Every ASC operator has a story about the mistake that taught them the most — the payer relationship they took for granted, the contractor they should have vetted more thoroughly, the hire they didn’t make fast enough.
Becker’s connected with seven ASC leaders to learn their most costly mistakes and how to avoid them.
Across their answers, one thing was clear: the costliest mistakes weren’t clinical, they were structural. Credentialing gaps, design decisions made without the right people in the room, and risks nobody was actively watching for made for costly mistakes.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What’s a mistake or setback that cost your ASC the most time or money — and what would you advise other leaders to do to avoid it?
Joe Carlon. President of Desert Spine and Sports Physicians (Scottsdale, Ariz.): Not spending more time ensuring the right people are in the right seats. Without that, it’s nearly impossible to create an organization that consistently operates at a high level in service of your physician partners, your patients and one another. We have been focusing more of our time as a leadership team on making sure everyone in the organization knows our core values, what the vision is for the future and what role they will play in bringing that vision to life. We believe maintaining this focus every day will become a competitive advantage. I would encourage other leaders to spend more time on recruiting and retaining great people and less time on pro formas.
Jennifer Corse. Administrator at Restore Orthopedics (Chadds Ford, Pa.): As a de novo center we did not have a strong clinical team supporting design and construction which ultimately resulted in construction delays and change orders. It’s imperative to have key stakeholders, including nurses, as part of the project from the start; relying heavily on architects and designers may result in high design and missing functionality.
John Critser. CEO of Wyatt Surgery Center (Tucson, Ariz.): That’s an easy one….failing to re-credential with a major payer. We missed Medicaid and they dropped us with no warning. Made us reapply to be reinstated and it took months. We had to turn down lots of cases while we waited.
Also gets surgeons and their schedulers really upset. So, don’t count on carriers “baby-sitting” you. Review annually where your notifications are going and set up a responsible party to proactively monitor your statuses — especially Medicare and Medicaid.
Sean Hayes. President of American Pain Consortium (Indianapolis): I would say the biggest initial risk is execution, specifically making sure we can build the facility and get it licensed, credentialed and contracted with payors in a timely manner. Once the facility is operational, the bigger ongoing risk is ensuring reimbursement keeps pace with the procedures being performed. As the procedure mix changes over time, we need to be proactive about going back to payors and making sure the reimbursement structure remains aligned with the services and complexity of care we are providing.
Raghu Reddy. CAO of MiOrtho Surgery Center (Southfield, Mich.): As an MSK-focused facility, our biggest lesson came from lacking redundant sterilization capacity to handle large single-day case volume — a gap that cost us through canceled surgeries.
My advice to other ASC leaders: thoroughly assess every part of your facility for redundancy, and leadership should review every maintenance report; this builds knowledge of your ASC’s plant maintenance. It gives real peace of mind — though I recognize that for many ASC leaders, time is a factor.
Sami Spencer. CEO at Missoula (Mont.)bBone and Joint Center: The Mistake/Setback: Operating under the assumption that we knew enough to navigate a major transition without actively seeking out external perspectives or expert consultants. In ambulatory surgery center (ASC) operations, the phrase “you don’t know what you don’t know” isn’t just a cliché, it is a financial and operational risk.
What We Learned: When we built our new surgery center in 2019, one of the best decisions we made was taking our team to tour other newly built facilities. We asked their leadership a single crucial question: “If you were to do this all over again, what would you do differently?”
The candid insights we received saved us from costly design and operational mistakes, resulting in a facility we are extremely proud of today. (Though no matter how many times you hear “build more storage,” it turns out you still won’t have enough!)
Advice for Other Leaders: Engage front-line staff early: Bring key team members into the room when designing new workflows, adopting new systems, or making operational changes. The people executing the daily work spot friction points leadership might miss.
Conduct “Lessons Learned” Field Trips: Before launching a major project, whether it’s a physical buildout, an EHR migration, or a workflow shift, talk to peers who have recently completed it. Their hindsight is your foresight.
Ask Direct Questions: Don’t just ask for best practices; ask explicitly about their failures, bottlenecks, and regrets. That is where the highest-value insights live.
Jim Stidham. President of Southern Radiology Specialists (Montgomery, Ala.): The wrong architect and wrong contractor can have a huge impact on operations and cost and ultimately the final outcome of patient care.
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.
