The most powerful cost-management tool at an ambulatory surgery center is not a software platform or a group purchasing agreement. According to four leaders at the 32nd Annual Becker’s ASC Conference, it is a willingness to show physicians exactly what they are spending and to be clear about what happens when they don’t pay attention.
“If your surgeons are not bought in, and you’re running that center, you should probably leave,” said Greg DeConciliis, PA-C, former administrator of Boston Outpatient Surgical Suites. “Because you can’t run a center without the people who are actually driving and bringing the revenue doing the right thing. So you can’t make those conversations delicate; there’s got to be total transparency.”
The argument is not that administrators have avoided engaging physician partners on cost. The argument is that the method matters and that the centers still relying on broad budget conversations rather than case-level data are leaving the most powerful lever untouched.
Elisa Auguste, administrator of Precision Care Surgery Center, an orthopedic ASC in Long Island, N.Y., said the shift started with case costing. Her center tracked what each procedure actually costs, estimating it in advance and then returning to the surgeon with the real number once the case was done.
“We actually case-cost every single case that doesn’t get reimbursed off implants separately,” she said. “This way we’re actually educating our providers based on the estimates, and what we’re doing on the back end is showing them, ‘Listen, we estimated this case is going to cost $2,000 when you bring the case to do it. On the back end, you spent about $5,000. Let’s talk about why did you do that? Is there any opportunity to convert products into quality equivalents, while also saving costs for the facility?'”
The receptivity to that conversation depends heavily on where the physician came from. Many of Precision Care’s surgeons previously operated in hospital settings, where they didn’t have visibility into supply costs or accountability for keeping costs low.
“A lot of my docs were hospital doctors before they worked in the ASC, so they weren’t used to someone talking to them about costs,” Ms. Auguste said. “They were used to working in the hospital where they got whatever they wanted, whatever the newest toy was and cost was never a thing. Now that they’re actually owners, actually looking at some of these products, they’re actually quite invested, because when you’re able to tie it back to the bottom line of what their distributions are going to look like, it really motivates them to really try to cut costs the best possible.”
Ownership creates an opening, but it does not guarantee the conversation lands, particularly when the administrator is the one delivering it.
“The doc is always going to tell you, ‘I’m a doctor. I know what I need,'” Ms. Auguste said. “Transparency really is key, and I also say rely on your other surgeons,” she said. “If you get, let’s say, one of the owners to talk to one of the other owners, the message is usually received better than coming from someone who’s an administrator.”
The data makes specific comparison possible. If five surgeons are performing the same procedure and one is consistently running at double the cost, the number exists and the conversation can be built around it.
“Don’t be afraid to compare,” Ms. Auguste said. “Look at what he’s doing, and then show him: ‘Listen, your partners are doing the same procedure, but they’re half the cost. Is there an opportunity to convert to what your partners actually do?'”
Mr. DeConciliis described a version of the same transparency, operationalized into the physical space of the OR. His centers developed a color-coded display — green, yellow and red — flagging implant cost by vendor, visible in the room.
“If a doc knew where a vendor had a red implant, they’d say, ‘You can always post it, get your stuff in the green,'” he said. “The transparency and all that stuff — just everyone has to be able to have an open conversation. If they want to be in, and they want to be involved in the center, and benefit from the profitability, they have to be able to have hard conversations.”
The tools to generate cost data at the case and physician level have become broadly accessible. Mr. DeConciliis noted that on-time starts, room turnover time and case cost by surgeon no longer require custom systems.
“These days it’s all right in front of you,” he said. “That doc who shows up late and you start looking at on-time starts. That doc who doesn’t get in the room right away and there’s data now you can track: turnover time from when you clean to whether the room’s ready. If your anesthesia group is not good, track that.”
Nirav Shah, MD, president of the DDA Division and chief medical officer at US Digestive Health, which operates across Pennsylvania and Delaware, approaches supply cost conversations through clinical rather than financial language, identifying a physician champion willing to review data alongside an administrator and working outward from that relationship.
“For the administrators in the room, look at your top three costliest items and top three used items,” Dr. Shah said. “Now with AI, you can find data on the clinical data. Just look it up, find a physician champion that’s willing to sit with you, look at those top three cost items, because at an ASC we’re getting one reimbursement whether I use five clips, 10 snares. We’re losing on that case dramatically.”
But the conversations with physicians have to be handled with care. Physicians who feel accused of overspending often disengage; physicians who feel consulted on clinical rationale often stay in the room.
“Physicians tend to get defensive quickly,” Dr. Shah said. “So I think the goal is — it’s not pointing out that you’re using more than the others; it’s more of ‘Can you tell me what the clinical utility is?’ Get on their side.”
The timeline for behavior change is longer than administrators typically expect and shorter than they fear once the conversation is structured correctly.
“It doesn’t happen overnight,” Dr. Shah said. “If you’re looking at in six months that physician A versus B will be back in line, it’s a slow process. Be patient with it. Show the financials to back up the data, but the clinical input from physicians needs to be there to have that engaging conversation both ways.”
The environment that makes all of it possible, Dr. Shah said, is one the ASC model creates and the hospital setting cannot replicate.
“We feel ASCs are our safe space,” he said. “We have ownership. This is what we enjoy doing. Our efficiency’s high. We can start our day exactly when we want to. Turnover is better. So get that in alignment with the physician to really look at how you can mitigate some of the higher-used cost items.”
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.
