ASC leaders say some of the industry’s most hyped trends, from high-acuity case migration and robotic technology to premium implant systems, are being adopted faster than many centers can operationally or financially support.
Instead, executives told Becker’s the long-term success of ASCs still depends on fundamentals such as physician alignment, operational efficiency, staffing stability, payer strategy and patient safety.
Question: What’s the most overrated trend in the ASC industry right now, and why?
Editor’s note: Responses have been lightly edited for clarity and length.
Katlyn Hall. Administrator at Lorain (Ohio) Surgery Center: The rush to transition complex, high-acuity cases into the ASC setting is currently one of the industry’s most overrated trends. Centers eager to capture higher reimbursements often put the cart before the horse. While expanding ASC capabilities is exciting, these cases are only viable if backed by specialized equipment, rigorous compliance and optimized workflows. In the ASC space, reputation, patient safety and successful outcomes will always be the true drivers of long-term success.
Joseph Hurley. CEO of Embassy Surgery Center (Lancaster, Calif.): One of the most overrated trends in the ASC industry is the continued reliance on premium-priced implant systems without critically evaluating cost versus outcomes. Too often, higher implant pricing is assumed to mean better patient care, when physician leadership, surgical technique, operational efficiency and patient selection are what consistently drive outcomes.
At our ASC, we perform more than 500 cases each month, with orthopedics serving as the foundation of our growth. One of the biggest shifts we’ve seen over the past five years has been in shoulder arthroplasty. What was once an 80/20 split favoring anatomic total shoulders has now reversed, with reverse shoulder arthroplasty accounting for about 80% of cases.
At the same time, we’ve reduced implant-related supply costs by nearly 60% in select service lines by transitioning away from higher-cost systems while maintaining strong patient outcomes and surgeon satisfaction. Independent, physician-aligned ASCs are uniquely positioned to adapt quickly, control costs and deliver high-quality orthopedic care in the outpatient setting.
Les Jebson. Administrator at Prisma Health Orthopedics and Sports Medicine Institute (Columbia, S.C.): The most overrated trend in the ASC industry at present is the push for high acuity, highly complex surgeries migrating to the freestanding ASC arena.
Multi-level spine fusions and complex hip and shoulder replacements are good examples. These procedures are significantly more resource intensive and can erode any reasonable margin due to the extended anesthesia and recovery times and device utilization. While the impetus is for procedures to continue to shift, the payer contracting must be tightly aligned and safety should remain paramount.
Paul Krull. Director of Operations at The Oregon Clinic (Portland): One of the overrated trends in ASC management is that you need robots or fancy technology to continue to attract MDs. These technologies don’t usually provide the [return on investment] when efficiencies in doing what we do well can make the ASC a location an MD wants to provide care. They are appealing and fun to talk about, but the usage level and ability to get the volume through the ASC doesn’t usually happen. If the ASC is a single specialty ASC, there may be value, and it may make sense if it is the standard of care, mixed ASCs might not see the benefit.
Beth Russell, MSN, RN. Executive Director and Vice President of Surgical Services at Knoxville (Tenn.) Orthopaedic Surgery Center: One trend in the ASC industry that I believe may be somewhat overrated right now is the assumption that technology alone, particularly AI and advanced analytics, will solve operational and financial challenges. While these tools absolutely have value, many organizations are overlooking the foundational work of standardization, staffing stability, physician alignment, payer strategy and culture, which ultimately drive long-term ASC performance.
The most successful ASCs will be the ones that use technology to support strong operational leadership and clinical collaboration, not replace it.
Bradley Schmidt. CEO of Northern California PET Imaging Center (Sacramento): One of the most overstated trends in the ASC industry is the assumption that large-scale ambulatory expansion by health systems will automatically be financially successful. Moving more care outpatient makes sense for access, convenience and potentially cost, but many systems still rely heavily on commercial insurance margins to offset losses from Medicare, Medicare Advantage and Medicaid populations.
The concern is that systems may be overestimating the long-term stability of the commercial insurance market while building major outpatient infrastructures around it. As premiums and out-of-pocket costs continue rising, employer and employee participation could weaken, leaving systems with continued margin pressure despite ambulatory growth.
The more interesting long-term opportunity is not just ambulatory expansion itself, but rethinking the commercial insurance model around outpatient care through direct-to-employer relationships, pricing transparency, narrower networks and integrated ambulatory delivery models. Ambulatory care is clearly the future, but its financial success still depends heavily on a healthy commercial insurance market.
Allyn Wilcock, CRNA. Owner of Advanced Anesthesia Services (Snoqualmie, Wash.): Our group provides anesthesia services across 17 outpatient surgery centers in the Puget Sound region, so I spend a lot of time inside these organizations. What I see doesn’t always match the narrative. There’s a pattern I’ve seen in different facilities over the years.
It’s common for a surgeon or a group of surgeons to leave a hospital system to start their own ASC to gain more independence, freedom and financial benefits. But what I encounter when our group enters some of these facilities is a clinician-owner who’s excellent at medicine and stretched thin on operations, a skeleton admin team where one person is doing five jobs, and an infrastructure that was improvised over time, but never fully planned and built out.
The hospitals and health systems may have been frustrating for these surgeons and owners, but they absorbed an operational burden that physicians may not have appreciated until they had to build it into their own ASCs. Independence without operational maturity isn’t freedom. It’s just a different kind of constraint. Surgeons may have amazing skills and intellect, but building the operations side of an ASC requires a different skill set that is critical to its success. Some have it, but many struggle in this area.
At the Becker's 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, taking place June 11-13 in Chicago, spine surgeons, orthopedic leaders and ASC executives will come together to explore minimally invasive techniques, ASC growth strategies and innovations shaping the future of outpatient spine care. Apply for complimentary registration now.
