As GI volumes grow and patient expectations evolve, ASCs face new pressure to reduce appointment cancellations, streamline communication and strengthen operational and cultural foundations ahead of 2026.
During Becker’s 31st Annual Meeting: The Business and Operations of ASCs in Chicago, four GI leaders shared the strategies they believe will define success in the coming years.
The panel featured Dean Lehmkuhler, administrator of Indianapolis-based Northside Gastroenterology Endoscopy Center; Sumana Moole, MD, physician and founder of Suwanee, Ga.-based Merus Gastroenterology & Gut Health; Benjamin Levy, MD, gastroenterologist at University of Chicago Medicine in Chicago; and Emma Gimmel, BSN, RN, director of nursing at Manhattan Endoscopy Center in New York City.
Reducing late cancellations through communication and clarity
Late cancellations remain one of the most persistent and costly operational challenges for GI centers. Panelists agreed that the most effective solutions begin with proactive patient engagement.
Mr. Lehmkuhler said his center redesigned its prep instructions after realizing the previous version confused patients.
“It kind of was a column format day to day that just made it simpler, rather than paragraph instructions that really confuse you,” he said. He hopes to add more robust patient engagement technology to deliver automated reminders as well.
Dr. Moole emphasized language accessibility as a critical factor in reducing cancellations and improving safety. Despite being conversational in English, patients may miss important clinical details.
“Translate consents in different languages to make it easier for patients to understand,” she said. The goal is to ensure patients understand prep, consent and warning signs post-procedure.
Ms. Gimmel said Manhattan Endoscopy Center has spent years building a multilayered system to cut down on last-minute cancellations. The center now uses digital communication, licensed practical nurse-led pre-procedure outreach and daily nursing huddles to flag patients who may need extra support. She said the center has “almost eliminated” every cancellation within 24 hours.
Dr. Moole added that engaged patients are far less likely to cancel. In her independent practice, strong communication and a well-managed waitlist allow her team to fill dropped appointments quickly.
“It is key to keep patients engaged right from the start,” she said.
Balancing clinical excellence with business demands
As an independent physician and founder, Dr. Moole said sustainability requires being intentional about both clinical responsibilities and personal well-being.
“I don’t know if balance is possible,” she said, noting that setting boundaries — finishing work by 5 p.m., spending evenings with her children and taking breaks — helps her stay focused and engaged. Just as important, she said, is empowering staff to manage day-to-day decisions.
“They make the right decisions, and I am forgiving when there are genuine mistakes,” she said.
For physicians looking to remain independent, she recommended joining clinically integrated networks for stronger payer contracts and staying connected through collaboration and networking.
“It’s doable,” she said. “It’s a very high ROI … if you do it right.”
Dr. Levy added that strong communication with referring physicians is critical for growth. His team ensures reports are sent to the referring provider immediately upon signing.
“Anything we can do to improve the efficiency of the delivery of the information is better,” he said. He also emphasized verifying patient contact information so that earlier appointments can be offered without delay.
What will drive GI success in 2026
The panelists pointed to culture, technology and strategic expansion as key differentiators for GI ASCs over the next several years.
Shared governance and culture.
Ms. Gimmel said success starts with a strong, evolving culture shared by every role in the organization.
“Having a culture of safety that is progressive, that evolves, that maintains standards, is by all means shared by everyone,” she said. Empowerment and ownership, she added, drive patient experience and accountability.
Hiring and education: Dr. Levy said staffing excellence is foundational. “You’ve got to hire the right people and not just fill positions,” he said, also highlighting AI-driven, real-time dictation during procedures as a driver of both speed and accuracy.
“It speeds up your documentation so you can do more procedures in a day,” he said.
Service line expansion and financial strategy: Dr. Moole said adding selected high-value procedures — such as endoscopic myotomy — can strengthen financial sustainability. Still, “culture remains key,” she said, even as technology evolves.
Interoperability and data access:Mr. Lehmkuhler encouraged participation in state health information exchanges, so referring providers can access ASC records immediately. It requires investment, he noted, but “in the long run it pays off.”
Tackling cancellations, transportation barriers and no-show fees
Audience questions focused heavily on cancellations. Ms. Gimmel said most are driven by finances or prep issues, with younger patients more likely to no-show. Her center rebooks “a tad under 50%” of canceled cases.
Dr. Levy said nursing navigators at his center call patients after missed appointments to determine the reason and prevent repeat no-shows. He keeps a list of high-risk patients — especially those with alarm symptoms — to ensure follow-up. He said his biggest concern is that a patient may miss an appointment and never return for needed care.
Panelists also said no-show fees and deposits offer mixed results.
Dr. Moole said deposits sometimes deter cancellations but can also discourage patients with financial barriers. “It’s more of a psychological thing,” she said.
Transportation requirements were another common challenge. Dr. Levy’s ASCs require patients to have a responsible adult with them, even if they use Uber or Lyft for the ride home. Staff confirm the designated person is present before starting the procedure to prevent delays later in the day.
“We really emphasize it in the pre-op … because it’ll just minimize any disruptions to your day,” he said.
Looking ahead, Dr. Levy expects predictive analytics to play a larger role in managing cancellations. His clinic already receives no-show probability scores through Epic.
“It’s really interesting and generally it’s pretty accurate,” he said.
A changing landscape — and shared optimism
Despite financial pressures, staffing challenges and persistent cancellations, panelists said the future remains bright for GI ASCs that prioritize communication, culture and patient-centered operations.
“Everyone contributes to the center’s success,” Ms. Gimmel said. “When they own and are proud of their job, gosh, you have success.”
