A case estimated to cost $3,000 ended up costing about $5,000 at one New York ASC. As margins tighten, ASC leaders warn that centers not tracking the true cost of every procedure could be losing money without knowing it.
Some independent ASCs still can’t measure what a case costs them. Ray Brown sees that as one of the biggest risks to the industry heading into 2027.
“I worry that people aren’t doing their case costing. I’m worried that some people don’t even have EHR, EMR,” said Mr. Brown, CEO of Lake Lucien Surgery Center in Maitland, Fla. “They can’t do numbers if they don’t have them.”
Mr. Brown said CMS payment updates are “in most ways not keeping up with costs.” He named supplies and implants as his center’s largest cost drivers. His team is doing “a lot of number crunching, a lot of case costing” across specialties to keep up.
Not every center was built to operate that way. Mr. Brown said some ASCs began as “convenience items for some practices” and were never intended to be profit centers. His message to centers still catching up on EHR adoption or cost data is “no money, no mission.”
“We need to make sure this is profitable and that we can allocate resources to the patient,” he said.
According to the Ambulatory Surgery Center Association’s July 2025 survey, 76% of ASCs now use an EHR, up from 55% in 2021. Yet nearly one in four ASCs still rely on paper, and two-thirds of those plan to remain paper-based until regulations force a change.
Paul Doblhoff, director of sales and commercial strategy for ASCs at Athenahealth, said at Becker’s 32nd Annual Business and Operations of ASCs conference Oct. 30 in Chicago that adoption has come a long way.
When he started in the ASC space, about 85% of centers were on paper. Subscription pricing has lowered the upfront cost, he said, and the real expense of paper is staff time. Someone still has to pull data from paper charts and enter it into a spreadsheet or another system.
Greg DeConciliis, former administrator of Boston Out-Patient Surgical Suites in Waltham, Mass., which he opened in 2004, recalled doing case costing “on paper and then put in an Excel spreadsheet” two decades ago.
Leaders at the conference described case costing as a habit that pays off quickly.
Elisa Auguste, administrator of Precision Care Surgery Center, an orthopedic ASC on Long Island, N.Y., said her team prices out every case that doesn’t get separate implant reimbursement. Afterward, they compare the estimate with the actual spend. That process is how her team caught the $3,000 case that came in at about $5,000. Surgeons who once worked in hospitals “weren’t used to someone talking to them about costs,” she said. Tying the numbers to owner distributions changed that, she said.
Nyleen Flores, administrator and COO of Lake Oconee Orthopedics, said reviewing every payer contract raised reimbursement on one shoulder case from about $3,000 to $17,000. She found a workers’ compensation clause that covered implants and supplies, which her commercial contracts did not.
Terry Bohlke, CEO of Keystone Surgical Partners and a past ASCA president, said the next phase of ASC growth favors centers that are ready for it. “The new era of ASC profitability is here, but it’s only for those prepared to embrace it and sophisticated enough to handle it,” he said.
For smaller centers short on resources, Mr. Brown suggested two options. They can affiliate with larger organizations, or they can “contemplate consolidating themselves and becoming a large organization.”
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.
