Part 6: Where Care Is Moving

Surgery Centers, Urgent Care, and Retail Clinics

For decades, the hospital was the center of gravity in American healthcare. If you needed surgery, you went to the hospital. If you had an ear infection on a Saturday, you went to the hospital emergency room. If you needed stitches, you went to the hospital.

That’s changing fast.

Care is migrating out of hospitals into lower-cost, more convenient ambulatory settings. CMS is actively accelerating this shift through policy — adding procedures to the ASC-approved list, adjusting payment rates to favor outpatient settings.

Ambulatory Surgery Centers (ASCs) — Purpose-built facilities for same-day surgery. About 6,100 nationally. A knee arthroscopy that costs $15,000 in a hospital outpatient department might cost $6,000 in an ASC — same procedure, same surgeon, same outcome. The economics are compelling, which is why CMS keeps shifting procedures to this setting.

Urgent Care Clinics — Walk-in clinics for non-emergency acute problems: ear infections, sprained ankles, minor lacerations. Extended hours, no appointment needed. They exist because your primary care doctor is booked three weeks out and the ER charges $2,000 for a strep test. About 14,000 nationally and growing.

Retail Clinics — The smallest, most limited care setting. A nurse practitioner inside a CVS or Walgreens handles vaccinations, strep tests, UTIs, and pink eye. Maximum convenience, minimum scope. CVS MinuteClinic operates about 1,100 locations. Walmart tried and failed — Walmart Health closed all locations in 2024.

The Competitive Dynamic

The shift to ambulatory care creates a competitive tension. Every procedure that moves to an ASC is revenue that leaves the hospital. Every sore throat treated at urgent care is a patient who didn’t use the ER. Hospitals have responded by building their own ambulatory networks, but the trend is clear: the hospital is becoming the place of last resort, not the default.