From stagnant payer contracts to underutilized operating roomtime, the financial vulnerabilities in today’s ASC landscape are as varied as they are preventable.
Rising labor, supply and anesthesia expenses are outpacing reimbursement gains, squeezing margins at centers still operating on volume-first assumptions. Meanwhile, coding errors, front-end revenue cycle gaps and implant costs are quietly eroding the bottom line case by case.
Thirty-three ASC leaders joined Becker’s to discuss the biggest financial mistakes centers are making right now, and how to fix them.
Editor’s note: Responses were edited lightly for clarity and length.
Question: What’s the biggest financial mistake ASCs are making right now — and what should they be doing instead?
Elisa Auguste. Administrator of Precision Care Surgery Center and Vice President of the New York State Association of ASCs (East Setauket, N.Y.): The biggest financial mistake ASCs are making right now is settling into the status quo. As costs continue to rise at a pace that often outstrips contract rate increases, margins are getting tighter. Too many organizations take the path of least resistance, accepting higher expenses and shrinking profitability without stepping back to reassess.
Instead, ASCs should be in a constant state of evaluation. That means regularly reviewing expenses and actively identifying cost-saving opportunities. Sometimes the impact comes from small adjustments, like reducing excess inventory (such as unused scrubs), while other times it involves bigger decisions such as switching implant vendors when clinical quality is comparable, or entering into equipment placement agreements to avoid large upfront capital costs.
It’s equally important to revisit payer contracts. Are they auto-renewing without review? Have rates remained unchanged for years? These are missed opportunities to renegotiate and improve financial performance. Ultimately, financial sustainability and growth depend on a proactive approach. Don’t accept the status quo, continuously evaluate, challenge your costs, and negotiate wherever possible.
Vijay Bachani. President and Chief Growth Officer of New York Bariatric Group (Roslyn Heights, N.Y.): The biggest financial mistake I see ASCs making right now is leaving their payer contracts untouched as their case mix evolves. When an ASC adds a new service line such as orthopedics (total joints), spine or higher-acuity bariatrics, those procedures are often reimbursed under outdated carve-outs or default grouper rates that do not reflect current economics.
What ASCs should be doing instead is proactively reopening their agreements to negotiate procedure-specific carve-outs, benchmarked against what the payer would otherwise pay in the hospital setting. If a case migrating from HOPD to ASC saves the payer thousands of dollars per episode, the ASC should be capturing a meaningful share of that delta rather than accepting the legacy rate. The same logic applies to any new technology or implant-intensive procedure where the standard rate was never designed for the current cost structure.
Peter Bravos, MD. Chief Medical Officer of Sutter Health Surgery Center Division (Sacramento, Calif.): When an ASC hits 80% utilization, leadership tends to celebrate, yet margins may be flat or compressing. The mistake is optimizing for volume instead of value capture. Case mix drift toward lower-margin work crowds out spine, total joint and complex ophthalmology, leaving real margin on the table. Correction begins with case-level contribution margin analysis by surgeon, payer, and procedure. Then structure block allocation and recruitment to protect it. Volume fills rooms, but margin builds value.
Charlene Cioe, MSN, RN. Chief Nursing Officer of Summit Center for Surgery (Oakbrook Terrace, Ill.): ASCs’ most significant financial misstep is pursuing case volume growth without aligning payer contracts and cost structure. Reimbursement has not kept pace with escalating labor and anesthesia expenses, compressing margins that typically range from 15% to 25%. Despite generating over $4.2 billion in annual Medicare savings, many centers fail to capture their proportional share of that value.
An executive or business model of compliance-aligned approach requires a disciplined case mix, rigorous contract optimization, and adherence to CMS payment policies. ASCs will need to shift their strategy from a growth-driven, volume-based approach to a sustainable, margin-focused approach or a combination of the two, after evaluating their market share.
Daniel Decker, MD. Co-Founder of Vitality Plus Urology Clinic (Mountain Home, Ark.): From a clinical standpoint, it is financially detrimental if there is not a synergy and collaboration between the “ASC triad” team. The surgeon, anesthesia provider and nursing team working as one (and not three separate entities) creates numerous clinical efficiencies and massive downstream revenue/savings. If there is continuity and familiarity within the clinical team, minutes will be shaved off on surgeon start and end times with smooth wake-ups, lessened anesthetic costs, and quick but safe post-op discharges. During a busy, high volume ASC day, these minutes will add up substantially with increased volume and decreased overhead. ASCs have to use this natural, focused efficiency of a well-oiled triad team working together that larger hospital operative settings cannot compete with.
Additionally, from a business standpoint, using the same clinical triad team to leverage vendor contracts is a huge financial mistake if not utilized. ASCs tend to be on the forefront of innovation and new surgery technologies across all fields. This creates a competitive market, where vendor contracts should be constantly leveraged. It is imperative to employ the ASC triad’s clinical acumen to guide business leaders of when/why/who to engage for a particular vendor contract optimization. The financial mistake of just not asking is significant and frequently overlooked.
Jack Dillon. CEO of Anesthesia Practice Consultants (Grand Rapids, Mich.): The biggest financial mistake ASCs are making right now is chasing volume without understanding whether their market, case mix, and surgeon alignment actually support profitable growth. Many centers are focused on filling operating rooms, but in today’s environment — where labor, anesthesia and supply costs are rising faster than reimbursement — more cases do not necessarily mean better margins. The critical question is no longer “How do we stay full?” but rather, “Do we have the right cases and the right surgeons in our market to achieve our financial and operational goals?”
The most successful ASCs are shifting from a volume-first mindset to one grounded in market discipline and case-level economics. They are actively managing case mix, aligning block time with high-value procedures and ensuring their surgeon base supports sustainable performance. In some cases, that means making difficult decisions — limiting low-margin work or being more selective about growth. Ultimately, the path forward is clear: right cases, right surgeons, right market — because volume without alignment is no longer a viable strategy.
Deena Edwards, MSN, RN. Administrator of The Surgery Center of Southwest Ohio (Moraine): Missing out on the benefits of partnering with local hospitals to negotiate better rates in their managed care contracts or improved discounts with their GPO.
Bruce Feldman. Administrator of Bronx Ambulatory Surgery Center (New York City): Not knowing your total costs per case especially when implants are involved. It’s imperative that as higher-acuity level cases shift from the hospital setting to the ASC setting that you know exactly how much it costs to do that case (medical supplies, labor, utilities, etc.) at your ASC. It’s no longer about the number of cases/volume, but rather profitability. Higher acuity level cases are often associated with higher costs due to their complexity resulting in higher utilization of supplies and labor costs because of operating room time being longer. Having accurate data from your EMR system is key in determining if a particular case is suitable to be done at your facility no longer from just a clinical perspective but from an economic one.
Megan Friedman, DO. Chair and Medical Director of Pacific Coast Anesthesia (Los Angeles): The biggest financial mistake ASCs are making right now is shopping around for anesthesia coverage instead of partnering with a single, aligned group. Treating anesthesia like a commodity creates inconsistency, coverage gaps, and inefficiencies that ultimately lead to lost cases, lost revenue and poor surgeon alignment. At the same time, many centers still view anesthesia as a variable, per-case expense rather than a fixed operational requirement. The highest-performing ASCs do the opposite. They align with a reliable anesthesia partner and build staffing around their schedule, driving on-time starts, fewer cancellations and sustainable growth.
Judith Gary. Executive Director at Algonquin Road Surgery Center (Lake in the Hills, Ill.): One of the most significant challenges facing ASCs today is the continued reliance on a volume-driven operating model, rather than adapting to what has evolved into a highly precise, revenue-cycle-focused environment. Denial rates are increasing, largely driven by deficiencies in coding accuracy and clinical documentation. At the same time, growing prior authorization complexity is delaying reimbursement and, in some cases, preventing procedures from occurring altogether. Compounding these pressures, operating costs — including labor, implants and anesthesia — are rising at a pace that outstrips reimbursement rates. Additionally, payers are implementing more stringent requirements and increasingly shifting financial risk onto providers. An overreliance on volume-based decision-making rather than margin optimization is a financial mistake that many ASCs today face. Many centers prioritize surgeon preference, historical case mix and full OR schedules, instead of focusing on which cases, payers and physicians contribute most effectively to financial performance. Success is no longer determined by efficiency alone, but by ensuring the right procedures are performed at the right reimbursement levels. Top-performing centers demonstrate selectivity in case mix, discipline in payer relationships, and a consistent emphasis on margin optimization.
Sean Gipson. CEO and ASC Division President of Remedy Surgery Center (Houston): Most ambulatory surgery centers don’t have a volume problem; they have a collection problem. Every day, ASCs perform high-quality, efficient procedures, and then fail to capture the full value of that care. Not because payers aren’t reimbursing, but because the system designed to secure that reimbursement is underpowered, under-prioritized or outdated. The result isn’t always visible on a single report. It shows up gradually. A few percentage points lost to denials, incremental underpayments that go unchallenged, delays in accounts receivable, missed charges that never make it to a claim. Individually, these seem manageable. However, together, they are quietly eroding your margins; often by 5% to 15% per case. And in today’s ASC environment, that’s the difference between a high-performing ASC and one under financial strain.
Revenue leakage, not reimbursement, is the real threat. The most significant financial mistake ASCs are making today is treating revenue cycle management as a back-office function instead of a core operational strategy. Across the industry, centers are performing the work but failing to capture its full value. The impact shows up in several ways. Rising denial rates, often tied to preventable coding or authorization issues. Underpayments that go unidentified and unchallenged, delays in accounts receivable that strain cash flow and missed or incomplete charges at the case level.
At a time when reimbursement increases are limited, this level of leakage is unsustainable. The front end is where most revenue is lost. Many organizations focus their efforts on denial management after the fact. That’s necessary; but it’s not sufficient. The highest-performing ASCs are shifting their attention upstream. Eligibility verification, prior authorization, and documentation accuracy are no longer administrative checkpoints. They are financial control points. If these elements are incomplete or inconsistent before the case occurs, the likelihood of full reimbursement drops significantly, and recovery becomes far more resource-intensive.
In other words, a broken claim at the front end rarely gets fully repaired on the back end. Coding precision has become a financial differentiator. As payer scrutiny increases and reimbursement models evolve, coding accuracy is no longer just about compliance, it’s about revenue integrity. Small errors now have outsized consequences, such as incorrect modifiers, incomplete documentation, and misalignment between clinical notes and billed services.
Leading ASCs are responding by investing in specialty-specific coding expertise, routine audits of high-value procedures, and tighter alignment between clinical and revenue cycle teams. Much of the time the overlooked problem is underpayments. Denials tend to get attention. Underpayments often do not. Without systematically comparing contracted rates to actual reimbursement, ASCs have limited visibility into whether they are being paid correctly. In many cases, they are not.
Organizations that actively monitor and pursue underpayments are recovering meaningful revenue, often without increasing volume or adding new service lines. A shift in mindset is required. The most successful ASCs are moving away from a volume-driven model and toward a margin-optimized one.
That shift includes tracking profitability at the case and payer level, understanding revenue per OR minute, using data, not relationships, to inform payer negotiations. Just as importantly, it requires elevating revenue cycle management to the same level of priority as clinical operations.
Tara Good-Young. CEO of PDI Surgery Center (Windsor, Calif.): The biggest financial mistake ASCs are making right now is treating revenue as predictable while downplaying urgency of the growing volatility in collections, especially under new credit‑loss expectations, instead of aggressively tightening AR management, payer‑mix strategy, supply‑chain discipline and workforce planning. ASCs are still budgeting as if historical reimbursement patterns will hold, even as collection risk increases and credit‑loss forecasting becomes more complex.
But the financial exposure doesn’t stop at AR. Many centers are also failing to renegotiate supply pricing regularly or diversify vendors, leaving money on the table in an environment where costs are rising faster than reimbursements. At the same time, too many ASCs wait to recruit until a vacancy appears. This reactive approach forces “hurry‑up‑and‑hire” decisions that can lead to poor fit, destabilize high‑performing teams, and create expensive turnover. In today’s labor market, recruiting is a financial strategy, not an HR preference.
What ASCs should be doing instead:
- Tighten AR and collections discipline to reduce exposure under evolving credit‑loss standards.
- Reevaluate payer mix based on true net yield and days‑to‑pay, not just contracted rates.
- Renegotiate supply pricing regularly and interview multiple vendors to stay cost competitive.
- Maintain a continuous talent pipeline so staffing decisions are proactive, not crisis‑driven.
- Protect team stability by avoiding rushed hires that can erode culture and performance.
Narasimhan Jagannathan, MD. Division Chief of Anesthesiology at Phoenix Children’s:. The biggest financial mistake ASCs are making is treating anesthesia as a commodity to minimize rather than a driver of efficiency and throughput. This leads to understaffing, locum reliance and downstream costs from delays and cancellations.
Instead, ASCs should invest in stable anesthesia teams and optimized perioperative workflows, especially preoperative screening and staffing aligned to demand. Strong anesthesia teams directly improve utilization, throughput and overall financial performance.
Thomas Jeneby, MD. CEO of Palm Tree Surgicenters, Chrysalis Cosmetic Surgicenter and Maximus Plastic Surgicenter (San Antonio): The biggest financial mistake is not getting ready for anesthesia shortages by interviewing and hiring constantly. I have found my Indeed account and headhunters open 24/7 to try and find good single anesthesia and single CRNA to add for part-time help. This also applies to staff. [Practice] ABI “Always be interviewing”/Do not let staff dictate the hourly rate based on hunches. You must have clear data of pay (salary.com, MGMA numbers) and if you own the ASC, step in on salary negotiations.
Maher Kodsy, MD. Chairperson, Anesthesiology Department and Perioperative Physician Director, UH Elyria (Ohio) Medical Center: There are a few financial mistakes an ASC can make.
- Taking on unnecessary debt mostly in the form of loans. I witnessed some ASC borrower’s money for equipment without a thorough feasibility study. A common example is purchasing equipment and implants based on a salesperson presentation. Loans can consume all the profit an ASC can generate. Some ASCs don’t recover from high debt and exposure to overwhelming liabilities.
- Over- and understaffing. If an ASC uses more than 5% of PRN/locum, they are understaffing. The opposite is also true. Less than 5% utilization of PRN, you could be running a scenario of overstaffing.
- Recruitment of specialists that can cost the center more than they can generate from cases. For example, an expensive implant that is reimbursed per commercial/CMS insurance.
- Nonadherence to the working hours with the risk of overtime cost. This creates a major dissatisfaction among staff and is one of main reasons staff depart ASC.
Ira Kornbluth, MD. President of Clearway Pain Solutions (Annapolis, Md.): It is imperative that projections account for sufficient time to construct and credential an ASC. Prolonged timelines to credential and contract surgery centers affect investor returns. Before the onset of construction, architectural planning should also properly consider life cycle code and CMS compliance requirements. Requirements may vary by state; facility rework can delay project completion and be costly.
Scott Kulstad. CEO of St. Paul (Minn.) Eye Clinic: They’re expanding (or simply continuing to operate) without a rigorous, case-level understanding of profitability — and they’re letting payer rules, implant economics, anesthesia coverage, and denial behavior quietly decide (and often erode) their margins. Put simply, the unsuccessful (or less successful than they could be) ASCs are “busy” chasing volume but financially blind — doing more cases, adding higher-acuity procedures, or accepting more payer mix shifts without knowing true cost-per-case and net reimbursement-per-case (after denials, carve-outs, implants and stipends).
What should they do?
- Run the center like a portfolio of “micro-businesses” across service lines, not a single, enterprise-wide profit-and-loss. Build (and update monthly) a case-level contribution margin model.
- Treat payer contracting and contract operations as a core competency (not an annual event). Hire for this talent and protect it like currency.
- Understand implant and device costs. Implants are a top profitability killer because reimbursement approaches differ (thresholds, carve-outs, no separate reimbursement), and small billing mistakes can mean no reimbursement for an implant that cost you real dollars.
- Understand anesthesia: It’s no longer just coverage, it’s margin strategy. Anesthesia coverage is now a very significant operating expense.
Jessica Lam, PhD. Practice Manager at Pacific Coast Anesthesia (Los Angeles): A major financial mistake ASCs are making is focusing on cost reduction instead of eliminating operational waste. Many centers look to cut expenses, but the bigger opportunity is in improving schedule integrity, reducing same-day cancellations, and optimizing room utilization. Even small inefficiencies, such as underfilled OR time, poor block utilization, or last-minute schedule changes, compound into significant financial loss over time. These gaps often go unmeasured but directly impact revenue and staff productivity. ASCs that perform well financially prioritize predictable scheduling, disciplined block management and alignment of staffing with actual demand. The focus should be on maximizing the value of each operating day, not simply reducing line-item costs.
Benjamin Levy III, MD. Gastroenterologist at University of Chicago Medicine: Most gastroenterology-focused ASCs could better prevent procedure cancellations by reviewing prep instructions multiple times and in different ways: in the clinic, via paper instructions, electronically sent instructions, and pre-procedural phone calls one week and three days before the colonoscopy. I recommend that ASCs send redundant electronic prep reminders via text, email, and MyChart/electronic health record. The colonoscopy prep instructions should be uniform. Next, ASCs should try to renegotiate medical equipment contracts for snares and biopsy forceps every six to 12 months and spend time pricing alternative suppliers. ASCs should also consider bundle pricing (including hemoclips and injection needles) and promotional pricing. When new gastroenterologists are hired, it’s a great opportunity to revisit and potentially renegotiate these contracts especially because endoscopists might have different instrument preferences. Another pricing strategy is dual-vendor, which helps maintain leverage by using a primary and a secondary vendor. Finally, some ASCs could better prevent out-of-network billing exposure especially for employed anesthesiologists and CRNAs.
Paul Lynch, MD. Founder and CEO of US Pain Care (Scottsdale, Ariz.): The biggest financial mistake ASCs are making right now is underusing technology and artificial intelligence — not as a future concept, but as a practical tool to decrease cost, reduce headcount and improve efficiency today. Too many centers are still relying on labor-heavy workflows for scheduling, reminders, callbacks, billing, denial management and reporting, which drives overhead up at the exact time margins are getting tighter.
Instead, ASCs should be actively deploying technology and AI across both operations and revenue cycle management to automate repetitive tasks, improve collections, reduce denials, streamline staffing and generate predictive analytics around financial performance. The centers that win over the next few years will be the ones that use technology not just to support the business, but to fundamentally run it better, leaner and smarter.
Carrie Marut, MSN, RN. Administrator of Mentor (Ohio) Surgery Center: While I cannot say the exact financial mistakes that ASCs are making, I can say that the impact of operational costs and the decline of real-term reimbursements are creating issues for ASCs. Although the volume of surgical cases are strong in an ASC, labor costs for ASCs struggle to compete with hospitals, and AI is creating issues for reimbursement due to the use in detecting discrepancies of claims and increasing claim denials. One thing I think ASCs can do to address labor costs is to look at moving away from the 7-3:30 job schedule and be flexible with staff along with cross training. This way you can ensure coverage for peak times without paying for staff during the slower part of a day. Also take the time to review your case mix and what the insurances are reimbursing for your specific ASC. Implant costs are one of the big issues with insurance reimbursement so look at what implants are being used and work with implant companies on lower costs or rebate options to offset the burden.
Brett Maxfield, CRNA. President and CEO of Maxfield Healthcare Solution (Rigby, Idaho): The biggest financial mistake that ASCs are making right now is losing money on anesthesia services by trying to cater to physician owner schedules rather than optimizing anesthesia usage. Most anesthesia providers are requiring a daily minimum and possibly a stipend, so four operating rooms with four anesthesia providers and one case for each surgeon is going to kill the financials of that ASC. What needs to be done is an adjustment in the schedule so that one or two anesthesia providers can provide the anesthesia for all four surgeons. To be successful, it will require a large amount of physician owner buy-in on the schedule as they will need to be flexible for it to work.
James Mitchell, MD. Hip and Knee Replacement Specialist at Total Joint Solutions (Oklahoma City): The biggest mistake ASCs are making right now is aversion to higher-acuity cases. Total joint replacement, spine surgery and cardiology procedures such as angioplasty, pacemaker placement, etc., can be done in the ASC setting. In fact most elective surgery for healthy patients is going to transition to the ASC over the next five to 10 years.
Mick Perez-Cruet, MD. Professor and Director of Oakland University William Beaumont School of Medicine’s Department of Minimally Invasive Spine Surgery and Spine Program (Rochester, Mich.): The biggest financial mistakes ASCs are making is allowing cases to be performed in the ASC that do not cover cost adequately. These may include low-paying cases such as general surgery or eye surgery. Instead, ASCs should focus on neurosurgery/orthopedic spine and orthopedic joint cases that allow better payer mix to cover the cost of ASC facility. In addition, ASC board members should be made up of neurosurgeons and orthopedic surgeons that are bringing better paying cases to the ASCs and actually use the ASC regularly.
Faisal Rahman, PhD. President and CEO of APAC Partners (Crown Point, Ind.): They should partner now to reduce uncertainty. Ideally, this should be a three-way partnership between hospital, physicians/surgeons and a professional ASC management company.
Priyantha Ranaweera, MD. Interventional Cardiologist and Medical Director of Manhattan Specialists Center (New York City): In our experience, the biggest financial pitfall for cardiovascular ASCs is underestimating procedural costs. This is particularly risky for smaller centers, where low volumes collide with thin margins on expensive devices. To boost profitability, facilities should prioritize negotiating better per-device pricing; forming or joining a purchasing consortium can provide this leverage without sacrificing independence through an acquisition.
Melissa Rice. Administrator of Loyola Ambulatory Surgery Center at Oakbrook Terrace (Ill.): One of the biggest financial mistakes ASCs are making right now is chasing short-term cost cutting without a clear, data-driven strategy for long-term sustainability. Centers often delay investments in revenue cycle infrastructure, analytics and payer contract optimization, which quietly erodes margins over time. Another common issue is underestimating labor and supply cost creep instead of proactively redesigning workflows and surgeon alignment models. ASCs should be shifting toward real-time financial visibility, benchmarking performance by service line, and renegotiating payer contracts based on actual case mix and outcomes. Investing in technology that improves scheduling, billing accuracy, and case profitability pays off far more than reactive expense trimming. Equally important is engaging physicians as true financial partners, not just users of the facility. The ASCs that win will be those treating financial management as a strategic discipline, not an accounting exercise.
Ken Rich, MD. President of Raleigh (N.C.) Neurosurgical Clinic: Our biggest mistake in our ASC has been not strictly regulating what implants surgeons can use. Earlier, we were paying up to $20,000 for implants on a one-level lumbar fusion. By insisting that all surgeons performing this operation now use a single supplier whose quality is equivalent to others, we’ve got the cost for implants down to $5,900. We now have begun to look at all products which have multiple suppliers and strictly regulate who can bring things into our center.
Randy Robbins, MD. President of Valiant Anesthesia Associates (Milwaukee). As an anesthesiologist, I recognize that I may have some inherent bias on this topic; however, I believe one of the most significant challenges affecting the ASC market over the past five years has been the increasing surgeon demand for “flip rooms.”
In practice, this often results in two operating rooms being utilized at 50% capacity or less, creating operational inefficiencies and increased costs. While the intent is to enhance surgeon satisfaction, the financial trade-offs can be substantial. In particular, flip room utilization has become a key driver of rising anesthesia overhead and is frequently a contributing factor in subsidy requests from anesthesia groups to surgery centers. Given these considerations, it is important that we work collaboratively with our surgeons to better utilize downtime in flip room settings or, alternatively, ensure there is clear communication regarding the financial implications of this model. Alignment among all stakeholders is essential to balancing operational efficiency with provider satisfaction. Without a coordinated approach, these dynamics can lead to avoidable financial strain and frustration across the organization.
Greg Schooler. COO of Cincinnati GI: There are so many ways to make financial mistakes in an ASC. For example: not diversifying revenue sources, ineffective and noncompliant budgeting, debt burden, not watching your case cost year over year, etc. I ran down the list of even more errors that can have a negative financial impact on centers but couldn’t quite figure out which was the “biggest” mistake.
Then late last week we had our deemed status AAAHC survey and the answer to the “biggest” question became apparent. Both the surveyors conducting our survey commented on how happy and polite our staff were, one added “a happy staff usually means a well-run center.” I started to contemplate the financial advantages created by high staff morale, which includes recruitment and retention. Labor costs are often the biggest expense in any center so financially it is critical to success and profitability. For example, we have an anesthesia company and competition is stiff for CRNAs. We have a reputation as a great place to work, so there is no problem recruiting really talented anesthesia staff; they generally approach us about employment and are usually referred by a currently employed CRNA. Techs, especially room techs, are also in short supply, but we have an excellent group of techs that our competition is always trying to recruit through overpaying the market wage rates.
Not tending to your human capital, investing in their training and development, creating a positive and rewarding work environment is actually a huge financial mistake and one that is often overlooked.
Syed Shah, MD. Medical Director of Stony Brook (N.Y.) Ambulatory Surgery Center: ASCs are recognized for delivering efficient, safe and patient centered care in a cost-effective manner. Both patients and surgeons consistently value the ASC experience. ASCs perform optimally when cases are of shorter, predictable duration and when room turnover is streamlined and efficient, allowing for a higher volume of cases to be completed within a given day. Scheduling more complex or unpredictable procedures can diminish these advantages, adversely affecting operational efficiency as well as the experience of both patients and staff. To sustain their strengths, ASCs should remain focused on efficiency through thoughtful case selection, prioritizing procedures of predictable duration and aligning them with an appropriate patient population.
Michael Sheerin. CEO of NueHealth (Leawood, Kan.):
1. Lack of real-time cost visibility
Many ASCs still lack consistent, real-time insight into cost per case by physician and service line. In some cases, this data isn’t tracked at all; in others, it’s reviewed only through lagging monthly reports — making margin issues visible only after they’ve already impacted financial performance. The solution isn’t necessarily new technology, but disciplined use of simple dashboards that track implant costs, supply utilization and contribution margin at the surgeon level. When data is transparent and timely, behavior and margins improve.
2. Underperforming revenue cycle operations
Despite having more scheduling lead time than other care settings, many ASCs fail to fully optimize revenue cycle processes. Inadequate benefits verification, weak pre-service collections and missed charges (implants, add-ons, supplies) leave meaningful revenue uncollected. Coding gaps, modifier errors and denials further erode margins. In today’s high-deductible environment, disciplined front-end collections and accurate charge capture are essential to financial performance.
3. Expanding service lines without proper diligence
Growth initiatives often outpace financial discipline. ASCs sometimes add new service lines without fully understanding reimbursement, cost structure, denial risk or payer requirements — resulting in increased volume but declining profitability. Successful expansion requires clear visibility into true margins, payer alignment before launch, controlled pilots and operational readiness. Without this rigor, growth can quickly become a financial liability rather than an asset.
4. Overbuilding new facilities
A common mistake among new entrants is overbuilding facilities with excessive non-revenue-generating space — large waiting areas, offices and amenities that drive up fixed costs. In a business defined by tight margins, unnecessary overhead can significantly impact long-term viability. Efficient, right-sized design is critical to maintaining financial discipline.
Sherman Tran, MD. Spine & Sports Medical Group (Campbell, Calif.): The biggest financial mistake ASCs are making right now is chasing volume instead of profitability, continuing to fill ORs with lower-acuity cases that no longer generate meaningful margins in a high-cost environment. Instead, successful centers are shifting toward higher acuity procedures like total joints and spine, tightening revenue cycle management, and optimizing operational efficiency to extract more value from each case.
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.