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1、|Confidential|Draft1These materials are intended to supplement a discussion with L.E.K.Consulting.These perspectives will,therefore,only be meaningful to those in attendance.The contents of the materials are confidential and subject to obligations of non-disclosure.Your attention is drawn to the ful

2、l disclaimer contained in this document.L.E.K.ASC Insights StudyMedTech Publication DeckFebruary 2024|Confidential|Draft2L.E.K.Consulting presents the 2024 ASC Insights StudyL.E.K.2024 ASC Insights Study150 respondent surveyIn-depth review and syntheses of secondary sources such as:ASC Association,V

3、MG Health,Beckers ASC Review,market research reportsAnalysis of CMS claims for common and emerging ASC proceduresLongitudinal comparison to L.E.K.s 2020 ASC Insights study 80%physicians/medical directors,20%admins/nurses 80%multi-specialty,20%single-specialty Representative mix of physician-,hospita

4、l-,and management-owned ASCs Mix of geographies,indexed to regional locations of ASCsAdditional L.E.K.IP and resourcesL.E.K.ASC-focused projects with hundreds of interviews|Confidential|Draft3ASCs are becoming an increasingly important part of the provider landscape and offer large potential,but req

5、uire tailored strategies given different clinical,economic,and decision-making dynamicsASC related revenues and spending growing strongly at 6-8%p.a.overallRelatively higher growth expected within high-spend specialties like spine and cardiovascularHealth systems/hospitals increasingly investing in

6、ASCsDiverse and distributed network of smaller-sized call points vs.the hospital settingHigher price sensitivity with discount expectationsHigh variation in ASC segments with different needs,behaviors from hospital customersLearning how to succeed in the ASC setting is becoming increasingly critical

7、 for MedTechsASCs are becoming a more meaningful portion of the market and growing stronglyASCs present an attractive opportunity,but require tailored strategies|Confidential|Draft4Six key themes have emerged from the 2024 ASC Insights Study,reflecting how ASCs have advanced as customers and how Med

8、Techs can better support the evolving ASC landscapeRobust market growth:ASC revenue is expected to grow 6-8%p.a.through 2027,driven by increasing procedure volumes and reimbursement rates,increased ASC spending,and a mix-shift towards higher value procedures;pockets of higher growth are expected in

9、emerging specialties2MedTech partnerships and offerings:Many ASCs are seeking closer partnerships with MedTechs who can help them deliver on their clinical and economic objectives,including contracting(and support)models that are more aligned to ASC settings5Strategic priorities:While quality of car

10、e,staffing,and basic operations are key table stakes priorities,ASCs are also focused on expansion to new physicians,procedures,payer networks,and specialties as they continue to mature 4Increased professionalization:ASCs remain heterogeneous in their purchasing attitudes,but have made operational i

11、mprovements and are becoming more professionalized as they scale,with some differences by ownership structure3Developing a winning ASC strategy:ASCs have historically been a challenging(and deprioritized)customer segment for MedTechs,but require sufficient attention and tailored approaches as they b

12、ecome an increasingly important portion of the market6ASC segmentation:The ASC market is diverse,with a range of key archetypes based on ownership(i.e.,100%physician-owned,hospital-owned,management company-owned)and specialty of focus(i.e.,multi-vs.single-specialty)1|Confidential|Draft5The ASC marke

13、t is highly diverse with a few key customer archetypes that influence their purchasing attitudes and behaviors100%physician-owned(50%of ASCs)Partial/full corporate-/mgmt.-owned (20%of ASCs)Partial/full hospital-owned,including joint ventures with mgmt.cos*(30%of ASCs)ASCs are outpatient facilities w

14、here routine surgical procedures are performed,often in a more cost-effective and convenient environment than hospitals and HOPDsHospitals have been investing more in ASCs,with partial or full hospital ownership growing from 20%to 30%of ASCs in the past decadeMulti-and single-specialty ASCs tend to

15、operate similarly within an institutional ownership or affiliation(i.e.,hospital or corporate/mgmt.)However,100%physician-owned have different behaviors and attributes across multi-and single-specialty focusSingle-specialty(50%of ASCs)Multi-specialty (50%of ASCs)ASC segmentation by ownership and spe

16、cialty,with example ASCsNote:*Only 2%of ASCs are 100%hospital-owned,with the remaining 28%only partially owned by hospitals(as of 2021),and 7%are joint owned by physicians,hospitals,and corporate/management companiesSource:OR Manager;Beckers ASC;Avanza;ASC Market Trends Report;ASCdata;L.E.K.ASC Surv

17、ey,research,and analysisNON-EXHAUSTIVE1|Confidential|Draft6The ASC market has a robust growth outlook,with revenue and spend expected to increase 6-8%p.a.through 2027,with pockets of higher growth in higher value ASC specialtiesU.S.ASC market growth outlookFacility volume*Increasing growth rateGrowt

18、h driversProcedure volumeASC revenueASC spendfor emerging,high-spend specialties6-9%Not quantified9-12%9-12%6.2K6.5K1.5%1-3%25-30M30-35M1-3%3-5%$40B$50B6-7%6-8%Not quantifiedNot quantifiedNot quantified6-8%Note:*Only includes Medicare-certified ASCs;there are an additional 3,000-4,000 non-Medicare-c

19、ertified ASCs in the U.S.today;*Represents a range across specialties,not the CAGR range for each specialty;Emerging,high-spend specialties includes cardiovascular,spine,and orthopedics;List of relevant specialties included in following slideSource:Statista;CDC;CMS;ASCdata;Beckers Healthcare;Busines

20、s Wire;Grand View Research;Databridge Market Research;VMG Intellimarker;Ambulatory Surgery Center Association(ASCA);Life Science Intelligence(LSI);L.E.K.ASC Survey,research,and analysisMarket size20232027CAGR%19-2323-27FCAGR%*23-27FContinued investment by hospitals and management companiesRemoval of

21、 laws regulating establishment of new facilities in many statesFacility volume growthHigher case volume per ORProcedure volume growthIncreased reimbursement ratesMix shift to higher-value proceduresProcedure volume growthASC spending increase expectationsGrowth in higher-value,complex procedures tha

22、t require more expensive equipment and devicesCMS;ASCdataLSI;CMS;ASCA;L.E.K.surveyDatabridge Market Research;Grand View Research;Business WireL.E.K.research and IPKey sources1-3%3-5%6-8%6-8%2ASC procedure volumes are 35%of total procedure volumes in relevant specialties across all settings in 2023,e

23、xpected to reach 40%in 2027These growth rates contrast with those of hospitals,which are experiencing flat to declining numbers of staffed beds and declining number of inpatient days/patient admissions|Confidential|Draft7Continued market growth has been supported by growth in procedure volumes,encou

24、raged by a range of growth drivers and progress on key historical growth barriers051015202530351%19%5%2%3%9%3%13%20195%1%40%19%6%2%4%9%38%3%12%236%1%U.S.ASC procedure volumes by specialty*(2019,23,27)Number of procedures18%6%2%5%4%10%40%3%11%2722-27M25-30M30-35MCAGR%(2019-23)1-3CAGR%(2023-27)3-5Card

25、iovascularSpinePodiatryOb/GynENTPlasticsOrthopedicsUrologyOphthalmologyPain managementGastroenterologyTotal13-155-714-168-102-41-31-3(1)-15-74-65-71-35-77-91-33-5(1)-12-42-41-30-24-6Note:*Does not include all procedures within a specialty,only a representative set,and is based on a sampling of selec

26、t proceduresSource:CMS;LSI;L.E.K.ASC survey,research,and analysisImproved payer coverage due to payer cost savingsPhysician satisfaction and compensationEnhanced patient experience/satisfactionChanges to surgical techniquesLevel of reimbursement from payersPayer coverage of various proceduresASC gro

27、wth has been encouraged by a wide range of drivers as well as progress on historical growth barriersThe top remaining barrier to further growth is access to trained staff,which has become a more pressing problem in the last several years in line with the broader industry2|Confidential|Draft8Survey:A

28、cross the U.S.,in your opinion,what percentage of“insert procedure name based on logic below”procedures are performed in hospital inpatient settings(i.e.,hospitals in which patient remains overnight)compared to outpatient settings(e.g.,ASCs,hospital outpatient,physicians office,etc.)today(2023)?What

29、 about pre-COVID(2019)?Show for all.What do you expect it to be in four years(2027)?Note:*2023 percent of procedure in ASCs is calculated using percent of procedure in ASC from 2021 CMS data,then grown to 2023 using procedure-specific 2019-2023 CAGR from survey;*All data in chart are based on a repr

30、esentative subset of ASC-relevant procedures within each specialty,weighted by estimated procedure volume from 2021 CMS data to get the overall weighted average percent of a specialty done in ASCs today;Includes all procedures within specialty,and not just procedures approved by CMS for ASC reimburs

31、ementSource:CMS;LSI;ASCA;Anthem Public Policy Institute;Cataract&Refractive Surgery Today;Hospital&Healthcare Management;Beckers ASC Review;The Journal of Urology;OR Manager;American Academy of Otolaryngology;MedTech Dive;L.E.K.ASC Survey and analysisSpecialties have migrated to ASCs to varying degr

32、ees;cardiovascular,spine,and orthopedics are emerging ASC specialties with relatively higher ASC growth expectationsPercent of procedures performed in ASCs today(2023,%)DIRECTIONAL024681001020304050607080U.S.ASC share of procedures and expected annual growth by specialty*(2023,27E)Percent of special

33、ty,based on a representative set of procedures*OrthopedicsCardiovascularPain managementPlasticsPodiatryENTUrologySpineGastroenterologyOb/GynOphthalmologyTotal procedure volumes across all settings(2023)Low(1M)High(20M)Medium(5M)Relatively mature specialties high penetration of procedures performed i

34、n ASCsEmerging specialty areas where movement to ASCs may continue to accelerateExpected annual volume growth in ASCs(CAGR%,2023-27F)The maximum level to which specialties are able to shift to ASCs varies by specialty2|Confidential|Draft9Survey:Across the U.S.,in your opinion,what percentage of“inse

35、rt procedure name based on logic below”procedures are performed in hospital inpatient settings(i.e.,hospitals in which patient remains overnight)compared to outpatient settings(e.g.,ASCs,hospital outpatient,physicians office,etc.)today(2023)?What about pre-COVID(2019)?Show for all.What do you expect

36、 it to be in four years(2027)?Note:*2023 percent of procedure in ASCs is calculated using percent of procedure in ASC from 2021 CMS data,then grown to 2023 using procedure-specific 2019-2023 CAGR from survey;*All data in chart based are average of data for representative subset of ASC-relevant proce

37、dures within each specialty,weighted by estimated ASC procedure volume from 2021 CMS data,and does not include Commercial reimbursement or payment rates;Includes all procedures within specialty,and not just procedures approved by CMS for ASC reimbursementSource:CMS;LSI;L.E.K.ASC Survey and analysisE

38、merging ASC specialties with higher growth expectations(i.e.,CV,orthopedics,spine)are also those with higher-revenue procedures requiring higher spend on medical devices and equipmentDIRECTIONAL02468100123456789Estimated U.S.specialty growth and CMS reimbursement in ASCs*(2023,27E)Percent of special

39、ty,based on a representative set of procedures*OrthopedicsCardiovascularPain managementPlasticsPodiatryENTUrologySpineGastroenterologyOb/GynOphthalmologyEmerging ASC specialties with higher growth expectations also have higher device/equipment spendEstablished ASC specialties tend to have lower devi

40、ce/equipment spendCMS reimbursement per procedure*(2023,$,thousands)2Expected annual volume growth in ASCs(CAGR%,2023-27F)Total procedure volumes across all settings(2023)Low(1M)High(20M)Medium(5M)|Confidential|Draft10ASCs have made operational improvements in the last few years,addressing key pain

41、points related to billing,patient handling,clinical workflow management,and purchasingSurvey:Which,if any,of the following pain points have you experienced operating an ASC in the U.S.?Please rate on a scale of 1 to 7 where 1 means“not a pain point”and 7 means“significant pain point”Note:*Pain point

42、s without a 2020 survey comparison were not asked about in the 2020 ASC survey;Respondents who answered“I dont know”were included in N above but excluded from the analysis(0-5 respondents per pain point)Source:L.E.K.ASC Survey and analysis39%30%29%28%26%22%22%20%19%18%051015202530354045Difficulty re

43、cruiting new staffBilling issues with payersManaging out of network patientsExcess clinician time spent doing admin workPatient payment collectionsFrequently facing out-of-stock situationsInability to find alternate or comparable drugsDifficulty meeting guidelines of accrediting agencies and regulat

44、ory bodiesMarketing and attracting patientsScheduling difficultyMost ASC pain points have declined since 2020 as ASCs continue to mature and professionalizePercent of all respondents who answered 6 or 7 out of 7,where 7 means significant pain point*(n=153)Patient handling/managementClinical workflow

45、 managementPurchasing/inventory managementBilling,financials,and reimbursementSupply chainManagement and regulatory2020 surveyKey operational pain points have decreased in significance since 2020 as ASCs have continued to professionalizeRecruiting new staff has become a more significant pain point s

46、ince 2020,in line with the broader industry3|Confidential|Draft11Lower priority differentiatorsImproved clinical and non-clinical workflow efficiency tools35Access to specialized EMR/practice management software and other related tools34Improved patient-facing technology27Introduction of new locatio

47、ns/operating rooms27AI and predictive analytics for clinical use21Telehealth and/or remote patient monitoring capabilities21In terms of strategic priorities,ASCs are focusing on table stakes issues like quality of care,staffing,and basic operations,while also considering expansion to new physicians,

48、procedures,and payer networks Survey:How important are each of the following strategic priorities for your ASC today(2023)?Please indicate the importance of each need on a scale of 1-7,(1 meaning the need is not at all important and 7 meaning the need is very important).Note:Respondents who answered

49、“I dont know”were included in N above but excluded from the analysis(0-4 respondents per priority)Source:L.E.K.ASC Survey and analysisTable stakes prioritiesAttraction/retention of nurses73Improved patient satisfaction with clinical care63Quality metrics(e.g.,reduced readmission rates,medical errors

50、,improved infection control,etc.)59Improving efficiency of processes57Attraction/retention of allied medical specialties/non-clinical staff56Cost-effective contracting/purchasing of medical devices/equipment55Attracting new physicians to operate in existing specialties53Higher priority differentiato

51、rsImproved revenue cycle management(RCM),including charge capture/billing/reimbursement48Expansion to include new procedures within existing specialties47Access to new payer networks45Access to new medical device technologies(e.g.,novel transcatheter interventions,robotic surgery)44Reduced total cos

52、t of ownership of equipment and supplies(e.g.,reduced waste)43Expansion to include new surgical specialties38Improved supply chain resilience(e.g.,ensuring suppliers guarantee inventory,shifting to near-shore suppliers)37Quality of careTech/digital health Operating performance/staffingExpansionImpor

53、tance of ASC strategic prioritiesPercent of all respondents who answered 6 or 7 out of 7,where 7 means very important(n=153)4|Confidential|Draft12Many ASCs are seeking closer partnerships with MedTechs to help deliver on their clinical and economic objectives,especially hospital-owned and 100%physic

54、ian owned multi-specialty ASCsSurvey:Please indicate the extent to which you agree or disagree with the following statements regarding your ASC(s)relationship with its MedTech suppliers.Please rate on a scale of 1-7,1 meaning“Strongly disagree”and 7 meaning“Strongly agree”Note:Respondents who answer

55、ed“I dont know”were included in N above but excluded from the analysis(0-1 respondent per ownership type)Source:L.E.K.ASC Survey,research,and analysis585%61%82%62%020406080100Partial/full hospital-owned,including joint ventures with mgmt cos.(n=53)Partial/fullmanagement-owned(n=50)Multi-specialty(n=

56、29)Single-specialty(n=21)Most ASCs want MedTechs to provide valuable services,solutions,and support beyond just their productsPercent of all respondents who answered 5,6,or 7 out of 7,where 7 means strongly agree to the above statement100%physician-owned|Confidential|Draft13In particular,ASCs are mo

57、st interested in MedTechs providing them with better suited pricing models as well as product support(e.g.,education,training)58%55%51%48%43%42%34%30%24%0102030405060Pricing models conducive to the ASC settingAdequate offering of education and training for their productsAdequate level of clinical/re

58、p support for their productsProducts tailored to ASCs specifically vs to hospitalsBetter equipment services in support of their productsBroader product offering range to serve multiple specialtiesBetter digital connections and data access across productsAssistance in developing/building out de novo

59、ASC facilitiesMore data analytics and insights featuresASCs believe several offerings are needed from MedTech suppliers to provide better products/services to ASCsSurvey:Please rate the extent to which you agree or disagree that the following offerings are needed to provide better products/services

60、to ASCs.Please rate the following statements on a scale of 1 to 7 in which 1 means“Strongly disagree”and 7 means“Strongly agree”Note:Respondents who answered“I dont know”were included in N above but excluded from the analysis(1-4 respondents per offering)Source:L.E.K.ASC Survey,research,and analysis

61、MedTechs can provide better products and services to ASCs by offering modified pricing models and improved product support(e.g.,education/training,rep support,equipment services)Adequate education/support is a point of alignment across ASCs and hospitals in terms of desired offeringsDigital/data ana

62、lytics offerings are not as critical to ASCs today,but will likely grow in importance as ASCs evolve and matureProduct supportProduct modificationsPricingDigital/data analyticsPercent of all respondents who answered 6 or 7 out of 7,where 7 means strongly agree(n=153)5|Confidential|Draft14Survey:For

63、products/brands you use in the hospital,how much of a price discount off of the hospital supply price would you expect for you to then use in the ASC?;To what extent would you find the following changes to MedTech products/support acceptable in exchange for a lower price point?Please rate the follow

64、ing statements on a scale of 1 to 7 in which 1 means“Not at all acceptable”and 7 means“Very acceptable”Note:Respondents who answered“I dont know”were included in N above but excluded from the analysis(0-4 respondents);Respondents who answered“I dont know”were included in N above but excluded from th

65、e analysis(0-2 respondents per potential change)Source:L.E.K.ASC Survey,research,and analysisASCs expect price discounts compared to hospital prices and are willing to work with MedTechs on pricing models/arrangements to unlock lower prices51%42%36%27%020406080100Purchase broadergroupings of product

66、 to unlock lower priceCommit to purchasing volumesand/or auto-reorderingto unlock lower priceSimplified or more basicversion of productsLimited in-person supportPercent of all respondents who answered 6 or 7 out of 7,where 7 means very acceptable to suggested change(n=153)ASCs expect price discounts

67、 off hospital pricesDifferent ways to contract517%17%0204060801001-5%6-10%11-15%16-20%21-25%26-45%30%20%15%and are accepting of changes to MedTech products/support in exchange for a lower price pointDistribution of expected percent discount among respondents who work in both the ASC and hospital set

68、tings(n=43)|Confidential|Draft15While ASCs are interested in building broader relationships with MedTechs,they have been a challenging customer segment due to several unique dynamicsSome MedTechs have made meaningful progress in contracting/pricing,commercial strategy,and adjusting their portfolios,

69、and now have viable and cost-effective models and ASC strategiesFragmentation of ASCs across many small call pointsLimited data on ASC behaviors and attitudesPrice sensitivityDifficulty in sustaining traditional MedTech SG&A modelGreater distributor customer control/ability to disintermediateASC dyn

70、amics that complicate MedTech ASC strategy6Source:L.E.K.ASC Survey,research,and analysis|Confidential|Draft16To develop a successful ASC strategy,MedTechs need to address the following questionsCommercial model designPricing optimizationMarket expertise What is our forecast for procedure migration t

71、o ASCs,by market?How should we segment customers based on priorities and purchasing behaviors relevant to our specialty?Which customers should we prioritize for in-person targeting by account size and growth outlook?How should we create a customer-facing model(e.g.,sales force)that optimizes ROI of

72、serving highly fragmented customer base?What type of value-added services will be offered?How will we adapt internal bandwidth to support additional services?Is our supply chain prepared to distribute across a more diverse network with more customer sites?How should we set our pricing to be conduciv

73、e to the ASC?Which different ways to contract can we offer based on customer segment and preferences?How can we prevent cannibalization among core hospital customers from lower ASC prices or de-featured products?Source:L.E.K.ASC Survey,research,and analysis6Key questions to answer when developing AS

74、C strategy|Confidential|Draft17Please reach out to L.E.K.s MedTech leadership team to discuss any questions and/or for access to L.E.K.s more detailed ASC Insights study reportMonish Rajpal is a Managing Director in L.E.K.Consultings New York office.He leads the Global MedTech practice.M.R+1(646)652

75、 1912(office)+1(617)901 1834(mobile)Jonas Funk is a Managing Director in L.E.K.Consultings Chicago office and previously led the Americas Healthcare Sector.J.F+1(312)913 6418(office)+1(415)307 4676(mobile)Monish has an MS(Johns Hopkins-Computer Assisted Surgery/Medicine)and an MBA(Chicago Booth).Ily

76、a Trakhtenberg is a Managing Director in L.E.K.Consultings Chicago office and leads the U.S.Health Care Supply Chain practice.I.T+1(312)913 6421(office)+1(312)753 8643(mobile)Ilya completed an MBA with Honors at Kellogg(Northwestern)and a BA in Economics and Political Science at Northwestern.Jonas e

77、arned his Bachelors Degree from Carleton College where he graduated magna cum laude.Sheila Shah is a Managing Director focused on MedTech and digital health in L.E.K.Consultings Chicago office.Sheila earned an MBA at Kellogg(Northwestern)and a BA in Economics and Political Science at Barnard College

78、.S.S+1(312)913 6465(office)+1(312)722 9460(mobile)Nathalie Herman is a Managing Director in L.E.K.Consultings Atlanta office and has deep expertise across MedTech.Nathalie earned an MBA at Wharton(UPenn)and a BA at Wellesley College.N.H+1(678)387 6072(office)+1(718)974 2539(mobile)18 2024 L.E.K.Cons

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