Four ASC leaders joined Becker’s to discuss what made the greatest impact inside their centers, from a coding overhaul to robotic expansion.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: If you had to name one ‘breakthrough’ from this past year at your ASC, what was it and what impact did it have?
Elisa Auguste. Administrator of the Precision Care Surgery Center (Commack, N.Y.): This past year, the single biggest breakthrough at our ASC wasn’t a shiny new piece of equipment or a dramatic expansion. It was something far more fundamental to our financial health and operational integrity: recognizing how critical coding alignment and physician education truly are and then doing the hard work to fix what we found.
We initiated a quality study to compare surgeon coding with our external coding vendor’s facility coding over the course of one full quarter. The goal was simple: validate that our internal and external coding were consistent, accurate and supporting clean claims. The percentage of cases with aligned coding between the surgeon and facility sides was far below what any of us expected. At first glance, it looked like routine variation. But the more we dug in, the clearer it became that this wasn’t a minor drift, it was a systemic issue. That realization triggered a full-blown audit.
The audit uncovered two major gaps. First, vendor-side coding quality was not meeting standard. Errors and inconsistencies were frequent enough to create risk, not just for reimbursement, but for compliance. Second, surgeon-side coding needed education and reinforcement. We saw patterns that suggested a lack of shared understanding around best practices, documentation specificity, and how surgeon coding choices ripple into facility billing. Just as importantly, the audit exposed a third issue we hadn’t fully appreciated: our internal coding audit process wasn’t robust enough. Until that point, our review structure had given us a false sense of security. It wasn’t designed to flag deeper, trend-based misalignment early, and because of that, the problem went undetected longer than it should have.
This breakthrough forced us into action on multiple fronts. First, we switched coding vendors. Once the data was undeniable, it became clear that staying with a vendor producing subpar results would be more costly than making a change. We also redesigned internal workflows to support alignment, modifying processes to ensure that surgeon and facility coding are reconciled more proactively. Alignment is no longer assumed; it’s verified. We then began building a physician education plan to educate surgeons on coding practices, including documentation optimization, coding rationale, and the downstream impact of their selections. We are also investing in technology to reduce error risk. We’re looking into tools that can automate parts of the coding process, enhance accuracy, and catch inconsistencies earlier. The aim isn’t to replace people; it’s to support our teams, reduce avoidable errors, and strengthen reliability.
If I had to sum up what this breakthrough taught us, it’s this: never get comfortable, whether with a process, a vendor, or even your own assumptions. In healthcare, “good enough” is rarely good enough for long. Processes that feel stable can quietly drift into risk if they aren’t constantly evaluated. Vendors that once performed well can decline without obvious warning signs. And even strong teams need continuous education to stay aligned as coding rules and payer expectations evolve. We also learned to embrace transparency. Admitting that we needed help, whether that meant bringing in a new vendor, restructuring a flawed audit process, or leaning into new technology, wasn’t a setback. It was progress. That mindset shift has positioned us to be stronger, more compliant, and more resilient moving forward.
Because of this discovery, our ASC is operating with clearer visibility, tighter alignment, and a renewed commitment to continuous improvement. We’re building a culture where coding isn’t an afterthought, it’s a shared responsibility tied directly to quality, compliance, and sustainability.
Les Jebson. Administrator of the Orthopedics and Sports Medicine Network at Prisma Health (Greenville, S.C.): Continued careful implementation of robotic-assisted technologies for lower and upper extremity joint replacements.
Benita Tapia, RN. Administrator and Director of Nursing for 90210 Surgery Medical Center (Beverly Hills, Calif.): One major breakthrough this year has been our adoption of AI technologies to reduce operational costs and improve efficiency. We partnered with an AI company called AKARA to implement thermal cameras in our operating rooms. These systems accurately track case times and block-time utilization without requiring staff to manually monitor or document this information. As a result, we have been able to reduce staffing costs, optimize block scheduling, and reallocate unused time to new surgeons who need it — all driven by precise, objective data.
We also implemented AI with a company called Orbit Healthcare to assist with scheduling-related data entry. The AI robot inputs scheduling information into our system and verifies the correct insurance-carrier address, which helps prevent claims from being sent to incorrect locations. This has reduced claim denials and saved significant staff time previously spent on manual data entry.
Overall, these AI-driven improvements have created meaningful cost savings, increased accuracy, and allowed our staff to focus on higher-value tasks.
Ashley Tenbusch, BSN, RN. Clinical Director of Waverly Lake Surgery Center (Albany, Ore.): We used to use a three-RN model for our local-only pain injection room (preop RN, circulating RN and recovery RN). But then we cross-trained several of our nurses, and now we can run the room with just two RNs. They follow the patient all the way through and alternate. This really helps our staffing model in the running of our other OR and preop/recovery rooms.
