The disruptors posing the biggest threats to ASCs

Seven ASC leaders joined Becker's to discuss the disruptors with the most potential to shake up the ASC industry.

Editor's note: These responses have been lightly edited for length and clarity. If you would like to contribute to our next question, please email Paige Haeffele at

Question: What disruptor poses the biggest threat to ASCs?

Paula Autry. CEO of Leadership DNAmics (Grass Lake, Mich.): The early onset of ASCs was an opportunity for entrepreneurial surgeons to provide access to surgery for patients in their communities in an environment that they perceived to be more comfortable than hospitals.  Since inception, health systems have been conflicted on ASC development, given that reimbursements can be less than hospital-based reimbursements and partnering with physicians necessitated the sharing of profits. Despite the conflict, ASCs have continued to evolve as health systems and physicians have pursued more partnerships. In addition, patients have become more comfortable with the outcomes and service in ASCs, there is lower cost of care to payers than hospitals, and the evolution of medicine in which more complex cases can be provided in an ASC setting will continue to support their growth. Integrated health systems that are committed to improving the health status of their communities, providing cost effective care, developing alternative care models that target the reduction in costly hospitalizations and aligning with physician partners to improve outcomes, will likely continue to pursue ASC expansion. Increasing costs of resources and health systems that continue to prioritize resources for hospital services and that do not pursue alignment with physicians are the biggest threat to ASCs.

Norma Bacon. Administrator of New England Surgery Center (Beverly, Mass.): The biggest disruptor posing a threat to ASCs is staff — all staff. OR nurses are hard to find and the hospitals are paying hourly rates and sign-on bonuses that ASCs cannot pay. Front desk staff is just as hard to get and keep. I don't like blaming COVID-19 for everything, but this seems to have started with the outbreak and continues.

Joe D'Agostino. Administrator of Advanced Surgery Center Perimeter (Sandy Springs, Ga.) and Gwinnett Advanced Surgery Center (Snellville, Ga.): Staffing and supply chain are at least two major disruptors that pose the biggest threat to ASCs. The ASC industry has experienced major shifts in availability in both categories.  

The shortage of clinical labor is a phenomenon that has been ongoing for many years prior to COVID-19 (including not just clinicians in patient care roles, but also clinical educators). The pandemic made this a more substantial issue within the healthcare industry. The volatility of the clinical labor market continues to encounter challenges such as staff strikes, clinicians moving into travel assignment roles and away from single-facility commitments, etc.

Medical supply shortages and the recurring amount of products that are on national back order have dramatically increased over the past three years. Natural disasters, the pandemic and a shortage of labor force have also contributed to deficiencies in the supply chain. These new conditions have created an administrative burden that we have not had to overcome in the past.

Les Jebson. Administrator of Prisma Health (Greenville, S.C.): I would submit that rather than any single new disruptor that industry disruptive changes identified in the last 24 months will continue forward and, in some cases, will end.  

The elimination of the certificate of need in a growing number of states allows for new entrants into the ASC space. If they are not extremely well-capitalized to contend with outlays beyond brick and mortar — for robotics technologies and supply implant carrying costs — they will inevitably fold. Integrated healthcare systems will generally shy away from buying them. Patient utilization of current and new centers will continue to be influenced by referral pathways, price and quality of outcomes. Further specialization of dual- and single-specialty ASCs will continue, with more endoscopy and ophthalmology procedures leading the way. The incredibly tight labor market for anesthesia, nursing and surgical technology professionals will push compensation further as ASCs may inadvertently cannibalize labor pools in certain markets and may set the state for state specific legislative scope of practice changes.   

Don McComas. Director and Administrator of Plaza Surgery Center (Santa Maria, Calif.): ASCs are facing a multitude of uncertain issues related to legislation and reimbursements. Here in California those issues are magnified, but with everything I am facing as an ASC administrator, my biggest concern is anesthesia coverage. There is a national shortage and with the cost of living on the California coast, it is difficult to attract new anesthesiologists. 

Kim Mikes, BSN, RN. CEO of Hoag Orthopedic Institute (Irvine, Calif.): When considering a threat from a disruptor, the controversial trend of increasing private equity and investor-owned models and their move into the ASC space comes to mind. At Hoag Orthopedic Institute, physician ownership is central to the model, and while we focus on providing value and operate in a fiscally responsible manner, quality and excellent patient outcomes always come first. Our physician owners know that when you put patient safety and quality care first, success follows. Private equity firms have a different focus, namely to invest, increase the value over time and sell for a profit. With this goal in mind, in the private equity-owned ASC there may be a loss of physician autonomy, a prioritization of financial return with a resultant shift away from a focus on high quality patient care. I worry what may happen to patients when your principal priority is a return on investment.

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