From major implant manufacturers to supply distributors to back-office service providers, vendors have watched ASC volume grow, often without a corresponding renegotiation of the terms they set years ago.
The outpatient shift is accelerating. In its annual report to Congress released March 12, the Medicare Payment Advisory Commission found that the number of ASCs nationwide grew more than 2% per year on average between 2019 and 2024, and the volume of ASC surgical procedures per fee-for-service beneficiary increased 3.5% in 2024 alone, after growing at an average annual rate of 1.3% from 2019 to 2023.
ASC leaders say the opportunity to claw back margin is substantial — and largely untapped. The barrier isn’t leverage. It’s bandwidth, information and discipline. Here’s where experts say centers are falling shortest.
Many ASCs are still operating under pricing structures that were negotiated when their centers were smaller, simpler and seeing fewer cases. As volume and complexity have grown, those terms haven’t kept pace, and vendors have little reason to volunteer better ones.
Aaron Hayes, administrative director of North Pointe Surgery Center in Lancaster, Pa., told Becker’s the problem runs deeper than implant pricing. It encompasses primary distributors like Medline and McKesson, implant and disposable vendors including DePuy, Arthrex, Smith & Nephew and Stryker, and ancillary service providers covering everything from linen and scrubs to payroll systems, clearinghouses, revenue cycle management partners and IT services.
“Vendors will not proactively offer better pricing or service without pressure,” Mr. Hayes said. “In many cases, vendors benefit from ASC growth more than the centers themselves.”
The root cause, he said, is structural. ASC administrators are typically managing clinical, operational and financial responsibilities simultaneously, unlike large health systems with dedicated procurement and supply chain teams. The result is that vendor strategy defaults to a periodic task rather than a continuous focus.
According to a December 2025 report from ASC supply purchasing company Advantien, implants are regularly among the highest cost expense items for ASCs and can sometimes exceed the total reimbursement for a procedure.
“Rather than treating vendor contracting as a periodic renegotiation exercise, there is a significant opportunity to shift toward a more dynamic and data-driven approach,” Mr. Hayes said. This includes regular market benchmarking, physician utilization alignment and consistent competitive pressure across all vendor categories.
Vendor strategy is also about knowing what’s actually in the contracts already in place. Earl Kilbride, MD, an orthopedic surgeon at Austin Orthopedic Institute, said this operational knowledge is one of the most underrated financial assets an ASC can develop.
“It is not just good or bad contracts that can affect things, but having an administrator who is thoroughly familiar with each contract and its intricacies is vital to the ASC’s bottom line,” Dr. Kilbride said.
A clear example is how many contracts, including Medicare, do not cover the cost of implants. For an orthopedic or spine-heavy ASC, that gap between reimbursement and cost can erode margin on high-volume cases because no one was watching closely enough.
One of the most actionable savings opportunities in ASC vendor management is sitting inside surgical custom packs, according to some ASC leaders. As supply chain disruptions and tariffs continue to push item costs higher, the contents of those packs deserve a fresh look.
Carrie Marut, administrator of Mentor Surgery Center in Mentor, Ohio, said her center recently conducted that kind of review. She met directly with their vendor to evaluate each pack item by item, swapping out tariffed products, removing unnecessary items and consolidating where possible.The result was an estimated $100,000 in annual savings.
“Meeting with your vendor can be profitable to the ASC, especially with the increase in tariffed items in the packs,” Ms. Marut said.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.