Why do these 15 states have so few ASCs?

By Marcus Robertson for Becker’s ASC Review

With the COVID-19 pandemic ushering in many changes to the healthcare industry, leaders need to recognize emerging patterns to identify areas primed for growth.

In figures recently released by Becker’s ASC Review, nine states plus the District of Columbia were found to have fewer than one ASC per 100,000 residents — and the next five states hardly fared better.

Some, such as fifth-fewest New York and sixth-fewest Massachusetts, likely come as a surprise.

So, why do these states have so few ASCs? The following trends may shed some light:

  • Poverty rate figures show a moderate correlation with per-capita ASC figures: nine states listed below land among the 20 states with the highest poverty rates, while six are in the 20 states with the lowest poverty rates. 
  • Surgeons per capita figures show little, if any, correlation to ASC per capita figures: six of the 15 states with the fewest ASCs per capita rank in the top 10 in surgeons per capita, and eight of the bottom 15 states for ASCs rank in the top 16 for surgeons. 
  • In a modest correlation, the bottom 15 states for ASCs per capita generally, but not always, have lower rates than their immediate neighbors
  • All but one have certificate of need laws, the strongest correlation measured here.
    • New Mexico, the only of the bottom 15 states without a CON law, has the nation’s third-highest poverty rate, and all states bordering it have more ASCs per capita as well as more ASCs as an absolute figure.

Note: States are listed from fewest to most ASCs per capita.

State**ASCsASCs per (100k) capitaPoverty rateCON lawActive surgeons*Surgeons* per (100k) capita
Vermont20.319%Y13020.22
District of Columbia30.4414.6%Y26037.71
West Virginia80.4514.6%Y90050.18
Virginia610.718.8%Y8509.85
New York1470.7311.8%Y2,96014.65
Massachusetts540.778.2%Y1,86026.46
Kentucky350.7814.4%Y4008.88
Alabama410.8214.6%Y4308.56
Iowa290.919.1%Y41012.85
New Mexico200.9416.2%N60028.34
Oklahoma401.0113.2%Y40010.10
Illinois1311.029.2%Y1,1809.21
Michigan1061.0510.6%Y1,41013.99
Maine151.1010%Y22016.15
Rhode Island131.188.8%Y

* Surgeons include those employed by ASCs, hospitals and other organizations; ophthalmologists are not included in these figures. The Bureau of Labor Statistics did not include surgeon employment data for Rhode Island.

** List of states includes the District of Columbia.

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