As health systems continue acquiring surgical practices and folding physicians into employed models, Bethesda, Md.-based Capital Surgical Solutions is betting that surgeons who own their environment deliver better care, and that better care delivers better margins.
Benjamin Stein, MD, orthopedic surgeon and co-founder and chairman of Capital Surgical Solutions, has spent six years building something he believes the ASC industry has long needed: a surgeon-led, physician-owned model that refuses to trade its identity for growth.
Dr. Stein joined Becker’s to discuss how CSS has remained true to its vision even as the organization expands into new markets across the country.
Capital Surgical Solutions is opening in several new markets, including Washington, D.C., Colorado and Oregon, a significant expansion for a company that has kept physician leadership and independence at its core since day one.
“We’re touching different locations, which I think is unique, and still with that same boutique, physician-led, independent mindset,” Dr. Stein said. “It’s a business, there’s no doubt; there’s an economic lens to it. But for us as a surgeon-led, physician-led enterprise, it really gets back to surgeon ownership.”
CSS is designed from the ground up so the physicians steering patient care also have a meaningful stake in how the organization operates and grows.
Part of Capital Surgical Solutions’ momentum comes from tailwinds in the procedures in which it specializes. Dr. Stein told Becker’s growth has been fueled by rising surgeon and patient comfort with joint replacement and spine surgeries in the outpatient setting.
“Those are two cohorts at our facilities that have had a continued rise in volumes because of increased surgeon comfort and growing patient familiarity — whether it’s cervical fusions, joint replacements, or shoulder replacements,” he said. “The regulatory components of what’s allowed to come to centers has helped drive that too.”
Orthopedics continues to lead ASC specialties in revenue generation, and it continues to grow. According to HST Pathways data, average net revenue per case increased from $6,141 in 2023 to $6,419 in 2024, reflecting both patient demand and stronger payer reimbursements. Net revenue per case grew 11% year over year, while case volume rose 5.5%, signaling sustained growth.
CSS’ mission comes down to giving physicians the environment and authority to do their best work, according to Dr. Stein. It is about physicians feeling they are delivering the best level of care they can to their patients, and feeling that when they have the most control and ability to shape their environment, they perform best.
Additionally, there is a growing recognition among surgeons migrating to ASCs about the importance of their seat at the table, Dr. Stein said. This recognition is not just from an economic perspective, but from a controls and rights perspective, and being proactive about protecting that.
“That’s led to an environment that caters to that more,” he said. “You’re seeing more nuanced JV versions of ASCs that are much more focused on keeping physicians not only with fair equity positions, but with actual controls and rights in line with what they want. And I think that’s only improved [in the last year.] My model has always catered to that, which is great, so there’s increased engagement.”
Beyond governance, Dr. Stein points to a willingness to move fast and experiment as a core part of how CSS operates. Being nimble and tech-forward from the beginning has been key to its success, he said.
“The way that plays out is: If we see something that we believe is a real possibility, we’ll beta it. We’ll lean into it and see if it’s additive or not — and if it’s not, we’ll pivot and retract,” he said. “We’ve been able to be thoughtful in that method.”
When off-the-shelf solutions fall short, CSS builds its own. Dr. Stein said the organization has developed several in-house operational optimization tools tailored to its facilities and continues to refine them.
“They’re tailor-made for us, but they have broader application potentially,” he said.
The proof of CSS’ model, Dr. Stein said, shows up in results — across patient reviews, social channels, rankings, value-based metrics and the key performance indicators that reflect care quality.
“For us, it’s really delivering that air of excellence to patients in an environment where physicians feel like they’re in control — because they are,” he said. “And similarly, you have staff who feel dialed in to that level of excellence. Typically, if your goals are really on the service side — to deliver the best product, and to have the people involved in that delivery working in a happy, supported environment — you’ll end up with economic success. That’s how we kind of view it.”
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