Rising volumes and strong demand have masked some of the biggest vulnerabilities facing ASCs.
Six ASC leaders joined Becker’s to discuss how the industry may be underestimating risks ranging from reimbursement erosion to anesthesia coverage strain.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What risk do you think the ASC industry is underestimating right now?
Lisa Fagan. CEO of Smith Medical Denver ASC: I believe the ASC industry is underestimating how quickly employer- and patient-driven purchasing will disrupt traditional reimbursement models. Employers are increasingly frustrated with unpredictable surgical costs, and patients with high deductibles are already behaving like cash-pay consumers, whether the system is ready or not.
ASCs that rely solely on insurance contracts and fee schedules may find themselves exposed as more care shifts toward bundled, direct-payment arrangements. Transparency is no longer a differentiator, it’s becoming an expectation. Centers that don’t build operational models that support straightforward pricing and a consumer-friendly experience risk losing relevance to those that do.
Megan Friedman, DO. Chair and Medical Director at Pacific Coast Anesthesia (Los Angeles, Calif.): The biggest underestimated risk is treating anesthesia coverage as an à la carte service. Anesthesia requires predictable staffing, standby readiness and real-time deployment. ASCs that plan coverage purely around scheduled case volume, without accounting for delays, add-ons or acuity creep, are setting themselves up for coverage gaps, clinician burnout and rising subsidy pressure.
Tracy Hoeft-Hoffman, RN. Administrator of Heartland Surgery Center (Kearney, Nev.): The ASC industry is underestimating the cumulative risk of operational fragility. Our centers have become very efficient and lean, but that leaves little margin for disruption — whether it’s supply chain variability, vendor consolidation, payer delays, cybersecurity threats or sudden staffing gaps, which we have been seeing on some level since COVID started. Individually, these issues feel manageable; collectively, they strain governance, cash flow, compliance and patient access. Centers that don’t actively stress-test their operations and diversify their dependencies may find themselves vulnerable even while volumes remain strong.
Thomas Jeneby, MD, CEO of Palm Tree Surgicenters, Chrysalis Cosmetic Surgicenter and Maximus Plastic Surgicenter (San Antonio): AI denials. Anesthesia rates are permanently higher. Also the need to integrate certified registered nurse anesthetists.
Gary John Mullen, MD. Principal of Sovereign Anesthesiology Partners (Raleigh, N.C.): There has been a lot of discussion related to labor costs and a shortage of anesthesiology providers. However, I believe what is not being discussed is the value proposition of the anesthesiology providers relative to the overall cost in the “episode of care.” It is widely known that Medicare reimburses anesthesiology services at roughly 32% of cost (labor cost to deliver the service). However, if an ASC is able to maximize its throughput, with procedures that have a facility fee of 10 to 15 times the anesthesiology professional fee, savvy facilities will recognize that they should maximize throughput even though this represents a per case loss for the anesthesiology providers.
Subsequently, those facilities need to make it economically feasible for a group to provide the service-line. We have had success in developing subsidy models for ASCs that address this exact issue; a variable subsidy based on case volume and payor mix. While we are still supporters of fee-for-service reimbursement, the payers have created an environment where the total episode of care must be evaluated due to the disparity in payments to the various touchpoints in the patient’s care.
Lisa York, RN. Executive Director of the Hunterdon Center for Surgery (Flemington, N.J.): I think the industry is underestimating the disparity between reimbursement and costs and the sustainability of centers to provide excellent care in a cost effective manner.
