean for your day length and where the dollars land you can actually do a pretty good job of starting to trace how dollars and payments start to follow and almost map to both of those specialties and those age groups, right? So if you are more focused on pediatrics and you’re doing things like a lot of otolaryngology and you’re doing a lot of dental procedures, you’re going to see a lot more short-term cases that are quicker and on average are going to be lower payments than if you’re more focused on things like Ophthalmology and, uh, especially Orthopedics in Total Joint where you’re going to have a little bit older population, but along with that, you’re likely going to see higher payments per case on an average basis than you would if you’re, focused on more of the pediatrics.

Alex Larralde: Absolutely. Yeah. I thought it was really interesting to see that that pattern remained pretty consistent year over year too.

Will Evans: Yeah. I think one of the things that kind of helps summarize that takeaway is that minutes tend to follow the procedure intensity. So, if you’re doing shorter turn cases where maybe you’re only spending like tens of minutes in the room where there’s more minimal setup and positioning of equipment, and there’s a quicker recovery that’s going to lead to higher throughput naturally, right?

If you’re focused on more of the older adult lines, and especially if you’re doing things like arthroscopy and arthroplasty, that’s the longer in room time where it’s more set up and positioning. You’re doing more with imaging and equipment, and that’s going to lead to more OR minutes per case.

And all that together, that’s going to give you longer days in the OR.

Alex Larralde: Mm-hmm.

Will Evans: If you have a patient mix that shifts towards that older side of the population. The kind of corollary with that is that dollars tend to follow the resource intensity. So, if you have shorter term ear, nose, and throat and dental pediatric cases, that’s typically a lower dollar per case.

And that’s kind of coupled with that Ophthalmology and Orthopedics, and especially Total Joint in this area where we see a lot more of the. Higher dollars per case, and that obviously is accompanied with things like implants and devices and more time in the room.

When you look at the charts in the demographic data, you see that this is where a lot of the payment share tends to concentrate. And so, the net effect of both sides of that coin is that if you have pediatric-heavy windows, those are going to be faster and predictable blocks.

Whereas if you have chunks of your OR that are dedicated to older adult procedures, those are going to be more minute dense blocks that drive, finish times, and you’re going to see more of your payments kind of concentrate in those block times. And then particularly calling out Total Joints, you kind of feel that one twice where you have your minutes add up from a resource perspective, but also you have your dollars that kind of chase that.

So that even if like from just a case count perspective, you may not have a gigantic amount of Total Joints cases, it kind of sneaks up on you where you can increase that case count little by little, but really the OR utilization and the payments accompany that area basically by two.

Alex Larralde: There’s a lot of money there, but there is a lot of time and resource intensity there as well.

Will Evans: Absolutely.

Alex Larralde: Yeah. These are all really interesting implications I think for people as they’re thinking about expansion, potentially, about optimizing staffing, and just how they’re even scheduling their rooms.

If you understand these dynamics in your patient population and what you can expect to see based on your historical data.

Will Evans: Yeah, absolutely. I mean, I know in the past when we’ve done. Other RCM benchmarking reports and we look at things like specialties and just average payment per specialty.

And one of the popular things people like to recommend is, oh, Total Joints. It’s a really easy specialty, or it’s not a really easy specialty to go into, but it’s a very natural way to augment things that you’re doing at your facility if you want to kind of start pulling your net revenue per OR minute up.

But when you look at this demographic data and the OR time that Total Joints can start to consume, it really paints the picture that it’s not such a no-brainer that you to go into Total Joints, you really need to think about what is your or capacity look like, and do you have big chunks of time that you can really allocate to this specialty?

Alex Larralde: Absolutely. And there’s another dimension of time, which I want to get into, and that’s when it comes to the biological sex of the patient. I think we uncovered some really interesting differences there as well that we weren’t necessarily expecting to see. Tell us a little bit about some of the surprises there or the non-surprises also?

Will Evans: Yeah. I mean, this is one where, adding in the sex you always find some unique things in there that are sometimes counterintuitive and sometimes, as you said, not really that much of a surprise.

And as we looked at it, a lot of the lines, when you break it down by specialty, procedure volume, things like that, they’re pretty balanced. Obviously, some skew almost entirely for one sex or the other. For example, gynecology is a hundred percent female. Urology tends to heavily skew male.

And so, one of the things that we kind of analyzed in here was we wanted to look at basically what’s your OR minute per case gap by sex. And so, when we looked at that delta, it’s really just your OR minute percentage, minus the case percentage within a specialty. And so, a positive delta, when you subtract those two numbers, that’s indicative of longer or more intense average procedures for that sex.

And when we start to break it down by specialty, we started to see that, you know, there’s some trends in here where we can see positive deltas where that percentage of minutes is greater than the percentage of cases. And there’s some things that kind of jumped out where within cardio women actually had a 10-point positive share for OR minutes, right? Yeah. So, when we looked at the, that case share women had, I think it was 44% of the case share, but when you looked at OR minutes, they actually consumed a little bit more than that. They’re more than half there around 54%.

And we started to see similar interesting patterns within other specialties.

Where spine, for example, men basically had that they, they slightly dominated there where they had 43% of the case share, but on the OR minutes they’re taking up right around half of the time.

And so, it’s like there’s a lot more detail within that section you can kind of go through.

But it was really peculiar, starting to pull apart some of these things that jumped out at you that when you started to compare case volume with or time you put that together and then suddenly you started like, whoa. These are kind of interesting trends, like how are these things occurring?

Alex Larralde: Yeah. Yeah. Because you would expect it to be relatively equal. I mean, of course within every specialty there are specific procedures that one biological sex could be having over the other. What I would encourage listeners to do is calculate these numbers for yourself within each specialty and see how much that deviates from what we’re seeing here in the average, the benchmarking data.

If you are finding that your cardiovascular procedures for women is varying by 15 to 20 percentage points that’s a signal to dig a little bit deeper, I would say.

Would you agree?

Will Evans: Yeah. Yeah. I mean, especially when you start looking at some of these deltas, the kind of the gold standard of really what you would want to do to drill in with this level of analysis is you would look at like an apples-to-apples procedure, right? And you would kind of calculate those averages and figure out, does one procedure genuinely take a longer time for different sexes, or are we seeing other things that kind of crop up? Like do we have complications in certain areas where there’s a common theme of, hey, for some reason we see like a bigger band around OR duration for this one procedure for a certain demographic.

And it, it’s not just. You wouldn’t just do this for sex, right? Like you would do this for age.

And that’s really, I think, how you start to understand how demographics are affecting what’s happening at your facility, but also what are the inherent characteristics of those demographics that influence some of the outcomes that you’ll have when you’re performing these procedures.

Alex Larralde: Absolutely. And I think that’s really the big value of this data is that it gives you a view into the why and the reason that somethings may be happening.

So, this is, I think, really exciting for people to start to layer into their dashboards and to keep an eye on.

Okay. So, there is another thing that we saw because we did look at five and a half years of data, we were able to see how things changed quarter over quarter.

So, tell me about what we learned from the seasonality of this data.

Will Evans: Yeah, absolutely. Us being HST and working with our clients on a very consistent basis, one of the things we’ve always heard is that Q4 is crazy at surgery centers and logically it makes sense especially when you think about like patients using, trying to use up their deductibles if there is elective procedures, things like that.

People trying to get things done before the end of the year. And that 100% bore itself out in the data. We know it’s conventional wisdom that Q4 is the biggest quarter of the year, and I mean. You can see that it’s very apparent within all of the charts that there is a pretty consistent growth rate in what’s going on at surgery centers in Q4. It’s a very reliable year-end lift across; I want to say all of the specialties. I’m pretty confident it was pretty much a universal phenomenon.

Alex Larralde: Yeah. And what can people do with that information? Like how, how might that help someone from like a planning perspective?

Will Evans: The first one is going to be scheduling, right?

If, you know, it’s not like your OR capacity grows by that percentage in Q4 magically. So really, I think emphasizing scheduling. Being aware of things like block times and really understanding what is your capacity to handle potentially a 10% increase in what’s going through your facility. Uh, within Q4, we know that there’s always puts and takes throughout the year in terms of the throughput of a center.

But I think understanding truly what’s the art of the possible and how do you pull all the levers to really maximize your ability to handle that additional volume that you’re very likely going to see as you’re going into Q4.

Alex Larralde: Yeah, absolutely. That’s great. It’s there, it’s happening. You’re not going to outrun it, so plan for it.

Will Evans: Yeah. Yeah.

Alex Larralde: Awesome. Let’s talk really quickly about some benchmarks that people can actually track for themselves. So, this data’s super helpful, but what should listeners do with this information back at their own centers?

Will Evans: So, I think, rather than trying to digest 100% of all the information in the report, I would probably focus on just a handful of benchmarks that I would take out. And really specifically, I think we have four recommendations. The first one — try to understand what your age load is and specifically within the different ages what percentage of your OR minutes are dedicated to that 61 to 80 age range? And I think we generally see around 40% falling into that on an average day, right? Like we know it can fluctuate, but if you’re looking at just averages, it’s around 40%.

The second benchmark I would recommend checking out is what is your footprint for kids and pediatrics? And obviously this is going to skew more towards centers that have ENT or dental. And really if you fall into that arena, just understanding what percentage of your OR time in your case volume is kind of dedicated to that age group so that you can, if possible, consolidate those into blocks so that it’s really like high throughput windows.

The third one is in terms of Total Joints. If you’re a center that does these procedures, trying to understand what’s your momentum in this area and is it continuing to grow? We see it in aggregate across all of our centers.

Obviously not everyone does this but really if you see that growing within your facility, just understanding what amount of your OR capacity is dedicated to that. And then, ideally are payments, also joining your OR capacity so that you should see both of those kind of move in tandem.

And then the fourth one, uh, this one is a little more advanced, but I think still a worthwhile exercise is understanding the delta between your OR minutes and your case percentages by sex. So that’s like we talked about a little bit earlier, but what’s the delta between the OR minute percentages and the case volume percentages?

And especially if you can do that for the dominant sex in, uh, your highest OR minute specialties that’s going to help you understand, are you staffing appropriately? Are you really allocating the right amount of resources to those areas? So that you’re kind of, you know, appropriately, basically staffing and reacting to the reality of your, of the cases going through your ASC.

Alex Larralde: Fantastic. That makes perfect sense. So, everybody write those down. No, you don’t have to. You can just go to the report page. But, um, definitely check those out, how to calculate those and make sure that you are tracking on an ongoing basis.

Okay. And so, to wrap it up, something that we do every week on the podcast, we like to ask our guests what’s one thing they can do this week to help improve their surgery center? But I’m going to ask you specifically, what’s one thing they can do with this data to start applying it at their surgery center that can help make an impact?

Will Evans: No, I love it. Data for the sake of data is. Not always helpful. You really need to be able to make it actionable. Right? And so, what I would recommend is obviously check out the report. But once you’ve done that, pull the relevant numbers for you from these charts and then to the extent that you can, calculate your similar metrics, so that you can kind of compare them as well, right?

And don’t just compare them to the data that we’re showing you, but compare it against your historicals so that you’re comparing something like quarter over quarter from this year and last year and really see if your trends are stable or do you see shift in OR minutes or case volume mix? And then from there, I would recommend, just choose one lever to start with, whether that’s your capacity, your staffing, your scheduling, and start to adjust it and see what you can do and see what kind of impact you can drive, if not next quarter, then the quarter after that, so that you’re really using data-driven decision making. Honestly in the same way that we did when we started out looking at demographics, where we had things that we kind of felt and that we knew, or things that we heard a lot from our customers. But then once we really plotted it out and looked at it.

The trends really appear to you, and you can really validate, are these feelings like real or are they just kind of pain points that maybe I need to solve? That’s really the benefit of taking this external data, calculating your own relevant data points and kind of comparing them. That’s really a lot of the impact that I personally enjoy out of doing this sort of analysis.

Alex Larralde: Absolutely. Well, that’s great advice and I really appreciate you taking the time today to join us on the podcast and bring a level of translation to what is otherwise a lot of numbers in charts. But please do check out the report. It’s linked in the show description. Reach out to us with questions. We’d love to hear your thoughts about this data and what else you’d like to see from us in the future.

But thanks again, Will, I really appreciate it.

Will Evans: For sure. Thanks, Alex. Thanks for having me.

Alex Larralde: As always, it’s been a busy week in healthcare, so let’s jump right in. Last week, Oath Surgical announced a $24 million series A led by FPV Ventures with participation from McKesson Ventures and existing backers bringing the company’s total funding now to around 35 million. The new funding will back moves into new specialties like oncology, accelerate a surgeon owned network of ASCs, and further develop OathOS, its AI platform designed to coordinate surgical care with real-time insights. Press materials highlight a West Coast footprint of about 150 surgeon partners and position OathOS as a unifying layer for scheduling, coordination, and workflow.

The company previously emerged from stealth back in May with emphasis on digitally integrated surgeon-led care. This funding announcement sets up a bigger push to bring those centers to more markets and put Oath OS in production at scale.

A new report from the Center for Connected Medicine at the University of Pittsburgh Medical Center and KLAS Research, published on October 6th, finds many large and mid-size health systems are centralizing leadership over ambulatory, virtual, and home-based care.

Based on interviews with 25 C-Suite and senior leaders conducted in the May through June timeframe, respondents said ambulatory is no longer a side channel. It’s core strategy. Systems report prioritizing multi-specialty clinics, ASCs and virtual platforms to expand access, relieve inpatient pressure, and meet consumer expectations for convenience.

The report also spotlights how partnerships from independent physician groups to urgent care networks to third party telehealth and behavioral health providers are being used to expand access and reach.

One example is UPMC’s division, working with GoHealth Urgent Care to operate 80 plus centers across Pennsylvania and West Virginia. Becker’s summarized the findings as systems rethinking care delivery with more centralized governance and investment across outpatient sites.

Healthcare IT News pulled together three reports this week showing that cyberattacks are frequent and disruptive to patient care. The Health ISAC Q3 brief says 2025 is actually on track to surpass 2024 in terms of total breaches with thousands of incidents across sectors and 394 healthcare breaches through the end of September.

A Proofpoint and Ponemon survey of 677 US Security practitioners reports that 93% of organizations experienced an average of 43 cyberattacks in the past 12 months. 72% said attacks, disrupted patient care. Another 54% said that there were reported procedure complications alongside, 53 % reported longer stays, and some even cited increased rates of mortality.

The survey flagged cloud account compromise as the most prevalent threat while supply chain attacks were most likely to disrupt care. A third analysis from Comparitech tallied 293 ransomware attacks on direct care providers in the year’s first three quarters, with the US seeing the majority. There is a small bright spot, however. More than half of surveyed orgs say they’re embedding AI into security programs and finding it effective even as leadership and expertise gaps persist.

And finally for our last story this week, some good news coming out of the FDA. FDA just cleared Roche and Eli Lilly’s Elecsys pTau181 blood test as an aid to initial Alzheimer’s assessment for adults 55 plus with cognitive symptoms. In a 312-person study, the test could rule out Alzheimer’s with a 97.9% negative predictive value.

And why that’s uplifting? Diagnosing Alzheimer’s has leaned on spinal taps and PET scans, which are costly, invasive, and quite frankly, hard for a lot of people to access. Roche says it already has 4,500 analyzer systems installed in US labs, which could speed up equitable access and faster triage to treatment.

And with that, we’re going to wrap up this week’s episode. I hope you enjoyed my conversation with Will, and maybe you even learned something new today. If you find our podcast useful, please be sure to subscribe for new episode updates and leave us a rating or a review on your favorite platform so others can find the show.

We’re so grateful you took the time to join us, and we’ll see you again next time.