There Is No Such Thing as a “Standard ASC” Anymore
An ophthalmology ASC.
An orthopedic ASC.
A cardiovascular ASC.
A multispecialty ASC.
They share three letters.
Increasingly, that may be where the similarities end.
Ambulatory surgery is changing. CMS significantly expanded the ASC Covered Procedures List for 2026, and further expansion has been proposed for 2027 as more procedures become eligible to move out of the traditional hospital setting.
At the same time, ASC economics are getting more demanding. Proposed 2027 reimbursement would decrease payment for several of the highest-volume ASC procedures, even as the range of procedures eligible for the setting continues to grow.
That creates an interesting tension:
ASCs are gaining more clinical opportunity while facing greater pressure to be intentional about how that opportunity is built.
From an architectural perspective, that matters.
Because the broader ambulatory surgery becomes, the less useful the idea of a “standard ASC” becomes.
“ASC” Tells You Where Surgery Happens. Not What the Facility Needs to Be.
Consider the difference between specialties.
An ophthalmology center built around high-volume cataract procedures operates differently from an orthopedic center performing joint replacements.
A cardiovascular ASC introduces another clinical model.
So does GI.
Pain management.
A center combining several specialties has yet another set of demands.
The procedures differ. So can anesthesia, recovery, technology, imaging, sterile processing, staffing and clinical support requirements.
Those differences have physical consequences.
The architecture supporting one ASC model should not automatically become the template for another.
The facility has to respond to the care being delivered inside it.
More Procedures Don’t Mean Every ASC Needs to Do More
The expansion of outpatient surgery creates possibilities.
Existing specialties may grow. New procedures may become viable in ambulatory settings. Physician groups may consider adding service lines that previously belonged primarily in the hospital.
But more possibilities do not necessarily mean every center should become more complex.
In fact, the opposite may be true.
As ASC capabilities expand, organizations have more reason to be clear about what their center is actually intended to do.
What specialties are central to the business?
What procedures will drive volume?
What clinical capabilities are essential?
And what is being added simply because it might be useful someday?
That distinction becomes increasingly important when capital and reimbursement are under pressure.
When Margins Tighten, Clarity Matters More
The current reimbursement environment does not mean the ASC opportunity is disappearing.
ASC utilization and the number of centers have continued to grow, and outpatient surgery remains an important part of the changing healthcare landscape.
But tighter economics do raise the stakes.
A facility represents a long-term investment.
Every additional capability can bring additional infrastructure, equipment, space, staffing or operational requirements with it.
That makes “designing for everything” less compelling.
The goal is not necessarily to create the ASC capable of doing the most.
It is to create the ASC that makes the most sense for the organization behind it.
That requires understanding the clinical model and the business model before translating either one into a physical environment.
Specialization Doesn’t Mean Designing Yourself Into a Corner
Healthcare will change again.
Technology will evolve.
New procedures will continue moving outpatient.
Reimbursement will change.
Organizations will grow.
So designing around a specific clinical strategy does not mean creating a facility that can never change.
But flexibility should have a purpose.
Trying to anticipate every possible future scenario can add cost and complexity for capabilities that may never be needed.
A better question is:
What does this ASC need to do exceptionally well today - and where does it genuinely need room to evolve tomorrow?
The answer will not be the same for every center.
That is precisely why the “standard ASC” idea is becoming less relevant.
The ASC Is Becoming a More Diverse Building Type
MedPAC reported approximately 6,400 ASCs serving 3.4 million fee-for-service Medicare beneficiaries in 2024.
Ophthalmology and GI remain major parts of the market, while areas including orthopedics, pain management and cardiology continue to expand within ambulatory care.
Those specialties do not operate the same way.
So why would we expect their facilities to?
As the clinical boundaries of ambulatory surgery continue to expand, the architecture supporting it will likely become more specialized as well.
The future may not be one ASC model becoming the standard.
It may be many different ASC models, each shaped around a different approach to delivering care.
Maybe the Question Isn’t “What Does an ASC Need?”
Maybe that question is now too broad.
A better one is:
What does this ASC need to do?
What procedures will happen there?
Who will practice there?
What clinical resources will those services depend on?
What investments directly support the organization’s strategy?
Where does adaptability provide real value?
Those answers should define the facility - not a generic checklist of what an ASC is supposed to be.
Because “ASC” may describe the setting.
It no longer tells us enough about the facility.
And as ambulatory surgery continues to evolve, the most successful healthcare environments will be the ones designed around a clear understanding of the care, operations and business model they are actually there to support.
Center Design works with healthcare organizations and physicians to translate clinical and operational strategies into environments designed around the way care is actually delivered — because no two healthcare organizations, and increasingly no two ASCs, are exactly alike.
