From rising labor costs to shrinking reimbursements, seven leaders joined Becker’s to discuss the mounting financial pressures facing ASCs today.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What is the most significant financial challenge ASCs are facing today?
Michael Cournyea. CEO of University at Buffalo (N.Y.) Neurosurgery: The most significant financial challenge is keeping up with the labor market. Most ASCs are competing with hospitals and health systems for RNs and surgical techs, and this is driving up the costs for these positions. In addition to this, an even greater challenge is the rising costs of anesthesia in the ASC setting. Most ASCs are now responsible for providing an anesthesia stipend for any shortfall in anesthesia collections to help support the costs of employing anesthesiologists at the current market rates.
Bonnie Greenblatt. Director of Ambulatory Surgical Services at the Michigan Institute of Urology (Utica): There are multiple challenges that ASCs face currently. Declining or stagnant reimbursement rates from both commercial and governmental insurance payers, in the face of the increased cost of supplies, staffing and compliance. Site-neutral payments: As most complex cases shift to the ASCs from the hospital, site neutral payments would decrease ASC profitability despite case complexity. The rising cost of supplies and staffing have compounded the financial strain, eroding profit margins. While insurance companies encourage their patients to utilize ASCs, for all the cost-savings, efficiency and patient satisfaction reasons, they are doing nothing to support the ASCs in this process.
Vadim Coz, MD. Spine Surgeon at Reno (Nev.) Orthopedic Clinic: Overhead costs and payer contracting are among the most significant financial challenges facing ASCs today. Like many industries, rising labor costs have compressed margins, making it essential to optimize staffing and align OR utilization with case volume to maintain profitability. In spine care specifically, securing insurance contracts for procedures such as lumbar fusions remains difficult. This may reflect the strong, long-standing relationships between hospitals and payers, which can create barriers to expanding complex surgical offerings in the ASC setting.
Tracy Helmer, BSN, RN. Administrator of Tri City Cardiology Surgical Center (Mesa, Ariz.):, The benefits of being part of the leading edge of delivering new innovation, can be costly. These technologies are not always affordable. ASCs must be able to partner with vendors strategically to provide these services, deliver them, and refine them in such a way that patients can benefit from them as outpatients. Sometimes, all of those details can be harder than they appear, but ASCs are definitely nimble enough to handle the task.
Sarah Malaniak. Administrator of Peakpoint Flatiron Surgery Center (New York City): In 2025, ASCs are under growing financial pressure, with rising operational costs emerging as the most significant challenge. Healthcare inflation — now at a 23-year high — has sharply increased the cost of medical supplies, equipment, utilities and facility maintenance. ASCs, which typically operate on lean margins, are particularly vulnerable to these cost surges, making financial sustainability more difficult.
Staffing costs are also escalating. To attract and retain skilled professionals, ASCs must offer competitive wages, signing bonuses, and enhanced benefits. This is especially challenging as hospitals often outbid ASCs for talent, leading to increased turnover and recruitment expenses. The need to address burnout and improve work-life balance has further added to the financial strain, as centers invest in retention strategies and flexible scheduling.
Supply chain disruptions continue to complicate operations. Delays in acquiring essential equipment—such as sterilization units and surgical instruments — can force ASCs to postpone procedures or seek costly alternatives. These disruptions not only impact revenue but also compromise patient care and scheduling efficiency.
While rising costs are the most pressing issue, staffing shortages are a close second. Many ASCs struggle to maintain adequate personnel, which affects their ability to operate at full capacity. Shortages in anesthesiology and nursing staff are particularly problematic, often leading to reduced procedure volumes and longer wait times. Declining reimbursement rates from Medicare and private insurers further compound the financial strain, squeezing margins and making long-term planning more difficult.
To remain viable, ASCs must adopt strategic cost-control measures, invest in workforce development and improve supply chain planning. Embracing technology to streamline operations and enhance revenue cycle management can also help offset financial pressures. These steps are essential for ASCs to continue delivering high-quality, affordable care in an increasingly complex healthcare environment.
Phyllis Norton. Administrator of Central New York Eye Center (Poughkeepsie): Two significant financial hardships currently facing ASCs include:
Paying anesthesia stipends for unused block time – ASCs often enter into stipend agreements with anesthesia providers based on a projected minimum number of cases. However, when surgeons fail to meet these minimum case thresholds, the center is still obligated to pay the anesthesia stipend, resulting in a financial loss for time and services that were never utilized.
Maintaining staff employment during low case volume periods – In tandem with the above, ASCs must continue to staff adequately for anticipated surgical volume. When case volume falls short, the center faces the burden of covering payroll costs without corresponding revenue, further straining operational budgets.
These challenges create a compounding effect that threatens the financial stability of ASCs, especially when shortfalls in case volume become recurring.
Josh Troast. Director of Ambulatory Surgical Services at Muskegon (Mich.) Surgical Associates: The general inflation we have encountered recently has driven up staffing costs including related benefit costs. Similarly, the costs associated with service labor relative to an ASC operation have increased significantly. The cost of supply and some implants outpaces the allowable reimbursement afforded for certain procedures. As a result, while some procedures are clinically appropriate for an ASC, the financials don’t make it a viable option to offer patients.
