With case volume, supply costs and staffing expenses driving ASC financial success, the size of an ambulatory surgery center can have a direct impact on its revenue, expenses and bottom line. Here are 5 ways an ambulatory surgery center's size impacts its business, according to data from VMG Health's 2010 Multi-Specialty ASC Intellimarker. Editor's note: In this report, "large" ASCs can be interpreted as those with more than four ORs; "medium" ASCs as those with 3-4 ORs and "small" ASCs as those with 1-2 ORs.
1. Large ASCs have higher expenses and greater revenue. Higher case volume means more revenue, and the numbers prove it: ASCs with more than four ORs perform an average of 5,598 cases per year, over 3,000 more than their counterparts with 1-2 ORs. They bring in more revenue too, at $8,699 compared to $3,826. An ASC's level of revenue seems to correspond well with its size and number of cases; ASCs with 3-4 ORs sit comfortably in the middle of the spectrum, scheduling 3,540 cases and reporting $5,998 in net revenue. Of course, net revenue is always offset by total operating expense, and large ASCs have significantly more expenses than smaller ones. ASCs with more than four ORs reported an average of $6,630 in total operating expenses over the year, nearly $4,000 more than the $2,703 reported by ASCs with 1-2 operating rooms. The majority of the difference lay in staffing and supply expenses, with large ASCs spending almost $8,000 more on salary and wages and over $5,000 more on medical and surgical costs.
2. Small ASCs concentrate more on GI, ophthalmology and orthopedics. ASCs with only 1-2 ORs concentrate the bulk of their efforts on GI/endoscopy, ophthalmology, urology and orthopedics, with GI making up 35 percent of case volume, ophthalmology consisting of 25 percent, orthopedics taking 21 percent and urology filling 23 percent.
3. Small ASCs depend on fewer physicians for more cases. These four specialties make up a higher percentage of small ASC case volume than any specialties for large ASCs; the four highest-percentage specialties in centers with more than four ORs are ophthalmology (20 percent), GI/endoscopy (18 percent), pain management (15 percent) and orthopedics (13 percent). For ASCs with 3-4 ORs, the biggest specialty is GI/endoscopy, with 21 percent.
3. Large ASCs accept less Medicare. The difference in revenue for large ASCs could depend somewhat on payor mix. On average, ASCs with more than four ORs depend more heavily on commercial payors and less heavily on Medicare, with the difference in Medicare patients making up the biggest gulf. Small ASCs rely on Medicare for approximately 27 percent of their payor mix, while large ASCs report 20 percent Medicare patients. Commercial payor dependence shows a smaller gap, with large ASCs relying on Medicare for 60 percent compared to 57 percent for small ASCs. Percentage of other payors, including workers' comp, Medicaid, self-pay and other pay, is similar regardless of size.
4. Pay differs only slightly depending on size. If you're a nurse, tech or administrative worker, moving to a larger ASC may not do much to increase your hourly pay. While large ASCs understandably staff more full-time employees (31.1 on average compared to 20.6 in medium-sized ASCs and 12.0 in small ASCs), the difference in ranks does not mean a significant difference in pay. Nurse staff members actually earn more at small ASCs, bringing in $31.57 per hour compared to $31.14 in large ASCs. Nurse staff fare the worst in ASCs with 3-4 ORs, where the mean hourly wage is $30.88. Tech staff makes the most in medium-sized ASCs at $20.22 per hour, with large ASCs coming in second ($19.59) and small ASCs bringing up the rear ($18.68).
The only position where salary is commensurate with ASC size is administrator. Administrators make an average of $109,235 in ASCs with more than four ORs, compared to $105,793 in ASCs with 1-2 ORs. Medium-sized ASCs with 3-4 ORs sit in the middle at $106,573.
5. Medium-sized ASCs spend the most hours per case. ASC staff members — particularly nurses — spend more hours per case in ASCs with 3-4 ORs. The total average hours per case in medium-sized ASCs is 12.8, compared to 12.2 for large ASCs and 10.4 for small ASCs. Nurses in medium-sized ASCs work almost one hour per case more than their smaller colleagues at an average of 6.5 compared to 5.4. Medium-sized ASCs also perform the most surgical cases per operating room and the fewest non-surgical cases per procedure room than any other size of ASC.
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1. Large ASCs have higher expenses and greater revenue. Higher case volume means more revenue, and the numbers prove it: ASCs with more than four ORs perform an average of 5,598 cases per year, over 3,000 more than their counterparts with 1-2 ORs. They bring in more revenue too, at $8,699 compared to $3,826. An ASC's level of revenue seems to correspond well with its size and number of cases; ASCs with 3-4 ORs sit comfortably in the middle of the spectrum, scheduling 3,540 cases and reporting $5,998 in net revenue. Of course, net revenue is always offset by total operating expense, and large ASCs have significantly more expenses than smaller ones. ASCs with more than four ORs reported an average of $6,630 in total operating expenses over the year, nearly $4,000 more than the $2,703 reported by ASCs with 1-2 operating rooms. The majority of the difference lay in staffing and supply expenses, with large ASCs spending almost $8,000 more on salary and wages and over $5,000 more on medical and surgical costs.
2. Small ASCs concentrate more on GI, ophthalmology and orthopedics. ASCs with only 1-2 ORs concentrate the bulk of their efforts on GI/endoscopy, ophthalmology, urology and orthopedics, with GI making up 35 percent of case volume, ophthalmology consisting of 25 percent, orthopedics taking 21 percent and urology filling 23 percent.
3. Small ASCs depend on fewer physicians for more cases. These four specialties make up a higher percentage of small ASC case volume than any specialties for large ASCs; the four highest-percentage specialties in centers with more than four ORs are ophthalmology (20 percent), GI/endoscopy (18 percent), pain management (15 percent) and orthopedics (13 percent). For ASCs with 3-4 ORs, the biggest specialty is GI/endoscopy, with 21 percent.
3. Large ASCs accept less Medicare. The difference in revenue for large ASCs could depend somewhat on payor mix. On average, ASCs with more than four ORs depend more heavily on commercial payors and less heavily on Medicare, with the difference in Medicare patients making up the biggest gulf. Small ASCs rely on Medicare for approximately 27 percent of their payor mix, while large ASCs report 20 percent Medicare patients. Commercial payor dependence shows a smaller gap, with large ASCs relying on Medicare for 60 percent compared to 57 percent for small ASCs. Percentage of other payors, including workers' comp, Medicaid, self-pay and other pay, is similar regardless of size.
4. Pay differs only slightly depending on size. If you're a nurse, tech or administrative worker, moving to a larger ASC may not do much to increase your hourly pay. While large ASCs understandably staff more full-time employees (31.1 on average compared to 20.6 in medium-sized ASCs and 12.0 in small ASCs), the difference in ranks does not mean a significant difference in pay. Nurse staff members actually earn more at small ASCs, bringing in $31.57 per hour compared to $31.14 in large ASCs. Nurse staff fare the worst in ASCs with 3-4 ORs, where the mean hourly wage is $30.88. Tech staff makes the most in medium-sized ASCs at $20.22 per hour, with large ASCs coming in second ($19.59) and small ASCs bringing up the rear ($18.68).
The only position where salary is commensurate with ASC size is administrator. Administrators make an average of $109,235 in ASCs with more than four ORs, compared to $105,793 in ASCs with 1-2 ORs. Medium-sized ASCs with 3-4 ORs sit in the middle at $106,573.
5. Medium-sized ASCs spend the most hours per case. ASC staff members — particularly nurses — spend more hours per case in ASCs with 3-4 ORs. The total average hours per case in medium-sized ASCs is 12.8, compared to 12.2 for large ASCs and 10.4 for small ASCs. Nurses in medium-sized ASCs work almost one hour per case more than their smaller colleagues at an average of 6.5 compared to 5.4. Medium-sized ASCs also perform the most surgical cases per operating room and the fewest non-surgical cases per procedure room than any other size of ASC.
Learn more about VMG Health.