As CMS expands its coverage of procedures in ASCs and technology continues to advance what is possible in the outpatient setting, leaders must carefully balance risk, cost and logistics to meet the moment of ASC development.
Two ASC leaders recently joined Becker’s to discuss their approach to ASC case management — and what leaders might be getting wrong.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: With reimbursement rates shifting and competition for high-value cases increasing, what criteria are you using to decide which service lines deserve more of your OR time, and which ones may be quietly costing you?
Matt Eakins, MD. CEO of Atria Health (Philadelphia): I’d challenge the idea that this is a zero-sum decision about which service lines “deserve” OR time. In cardiovascular care, the more useful lens is patient appropriateness and site of care. In the ASCs we’re building with our cardiology practice partners AMS Cardiology and Stern Cardiovascular, we’re asking a different question around what setting allows us to deliver the highest-quality care for this patient, as efficiently as possible. When you start there, the allocation follows. Lower-acuity cases that can be safely and effectively done in an ambulatory setting move out of the hospital — not because they’re less valuable, but because they don’t require that level of resource. That shift actually solves the capacity issue leading to patients waiting months for treatment. It frees up OR time for the cases that truly need it — structural heart, transcatheter interventions, high-complexity procedures where the hospital environment is essential.
So the criteria aren’t about picking winners and losers among service lines. They’re about clinical fit, resource intensity, and where we can deliver the best outcome. When that’s aligned, you improve access to complex care, you use the OR for what it’s designed for, and you build the capacity needed to meet growing cardiovascular demand. The systems that approach this as a capacity strategy — rather than a competition for cases — are the ones that will be best positioned going forward.
Raghu Reddy, MD. Chief Administrative Officer of MiOrtho Surgery Center (Southfield, Mich.): At an ASC, OR time should not be allocated based on volume alone. The focus should be on which service lines create the strongest combination of margin, access, quality, surgeon engagement and strategic value.
The key criteria should include true case-level profitability, block utilization, payer reimbursement, implant and supply cost discipline, clinical appropriateness for the ASC, and strategic growth potential. Some cases may appear valuable because of volume or gross reimbursement, but may quietly reduce profitability due to high implant costs, weak payer contracts, long room times, poor turnover, staffing intensity or excessive supply variation.
In my view, the priority should be a case-level review by service line, surgeon, CPT, payer, implant cost, supply cost and OR time. This will help identify which cases should be expanded, standardized, renegotiated or reconsidered for ASC scheduling.
The goal is not simply to increase volume, but to protect OR access for the right cases — those that support quality outcomes, profitability, surgeon satisfaction and long-term growth for an ASC.
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.
