Methodology

For the rankings, U.S. News partnered with CareJourney to evaluate almost 5,000 ASCs in four different specialty areas:

• Colonoscopy & Endoscopy
• Ophthalmology
• Orthopedics & Spine
• Urology

Single-specialty ASCs received a single rating in their relevant specialty while multi-specialty ASCs received up to four separate ratings. Roughly 2,000 ASCs were rated in each of the first three specialties, and around 700 were rated in urology.

To assess ASC performance, U.S. News and CareJourney analyzed data from Medicare fee-for-service claims between 2020 and 2022 for five outcome areas:

• ED visits, excluding those that were immediately followed by acute care admissions (30% weight)
• Unplanned acute care admissions (30% weight)
• Days spent in institutional post-acute or long-term care (5% weight)
• Death (5% weight)
• Total allowed payment attributable to episode-related complications (30% weight)

The analysis also accounted for patient factors, including preexisting conditions, to ensure fair comparisons among the ASCs. Each ASC in a specialty was given a composite score to determine its rating and placed into three bands: below average, average, and high performing.

Notably, the ASC ratings rely exclusively on objective data rather than a combination of objective data and expert opinions like many of U.S. News' other hospital ratings. ASCs also did not submit data for the ratings. Instead, publicly available data was used for the analysis.

"We built this methodology around patient outcomes, taking account of the differences that individual patients have in terms of how severe their illness was, what they were getting treated for, and so on, and then really looked at which of these surgery centers was adding the most value in terms of the outcomes that are achieved for its patients," said Ben Harder, U.S. News' chief of health analysis and managing editor.

The best ASCs in the US

Overall, 717 ASCs — or fewer than 15% of evaluated facilities — earned a "high performing" rating.

In alphabetical order, the 10 states with the greatest number of high-performing ASCs include:

• Arizona (27 ASCs)
• California (96 ASCs)
• Florida (60 ASCs)
• Georgia (46 ASCs)
• Maryland (36 ASCs)
• New York (23 ASCs)
• Ohio (20 ASCs)
• Pennsylvania (37 ASCs)
• Texas (50 ASCs)
• Washington (20 ASCs)

U.S. News also reported the states with the greatest number of high performing ASCs for each specialty:

• Colonoscopy & Endoscopy: California (34), Florida (17), and Pennsylvania (20)
• Ophthalmology: California (25), Florida (17), and Texas (16)
• Orthopedic & Spine: California (32), Florida (22), and Georgia (21)
• Urology: California (5), Georgia (6), Maryland (8), and New Jersey (5)

"Same-day procedures play an increasingly prominent role in health care as an alternative to overnight hospital care. Building on our 34 years of experience evaluating Best Hospitals, we're proud to give patients this new, free, data-driven tool to help them navigate their health care needs," Harder said.

Commentary

According to Harder, surgical care has evolved over the last few years as some services moved toward outpatient settings.

"What we've seen over the past decade is a rapid shift for some services into ambulatory surgery centers, and more of it also going from inpatient to the outpatient setting within hospitals," he said. "And so there's really been this major innovation in how a lot of surgical care is delivered."

"For many patients, that's a preferable setting to receive care," Harder added. "And for many doctors, it's preferable as well. So with the rapid movement of care into the surgery center setting, we felt it was important to be able to provide healthcare consumers with a view of which of those were best and what they're really good at."

In general, Harder said that the ratings reflect a significant shift in the delivery of healthcare since patients are now undergoing complex procedures in outpatient settings when they would have likely required a hospital stay not too long ago.

"Healthcare innovation happens slowly, and then all of a sudden, and all at once," Harder said. "And I think there has been a very dramatic shift toward faster recovery and faster discharge, which, when it works well, is great. It's great for patients, it reduces costs, it helps doctors move on to the next patient who needs their attention and expertise. But you need to make sure that happens safely."

"And so that's been the concern as care moves to the outpatient setting … are we sacrificing quality for convenience and cost savings?" Harder continued. "And so that's one of the things that we're really looking at here, is making sure that ASCs are getting outcomes that are on par with their peers, or even better."

For more insights into ASCs, check out these Advisory Board resources:

• Site-of-care shift trends for key procedures and outpatient services
• Site-of-care shifts: The next savings opportunity for health plans?
• How LHSC shifted surgery volumes to Ontario’s first high-efficiency ASC

(U.S. News & World Report "Best Ambulatory Surgery Centers" rankings, accessed 5/14; U.S. News & World Report press release, 5/14; Harder et al., U.S. News & World Report, 3/14; Southwick, Chief Healthcare Executive, 5/14; Henderson, MedPage Today, 5/14)