Ambulatory Surgery Centers Surge: A Case Study in Shoulder Replacements Signals a Broader Healthcare Shift
The healthcare landscape is undergoing a rapid transformation, driven by evolving Centers for Medicare & Medicaid Services (CMS) policies. A recent wave of procedures removed from the inpatient-only list is triggering a significant migration of care to Ambulatory Surgery Centers (ASCs). New data reveals the speed and scale of this shift, particularly in total shoulder arthroplasty, offering a compelling preview of what’s to come for hundreds of other procedures.
In January, 285 procedures became eligible for ASC coverage, with over 1,400 more slated to follow by January 2028. But policy changes alone don’t dictate market behavior. The real story lies in how surgeons, facilities, and patients respond. To understand this dynamic, we examined the trajectory of total shoulder arthroplasty (CPT 23472), a procedure already navigating this transition.
The results are striking: within just two years, the percentage of total shoulder arthroplasties performed in ASCs more than quadrupled, exceeding 30% nationally.
National Shift in Site of Care
The following data illustrates the evolving distribution of total shoulder arthroplasty procedures across different care settings:
Two key inflection points are evident. The removal of total shoulder arthroplasty from the inpatient-only list in 2021 caused a dramatic decline in inpatient procedures, falling from 80% to 38% within a single year. Initially, much of this volume shifted to hospital outpatient departments. However, the real acceleration occurred in 2024, when ASC eligibility took effect. ASC market share surged from 6.4% to 23.6%, and has now surpassed 30% and continues to climb.
Where the Shift is Happening First
While national averages provide a broad overview, the adoption of ASCs for shoulder replacements is unevenly distributed across states. We analyzed state-level ASC volumes in 2023 and 2025, following the implementation of ASC eligibility, to identify early adopters.
Utah and Tennessee have experienced a fundamental shift in care delivery, with ASCs now handling the majority of shoulder replacement procedures. Montana led the nation with a remarkable 48.1 percentage point increase in ASC market share.
Here are the top 10 states demonstrating the most significant growth in ASC market share:
| Rank | State | 2023 ASC Share | 2025 ASC Share | Percentage Increase |
| 1 | Montana | 10.5% | 58.6% | 48.1% |
| 2 | Utah | 8.5% | 52.0% | 43.5% |
| 3 | Tennessee | 8.9% | 51.0% | 42.1% |
| 4 | New Mexico | 17.6% | 55.5% | 37.9% |
| 5 | Mississippi | 18.1% | 53.9% | 35.8% |
| 6 | Florida | 4.6% | 39.1% | 34.5% |
| 7 | Minnesota | 6.9% | 40.8% | 33.9% |
| 8 | Michigan | 8.6% | 41.9% | 33.3% |
| 9 | Arizona | 9.5% | 42.3% | 32.8% |
| 10 | Washington | 12.5% | 44.9% | 32.4% |
Looking at absolute volume, Florida experienced the most substantial increase, adding over 3,500 shoulder replacement claims in the ASC setting between 2023 and 2025 – and this is before the complete 2025 Medicare data is available.
The top 10 states in terms of absolute claims growth are:
| Rank | State | 2023 Claims | 2025 Claims | Net Change |
| 1 | Florida | 558 | 4,085 | 3,527 |
| 2 | Michigan | 826 | 3,631 | 2,805 |
| 3 | Ohio | 1,114 | 3,287 | 2,173 |
| 4 | Tennessee | 422 | 2,244 | 1,822 |
| 5 | Washington | 668 | 2,423 | 1,755 |
| 6 | Arizona | 492 | 2,092 | 1,600 |
| 7 | California | 763 | 2,318 | 1,555 |
| 8 | North Carolina | 256 | 1,808 | 1,552 |
| 9 | Minnesota | 360 | 1,735 | 1,375 |
| 10 | Indiana | 228 | 1,592 | 1,364 |
Strategic Implications for Device Companies
Fast Adoption Zones: States like Montana, Utah, Tennessee, New Mexico, and Mississippi, with over 35% ASC market share growth, represent opportunities for early expansion. Are your sales teams prepared to capitalize on these rapidly evolving markets?
Volume Powerhouses: Florida, Michigan, and Ohio demonstrate the potential of high-volume states. These ASC-friendly environments offer significant near-term revenue opportunities. How are you prioritizing resource allocation to maximize impact in these key regions?
The Sweet Spot: States like Tennessee, Michigan, and Florida combine both rapid growth and substantial volume, making them ideal candidates for a focused, ASC-centric commercial strategy. What adjustments are needed to your territory design and quota models to reflect this shift?
Ankle Arthroplasty: A Similar Trajectory
Total ankle arthroplasty (CPT 27702) is following a similar path, having been removed from the inpatient-only list in 2021 and becoming ASC-payable in 2024. While the volume of ankle replacements is lower than shoulder replacements, the trend is consistent. ASC share has steadily increased, though at a more gradual pace:
- 4.1% in 2017
- 7.2% in 2021
- 20.1% in 2025
Inpatient hospital utilization for ankle replacements has plummeted from 70.4% to 8.3% over the same period, mirroring the directional shift observed in shoulder arthroplasty.
Preparing for the Future of ASCs
The shift of procedures off the inpatient-only list is a powerful catalyst for change in healthcare. Total shoulder arthroplasty provides a clear illustration of how policy changes translate into real-world market dynamics. If your procedures are slated to become ASC-eligible, it’s critical to reassess your forecasting assumptions. Shoulder replacements saw a jump from 6% to over 30% ASC share in just two years, with some states now exceeding 50%. Building territory plans and quota models based on gradual shifts will leave you significantly behind.
We are developing new tools to help organizations navigate this evolving landscape. Stay tuned for more information.
Please note: State-level data patterns can be influenced by payer coverage and claims availability. These insights should be used as strong directional signals, not as absolute forecasts.
About Evan Knopp, Head of Market Strategy
Evan Knopp is the Head of Market Strategy at MedScout, where he leads positioning, competitive strategy, and market insight to drive growth. Prior to MedScout, he served as Head of Marketing at Turquoise Health and Director of Product Marketing at Sana Benefits, and held several marketing roles at IBM. Evan holds an MBA and a Bachelor’s degree from the University of Texas at Austin.
Frequently Asked Questions About ASC Growth
What is driving the rapid growth of Ambulatory Surgery Centers?
The primary driver is CMS policy changes, specifically the removal of procedures from the inpatient-only list, making them eligible for coverage in lower-cost ASC settings. Patient preference for convenience and lower out-of-pocket costs also contribute.
How can device companies prepare for this shift to ASCs?
Device companies need to revisit their forecasting models, territory planning, and quota setting to account for the accelerated adoption of ASCs. Focusing on states with high growth and volume is crucial.
What impact does CMS policy have on shoulder arthroplasty procedures?
CMS policies have dramatically altered the site of care for shoulder arthroplasty, with a significant shift from inpatient hospitals to ASCs following the procedure’s removal from the inpatient-only list and subsequent ASC eligibility.
Are all states adopting ASCs at the same rate?
No, ASC adoption varies significantly by state. States like Montana, Utah, and Tennessee have seen particularly rapid growth, while others are lagging behind.
What is the future outlook for ASCs in healthcare?
The future outlook for ASCs is very positive. As more procedures become eligible and patients seek more convenient and affordable care options, ASCs are expected to continue to grow in prominence.
This data underscores a fundamental shift in healthcare delivery. What strategies are your organizations implementing to adapt to this changing landscape? And how are you leveraging data to identify the most promising opportunities within the ASC market?
Share this article with your network to spark a conversation about the future of ambulatory surgery. Join the discussion in the comments below!
Disclaimer: This article provides general information and should not be considered medical or financial advice. Consult with qualified professionals for personalized guidance.
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