From high implant and supply costs to payer reimbursement pressures, ASCs are heading into 2026 with their margins squeezed from every direction.
Greg DeConciliis, administrator of Boston Out-Patient Surgical Suites, joined Becker’s to discuss how new technologies like robotics and AI are driving up procedure costs.
Editor’s note: This interview was edited lightly for clarity and length.
Question: Which margin pressures concern you the most?
Greg DeConciliis: The biggest pressures are supply and implant costs, reimbursement, and staffing. On the supply side, implant prices, especially in orthopedics, spiked during COVID-19 and haven’t really come back down. At the same time, there’s a lot of new technology entering the space. Advancements like robotics, AI and newer products are exciting, but they come with added cost. So the expense of doing business and performing procedures has stayed high and, in many cases, continues to rise.
Reimbursement is another challenge. We’re dealing with payer pressure in our area, including reduced reimbursement, and that’s been a real struggle.
Staffing is the third major stressor. We’re competing with hospitals for talent, and we’ve had to raise wages significantly. Surgery centers used to have an advantage — no nights, no weekends, no call — but there are more centers now, and people expect higher pay given the cost of living. Looking ahead to 2026, those pressures aren’t going away.
The way we sustain ourselves is by controlling staffing as best we can, improving efficiency, and increasing volume, because volume helps drive efficiency. But education also matters. If we can cut waste in supplies and implants by only opening what’s truly needed, that lowers expenses and supports the bottom line.
Q: When you say ‘education,’ what exactly do you mean?
GD: A lot of waste happens when staff aren’t fully confident about a procedure, especially newer nurses or surgical techs. Instead of opening only what’s appropriate, they’ll open everything they think might be needed because they don’t want to be caught unprepared or upset by a surgeon. The problem is that different surgeons use different items.
We focus on education in two main ways. First, we make sure preference cards are accurate and truly reflect what each surgeon uses for each procedure. That way, when staff are picking supplies, they’re picking the right items from the start
Second, managers and surgeons need to reinforce good habits in the room. If you’re paying attention, you’ll see patterns of leftover, unused items after cases. That waste often comes down to unclear communication, inaccurate cards or staff not feeling confident enough to stick to the plan. Tightening the cards, training staff on procedure-specific needs, and reinforcing that it’s okay to ask questions instead of opening everything helps reduce waste and protect margins.
