The biggest investments 23 ASCs have made in 2024

Running an ASC is not without its costs. Facilities are forced to make investments every day to add new technologies, new staff members and level up care for their patients. 

Twenty-three healthcare leaders told Becker's the largest investments they have made to better their centers so far in 2024. The executives featured in this article are all speaking at Becker's 2024 ASC conferences, including our 30th Annual The Business and Operations of ASCs, which is set for Oct. 30 to Nov. 2 at the Hyatt Regency in Chicago.

If you work at an ASC and would like to join as a speaker, contact Claire Wallace at

As part of an ongoing series, Becker's is talking to healthcare leaders who will speak at our roundtable. The following are answers from our speakers at the event.

Question: What is the biggest investment you will make this year?

Adam Shurtz. Administrator and CEO at Riverwoods Surgery Center, Timpview Surgery Center and Riverwoods Spine and Pain Clinic (Provo, Utah): Robotics!

Alfonso del Granado. Administrator and CEO at Covenant High Plains Surgery Center (Lubbock, Texas): The two biggest investments we are making this year are:

1. We are buying outright our leased Intuitive daVinci X robot. While we remain concerned about the higher case costs, there are three factors we have considered: Even with a break-even robotic surgery program, the additional cases contribute to margin and allow us to keep staff productively employed and available for when higher-margin cases are booked. The key here is to have regular open communication with your surgeons to minimize console time for cases that could be as easily performed with traditional laparoscopic instrumentation. Having the robot available draws in area surgeons who may also bring additional non-robotic cases to our centers. Looking to the future, more residents are graduating with a strong preference, or even a basic need for, a robotic platform.

2. We are midway through completion of an additional OR at one of our centers where we have been blessed with utilization rates of more than 100% for the last couple of years. Although the space was originally shelled for an OR, it's still a significant investment that carries some risk of underperforming, and I have not been able to shake off the persistent unease that took root as a result of the COVID pandemic. Nevertheless, we are reasonably confident of continued growth.

Andrew Lovewell. CEO of Columbia (Mo.) Orthopaedic Group: The biggest investment we are making this year is patient focused. We are going to improve patient access and patient experience and add services that complement what we do today. We recently opened a walk-in urgent injury clinic called OUCH (Orthopaedic Urgent Care Hub). We took time to create a strong strategic plan for this and executed it quite well. It has been so successful early on that we are looking to expand hours and add possible additional locations already. Next, we have several strategic locations where we plan to open outreach clinics and partner with local health systems to expand access to high-quality orthopedic care. As the trusted provider in MSK and Orthopedic care for almost 60 years, we want to make coming to see us easier and more accessible. Our outcomes, cost and value are a draw for any market that we enter. We're also looking to add several physicians and other providers to our organization to increase our service offerings. More pain management, total joint replacement and podiatry physicians are coming to our practice this year. Additionally, we will add other adjacent services to our practice such as rheumatology, nerve studies and others. 

Andrew Oh, MD. Interventional Pain Management Specialist and Anesthesiologist at Pain Care Specialists of Oregon (Salem): The biggest investment this year will likely be bulk purchasing of implantable medical devices. Bulk purchasing can significantly decrease overhead and improve margins but also has tax benefits as well.

Ananya Das, MD. Gastroenterologist at Covenant Physician Partners (Gilbert, Ariz.): I will be investing in an AI life sciences company that is interested in developing reinforcement  machine-learning processes for semi-automated clinical care algorithms for chronic care management.

Benjamin Levy III, MD. Gastroenterologist at University of Chicago Medicine: There are several new technologies that gastroenterology ASCs and hospital gastroenterology programs could be looking to acquire this year. My favorite new technology is GI Genius, a computer-aided polyp detection system powered by artificial intelligence that can be hooked up to a colonoscope to help gastroenterologists and surgeons more easily identify hard-to-see polyps during screening and diagnostic colonoscopies. The computer flashes a green box on the endoscopy screen (kind of like you would see in airplane action movies like "Top Gun") that identifies a polyp. It's like having an extra pair of eyes in the ASC endoscopy suite that can help identify flat polyps and difficult to see polyps. I'm also very excited that Medtronic just received FDA approval for their next-generation PillCam Genius SB capsule endoscopy. This updated platform will help gastroenterologists more easily evaluate for angioectasias, enteritis and small bowel lesions without the traditional data recorder and sensor belt. With this next-generation technology, the PillCam Genius SB kit can record the capsule endoscopy study with a slick adhesive patch, which is a lot more comfortable for patients. Now, gastroenterologists won't be limited by the number of data recorders in the endoscopy suite. In addition, many inflammatory bowel disease specialists are starting to use intestinal ultrasound in clinics to monitor disease activity, assess response to medication, and check for disease recurrence after surgery. Intestinal ultrasound can provide helpful information in clinic without a colonoscopy prep and does not involve any radiation. Intestinal ultrasound is a really cool non-invasive technology that can help gastroenterologists provide quicker medical management for ulcerative colitis and Crohn's disease patients.  

Bruce Feldman (New York City): The biggest investment we will be making this year is in staffing, specifically the hiring of seasoned CNRAs and OR nurses. We're looking to add additional procedures that are of a higher complexity and as such require highly trained/skilled clinical staff. We are facing greater competition for these individuals from hospitals and large healthcare systems that can offer higher salaries and richer benefit packages along with large sign-on bonuses.

Caleb Ashmore. Orthopedic Rehab Services Supervisor at Harris Health System (Bellaire, Texas): This year, I'm investing in my leadership potential. I started an executive MBA with an emphasis on healthcare organization leadership at the UTD Naveen Jindal School of Management. This program is a collaborative cohort with Harris Health, Baylor College of Medicine and UTHealth, and offers invaluable cross-organizational networking opportunities. The unique cohort approach fosters connections with fellow Houston healthcare leaders and leads to gaining valuable and diverse perspectives. 

Catherine Llavanes. CEO of Sante Health Partners (Los Angeles): My team and I recently revisited Surglogs' digital platform, and I'm very excited to learn about their recent collaboration with AAAHC and other accreditation bodies. This partnership will help streamline compliance and develop more efficient workflows for surgery centers like ours. With staffing shortages, this platform can help allocate tasks for logs, making weekly and monthly tracking easy to manage. They offer customizable pricing and creative payment terms, considering the pricing and cost-effectiveness, this might be the right direction for our organization.

Daniel Mulconrey, MD. Orthopedic Surgeon at Midwest Orthopaedic Center (Peoria, Ill.): The "biggest" professional investment I will make this year will be focusing on the delivery of patient care. Improving access to care and the patient experience are two key factors for 2024.  These goals have become more challenging in our current healthcare environment. Difficulties with staffing, insurance authorization and limited resources are barriers to improving the patient experience. However, I plan to invest time and resources to optimize patient access and experience at my office and surgical center. 

Fawn Esser-Lipp, BSN, RN. Executive Director at the Surgery Center (Franklin, Wis.): We are looking at increasing our total joint volume, so we need to invest in expanding our sterile processing department. That includes hiring and training staff, as well as reconfiguring the decontam and clean rooms. Our center will be purchasing new washers and sterilizers. This will be a big process as we need to include construction and infection control while trying to continue with normal day-to-day operations.

Gary Haynes, MD, PhD. Professor of Anesthesiology at Tulane University School of Medicine (New Orleans): Unquestionably, the biggest investment this year is in recruiting and retaining anesthesiologists and CRNAs. If we fail at that, we will have an even bigger expense in retaining locums anesthesiologists and CRNAs.

Geri Eaves, BSN, RN. Administrator at Bone and Joint Institute of Tennessee Surgery Center (Franklin): Identifying the specific area where my center needs the most investment will depend on operational gaps, patient needs and strategic goals for growth. This is an ongoing assessment of current state and future needs. As we grow and build volume, one of the biggest current investments that we see the center needing is equipment. Our total joint replacement program is growing, and new equipment will be necessary.

Jacob Rodman. CEO of Raleigh (N.C.) Neurosurgical Clinic: The biggest investment we will make this year was on upgrading our physical plant. We moved offices this year to a new, updated space that includes our office based angiography suite, our pain suite and our ASC on the second floor. It was not a cheap venture, but the feedback from our team and patients has been tremendous. It also cuts down on the commute for our surgeons.  

Jami Osterlund, MSN. Perianesthesia Manager at Houston Physicians' Hospital (Webster, Texas): The biggest investment that we are making this year is opening two more ASCs in the Houston market to better serve our patients by providing more convenient locations for their surgical needs. We are also expanding the service lines we offer at our main campus, so that location is also under construction to include a new OR that will be used for robotic surgery.

Janet Carlson, MSN, RN. Executive Director for Ambulatory Surgery Centers of Commonwealth Pain & Spine (Louisville, Ky.): The biggest investment I will be making this year is recruiting and onboarding top-tier clinical nursing leadership for my new ASCs. Talented and knowledgeable human capital is the most important investment a business can make. Once that leadership team is assembled, we can execute on our ambulatory surgical strategic vision and provide outstanding care to our patients in all of the communities we serve.

Jeff Dottl. Principal at Physicians Surgery Centers (Ventura, Calif.): The largest single investment we are making this year at Rancho Mirage Surgery Center is two Mako surgical robots. This is a major investment in the outpatient robotic joint replacement program. It is made possible by our affiliation with Eisenhower Medical Center and the physicians at Eisenhower Desert Orthopedic Center. We are so excited as we move our long-standing total joint program to the next level with the addition of these two Makos. Robotically assisted surgery is now available for inpatient and outpatient joint replacement patients. We performed our first robotic TJA just after New Year's and we will soon have performed over 100 robotically assisted total joints.

Johnny Russell. Director of Area Operations at Sutter Health (Sacramento, Calif.): We're investing in our employees' well-being. One of the ways we're doing this is by offering flexible work schedules--including part-time or reduced hours. When staff feel valued, we see improved employee satisfaction, greater stability in employee tenure and a positive impact on patient care.  

Kayla Schneeweiss-Keene, BSN, RN. ASC Administrator of Mann Cataract Surgery Center (Houston): We just opened our third ASC in Sugar Land, Texas, and received our Medicare number in April. As well as bringing on retina and facial plastics into our Houston center.

Ken Rich, MD. President at Raleigh (N.C.) Neurosurgical Clinic: We are fortunate to have all the expensive equipment we need such as microscopes, Image Guidance and so forth. What we plan on doing this year is attacking the debt it took to get our two-and-a-half-year-old clinic up and running and profitable. To get to a debt-free situation makes a huge difference in economics.

Randal Reynolds. Senior Vice President of Field Operations at HealthCrest Surgical Partners (Edmond, Okla.): The biggest investment that our company will make this year involves automating various processes. This includes the preparation of various operational and financial reports as well as functional activities, including the installation of operating systems with integrated electronic medical records. Within this data accumulation process, we are also evaluating best methods for distributing the related information obtained to end users in an efficient and effective manner. With increasing labor and benefit costs, it is critical that all activities be assessed periodically to see how automation might be used to perform them in the most cost-effective means possible.

Ronald Bullen. Executive Director at ProHealth Aligned (Waukesha, Wis.): Our biggest investment is in renovating our existing space to accommodate growth, increase efficiency, and improve patient, physician and employee satisfaction. Optimizing our facility space is a critical part of selling "surgery center efficiency" to physicians and patients to support our strategic plan.

Todd Currier. Administrator of Bend (Ore.) Surgery Center: In 2023, we made major modifications to our staffing structures and pay scales. Investing in our staff was and continues to be an ongoing priority for our business. In 2024, we have added an intense review of our software platforms. We are reviewing all of our software to ensure we are utilizing them to their fullest extent, and creating greater efficiencies in our processes.  

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