Ambulatory surgery centers (ASCs) have long operated with lean, highly efficient teams. But as the industry evolves, with rising case acuity, tighter payer scrutiny and expanding administrative requirements, staffing challenges are becoming less about headcount and more about access to specialized expertise.
Today’s ASC leaders are navigating a new reality: the work behind surgical care has grown more complex while traditional staffing models have remained relatively flat. The result is a widening gap between the skills ASCs need and what most centers can reasonably support in-house.
Specialization Is Outpacing Traditional Staffing Models
“As organizations evolve and technology continues to play a bigger role in each employee’s day-to-day, we are finding the work itself is becoming more specialized,” says Trista Stahr, chief human resources officer at nimble solutions. “For many roles, you may no longer need a full-time employee in every niche function – they may need a fraction of that expertise. The challenge is how to access it without overbuilding the team.”
Historically, many ASCs relied on strong generalists. A single business office leader might oversee billing, denials, authorizations and reporting. That model is becoming increasingly difficult to sustain.
Today, the “fractional need” is showing up across functions such as prior authorization, specialty coding, payer analytics, denials management and compliance monitoring. For independent and mid-sized ASCs especially, the expertise is critical, but the workload may only justify a portion of a full-time employee.
Stahr notes that finding talent in these niche areas requires a more intentional strategy. “Because surgical RCM is so specialized, some of our strongest hires at nimble come through employee referrals and adjacent industries where the problem-solving mindset already exists,” she says. “We’re not just looking for credentials – we’re looking for people who can think critically in a nuanced environment. We also invest in career development programs and actively showcase our company culture across social media and industry channels. Building long-tenured teams and a positive work environment ultimately supports our clients’ ability to be more successful and focus on serving their patients.”
Pressure Points Beyond the Clinical Workforce
Staffing pressures are not limited to the business office. National nursing shortages and evolving regulatory requirements—such as RN coverage expectations in the OR—are forcing ASC leaders to think more strategically about their overall workforce model.
While clinical staffing shortages remain a national concern, many ASC leaders report growing strain on the business and revenue cycle side of operations.
According to Sue Sumpter, an ASC consultant with over two decades of administrative experience, expectations for back-office performance have increased substantially.
“It’s no longer enough to simply process claims,” Sumpter explains. “You need people who understand payer behavior, contract nuances and where revenue leakage actually occurs. That level of sophistication is harder to recruit and retain.”
Common areas of pressure include:
- Front-end financial clearance and prior authorization
- Specialty-specific coding depth
- Denials and underpayment recovery
- Managed care and payer strategy support
- Advanced analytics and performance reporting
As case complexity increases—particularly in cardiology, orthopedics and complex pain—these roles require deeper expertise than many centers historically maintained.
The Risk of Single-Threaded Teams
One of the most significant workforce risks in ASCs is reliance on a single individual who holds critical institutional knowledge. This creates vulnerability during turnover, growth or when payer requirements change quickly.
This single-threaded model can expose ASCs to operational disruption, delayed cash flow and compliance risk. As a result, leadership teams are becoming more intentional about building redundancy and accessing specialized support where needed.
When Outsourcing Becomes Strategic
Outsourcing in the ASC environment is evolving from a cost-driven decision to a more strategic workforce lever. Leaders are increasingly evaluating outsourcing based on three core questions: frequency, complexity and risk.
“The most effective organizations aren’t outsourcing to reduce headcount,” Sumpter adds. “They’re doing it to close expertise gaps and protect performance.”
For many ASCs, hybrid models are emerging—maintaining strong internal teams for patient-facing functions while leveraging specialized partners for complex or highly variable workstreams.
“In my previous administrator role, we turned to outsourcing largely because finding and retaining highly specialized revenue cycle talent in remote areas is uniquely challenging,” Sumpter says. “In these markets, the pool of experienced coders and RCM professionals is extremely limited, and outsourcing ensured we consistently had the right expertise in place.”
She adds that the pace of change also influenced the decision. “Revenue cycle requirements change constantly—payer rules, documentation expectations, regulatory updates. Maintaining that level of expertise internally would have required significant manpower.”
Looking Ahead
The ASC industry is entering a phase where operational precision matters as much as efficiency.
“At the end of the day, building the right team isn’t just an HR priority, it directly supports our mission of helping ASCs operate more efficiently and care for patients more effectively,” Stahr says. “As ASCs take on a larger role in healthcare delivery, the expertise behind the scenes matters more than ever.”
For ASC leaders, the path forward is becoming clearer: align staffing models to the growing complexity of surgical care delivery, and ensure the right expertise is in place to support both clinical excellence and financial performance.
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.