ASC administrators and physician partners say that block time is the most avoidable margin drain hiding in plain sight.
“Holding onto block time ‘just in case’ hurts the bottom line,” Elisa Auguste, administrator of Precision Care Surgery Center in East Setauket, N.Y., told Becker’s. “If another high-volume surgeon can fill that time, let them. The center wins, and so do you as an owner.”
Block time is inventory, and unused inventory is lost revenue, ASC leaders said. But unlike supply waste or overtime, idle OR time rarely shows up as a line item, which is exactly what allows it to persist.
Scott Kulstad, CEO of St. Paul Eye Clinic in St. Paul, Minn., told Becker’s he has made block discipline a strategic priority rather than an administrative task.
“A surprising amount of ASC margin is left on the table in the form of minutes: late starts, variable room turnover and underused blocks that could support incremental cases, new service lines or carefully selected partner surgeons,” he said.
His approach treats time management the same way strong ASCs treat supply chain. This includes standard work, visible readiness metrics, surgeon-level feedback loops and clear rules for releasing and backfilling time without disrupting core schedules.
The behavioral dimension of the problem is harder to fix than the operational one. Many surgeons hold blocks out of habit or self-protection, not because they intend to leave the room empty. Kathleen Hickman, RN, administrator and clinical director of Dutchess Ambulatory Surgical Center in Poughkeepsie, N.Y., said many surgeons simply don’t track their own utilization.
“Many surgeons do not monitor their surgical blocks and often have half days,” she said. “If multiple surgeons have the same pattern, the ASC is not operating in an efficient and profitable manner.”
The downstream effects extend beyond the lost case revenue. Brett Maxfield, CRNA, president and CEO of Maxfield Healthcare Solutions, pointed to anesthesia as a concrete example of how poor block management compounds costs. Scheduling five anesthesia providers for five simultaneous room starts that run at 20% to 60% utilization is a significant resource waste, he said. And on the back end, per-diem and outside anesthesiologists have become expensive enough that a cancellation with insufficient notice still triggers payment, turning a scheduling failure directly into a margin hit.
Randy Robbins, MD, president of Valiant Anesthesia Associates in Addison, Texas, flagged flip rooms as another version of the same problem.
“One of the places that ASCs are leaving significant revenue on the table is utilizing flip rooms for cases that take 90-plus minutes,” he said. “If a room is sitting empty multiple times a day for over an hour, that room could be utilized to recruit new surgical volume or allow current providers to use the room more effectively.”
The fix, leaders say, is structural. Clear release windows, visible utilization data shared at the surgeon level and a standing waitlist of cases ready to fill open time are the basic components most high-performing centers have in place. The centers that haven’t built those systems are often the ones where the problem is hardest to surface, because the revenue that never materialized doesn’t appear anywhere on the books.
“We need to capture value from unused capacity by systematizing OR efficiency,” Mr. Kulstad said. “This is operational discipline as strategy, not a housekeeping project.”
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.