ASCs are currently experiencing many hurdles such as rising supply costs and staff shortages. Forty ASC leaders told Becker’s all about the biggest obstacles they’re currently facing and how they’re planning to overcome them.
The leaders featured below are speaking at Becker’s 31st Annual: The Business and Operations of ASCs, Oct. 16-18, 2025, at the Swissotel in Chicago.
If you would like to join the event as a speaker, please contact Scott King at sking@beckershealthcare.com.
As part of an ongoing series, Becker’s is connecting with healthcare leaders who will speak at the event to get their perspectives on key issues in the industry.
Editor’s note: Responses have been lightly edited for length and clarity.
Question: What is currently your ASC’s biggest hurdle to overcome?
Michael Gale. Administrative Director, Sentara Obici Ambulatory Surgical Center (Suffolk, Va.): There are several competing challenges for ASCs that are significant and without easy solutions. Anesthesia services, managing the cost of implants and the constant battle with payors over prior authorizations are at the top of that list. The cost of anesthesia contracts is tied to the ever-increasing price of their labor as they live through chronic labor shortages.
These costs are passed along to ASCs as we are being asked to underwrite the disparity between anesthesia reimbursement and those labor costs. Additionally, the cost of implants requires aggressive negotiations with surgical suppliers. These negotiations are complicated by our desire to accommodate physician surgeon preferences. Lastly, commercial payors have made prior authorizations a muddled mess of contradictions that usually end in claims denials. On the bright side, ASCs have always been leaders in operational improvisation and dynamic adaptation. We will adapt because we have to.
Tina Driggers. Administrator, Credentialing, Day Surgery Center (Winter Haven, Fla.): Currently, our ASC’s biggest hurdle involves maintaining the stability of our staffing, rising supply costs, and anesthesia coverage in a competitive healthcare market. Our ASC employs a fantastic staff, and it is important to maintain the staff that we have. Rising supply and staffing costs have squeezed margins. We are focusing on managing supply utilization and renegotiating vendor contracts to sustain profitability without compromising care quality. Securing consistent anesthesia coverage remains a challenge due to nationwide shortages and increasing compensation demands. The hurdle is balancing workforce and financial stability along with anesthesia coverage to support our case volume and patient care standards.
Monte Goldstein, MD. Chief Medical Officer, Virtua ASC Joint Ventures (Marlton, N.J.): Across our portfolio, a major concern is the aging and attrition of investor physicians without succession plans within their practices. We are always searching for ways to support our physician partners and enhance patient care while remaining an attractive worthwhile investment opportunity. As fewer younger physicians enter the private practice arena, this is becoming increasing more difficult, especially in those specialties where hospital-based practice/employment has become the norm.
Thomas Hutchinson. Administrator, Surgery Center of Central Florida (Altamonte Springs, Fla.): With the anticipated approval of electrophysiology (EP) ablations in the ASC setting, our center is currently evaluating how to incorporate these cases into our schedule without compromising our existing caseload.
Our ASC’s core procedures consist primarily of cardiac catheterizations and device implants, including both de novo implants and generator changes. These cases are typically performed under conscious sedation, have shorter procedure times, and require brief recovery periods.
The introduction of EP ablation cases will bring a significant shift to our workflow, as these procedures require general anesthesia, longer OR times, and extended recovery durations. While EP ablations are projected to be profitable, ASCs preparing to add these cases must also consider the associated challenges—such as capital investment, staff training, and increased anesthesia costs.
Overall, we believe this transition will be both financially sustainable and highly beneficial for our patients. We are excited to expand our cardiovascular services and proud to offer this advanced treatment option, even as we work through the logistical challenges of implementation.
Tara Good-Young. Chief Executive Officer, PDI Surgery Center (Peoria, Ill.): Our ASC’s most significant challenge is navigating rising supply and staffing costs alongside delayed managed care reimbursements. This is compounded by proposed Federal Medicaid and State Medi-Cal cuts, of uncertain scope and duration, which create major budgetary instability. Additionally, we face the troubling reality that many families of color hesitate to seek care due to fear of harassment at facilities known to serve diverse populations. Delayed care turns into more costly case delivery for potentially less robust health outcomes down the line, further driving the revolving door of rising treatment costs against lagging reimbursement rates.
Maher Kodsy, MD. Chairperson, Anesthesiology Department and Perioperative Physician Director, UH Elyria Medical Center (Elyria, Ohio); President, Elyria Anesthesia Services, Inc.; Medical Director, Amherst (Amherst, Ohio): Indeed, the immediate challenge for ASCs is the shortage of anesthesia providers.
This shortage may persist for an extended period. This crisis has resulted in artificially inflated compensation for anesthesia services, setting unrealistic dollar figures. Furthermore, the impact on the number of surgeries performed within ASC arenas cannot be overlooked. The primary hurdle facing ASCs currently lies in achieving profitability and maintaining their operations despite the anesthesia shortages.
The surgical schedule serves as a pivotal factor that can lead to either remarkable success or catastrophic failure. By aligning the interests of physicians with a shared objective of collaborating as true investors in the enterprise, it is possible to mitigate the obstacles that arise during the crisis.
The practice of scheduling two consecutive 2-hour surgeries in the morning and another two hours after working hours is outdated. Compensating nursing staff and anesthesia providers for unproductive time and incurring unnecessary expenses due to overtime, related to working beyond regular hours, is a flawed approach.
An operating room within an ASC should generate between 390 and 420 minutes of genuine surgical time and between 60 and 90 minutes of turnover time.
Surgeons working within hospitals often perceive staff and anesthesia shortages as the responsibility of others to address. However, this perspective does not apply when physicians are shareholders of ASCs.
A genuine compromise should be made to prioritize filling operating rooms before opening others for surgeries. By doing so, the hurdle of anesthesia shortages can be effectively minimized.
A comprehensive understanding of the concept of building and operating an ASC is essential. The trade-offs between various “egoistic” interests and profitability should be clearly understood among all stakeholders.
Even a few cancellations of scheduled surgeries due to provider shortages can quickly label an ASC as lacking in patient consideration and lead to its closure.
Prioritizing the interests, needs, and addressing it in a team approach could lessen the damage. In essence, it is imperative that all stakeholders fully embrace and support the fundamental distinctions between ASCs and hospitals settings.
David McConnell, MD. Medical Director, Kearney Ambulatory Surgical Center (Kearney, Neb.): Our ASC is over twenty years old, it’s a strong multi specialty center.
Presently, our hurdle is transitioning ownership from the handful of retiring physicians to the younger physicians, and at the same time working with our local hospital partner who wants to purchase more shares.
Nikhil Shetty, MD. Chief Operating Officer, Midwest Interventional Spine Specialists (Elmhurst, Ill.): There are many hurdles a successful ASC has to navigate daily. One of the biggest hurdles in the ASC space is prior authorization. Typically, commercial insurers will employ restrictive prior authorization practices to manage utilization. With CMS now adopting prior authorization initiatives, the ripple effect of further impediments to healthcare delivery will become more broadly clear across America. Though this is a pilot program, it seems logical that this will ultimately be adopted uniformly across more states. There is a reasonable risk that this will lead to higher indirect or direct costs for the average American through increased administrative overhead, healthcare delays, and increased cost-sharing burden.
Paul Lynch, MD. Founder and Chief Executive Officer, US Pain Care (Scottsdale, Ariz.): The biggest hurdle for our ASC right now is cost. Over the course of my career, which began in 2007, the cost of providing healthcare has nearly doubled while reimbursement has stayed the same—or even declined. That imbalance has created enormous pressure on surgery centers to maintain quality and access while keeping their doors open. We’ve addressed this challenge by building a group purchasing organization that negotiates contracts on behalf of our centers and physician partners. By leveraging scale, we’ve been able to reduce the cost of high-dollar devices and other critical supplies. Even so, cost inflation remains one of the most significant threats to independent medicine and the ASC model as a whole.
Melissa Rice. ASC Administrator, Loyola Ambulatory Surgery Center, Trinity Health (Maywood, Ill.): Our ASC’s biggest hurdle right now is securing affordable anesthesia coverage. Rising costs and limited availability of anesthesia providers have made it increasingly difficult to maintain coverage without compromising financial sustainability. This challenge directly impacts our scheduling flexibility and case volume. We’re actively exploring collaborative solutions and alternative models to ensure patient care remains uninterrupted.
George Hanna, MD. President, Director of Pain Management and Chief Transformation Officer, Vein Clinic and Pain Treatment Center, VIP Medical Group (New York City): One of the biggest hurdles ASCs face today is the rising out-of-pocket burden placed on patients by insurers through higher deductibles and cost-sharing. These shifts can create financial anxiety and delay access to highly effective outpatient vein and pain procedures that dramatically improve quality of life. At VIP Medical Group, we address this challenge through transparent, empathetic discussions about costs, coverage, and expected outcomes early in the patient journey. By providing individualized payment plans and financial counseling, we ensure patients can confidently access the advanced care they need in a timely and compassionate outpatient setting.
Neal Kaushal, MD. Division Chief, Gastroenterology, Integris Health (Oklahoma City): Our biggest hurdle — and opportunity — is evolving our ASC model to meet the growing demand for advanced procedures outside the hospital setting. We’re focused on optimizing efficiency, expanding capabilities, and integrating new technologies that enhance both patient outcomes and physician satisfaction. As case complexity increases, our goal is to evolve from a traditional procedural site into a high-performance, innovation-driven extension of the health system’s care continuum.
Jay Weller, MD. Anesthesiologist, Seven Hills Anesthesia; System Chief, Perioperative Medicine and Anesthesiology, TriHealth (Cincinnati): 80% of the more than 225,000 anesthetics provided by Seven Hills Anesthesia in 2024 were performed on an outpatient basis, spread across 9 hospitals and 26 ambulatory facilities. For a variety of reasons, the volume of procedures being performed in the ambulatory setting continues to grow. Demand for anesthesia services in non-operating room locations in the hospital (e.g. Endoscopy suites, Cardiac Cath Labs, etc) setting is also exploding. The result is a gross mismatch between the supply of anesthesia providers and the demand for their services. Unfortunately, third party payer reimbursement for anesthesia services has not nearly kept pace with compensation, particularly for Certified Registered Nurse Anesthetists, whose incomes have increased 10-12% annually for many years.
Without a doubt, the greatest challenge faced by Seven Hills Anesthesia is recruiting and retaining enough qualified anesthesia providers to support this growing volume. Since the late 1990’s, hospitals and anesthesia groups have been learning to work collaboratively to optimize OR utilization and to support the gap between clinical reimbursement and the cost of coverage. That type of collaboration is now being required in the ASC setting as well. Our focus at Seven Hills Anesthesia is to ensure alignment that ensures stability for our ASC partners.
Jack Dillon. Chief Executive Officer, Anesthesia Practice Consultants (Grand Rapids, Mich.): Right now, the biggest hurdle for most ASCs is maintaining reliable anesthesia coverage while managing cost pressures and fluctuating case volumes. The challenge isn’t just staffing—it’s finding the right level of flexibility and consistency to match the rhythm of outpatient surgery.
At Anesthesia Practice Consultants, we’ve been addressing this by leveraging an anesthesia staffing model that blends stability with scalability. Whether a center needs full-time coverage, supplemental support, or short-term staffing to bridge growth phases, our team can adapt quickly without compromising quality or efficiency.
In today’s environment, that ability to flex anesthesia services to meet volume and budget realities is one of the most important competitive advantages an ASC can have.
Sean Gipson. Division Chief Executive Officer and President, Remedy Surgery Centers (Dallas): As the healthcare landscape continues to evolve, Ambulatory Surgery Centers (ASCs) are playing an increasingly vital role in delivering high-quality, cost-effective surgical care. However, despite their growth and popularity, ASCs face a range of operational and financial challenges. Of these, the most pressing—and persistent—is the issue of staffing shortages and workforce management.
Unlike hospitals, ASCs operate on leaner staffing models, relying on tightly coordinated teams to manage high patient throughput in a short period. Every role, from OR nurses and surgical technologists to CRNAs and front office personnel, is essential to the patient experience and surgical outcome. When even one position is vacant or under-resourced, the entire operation feels the impact.
The national nursing shortage, coupled with increasing burnout and workforce attrition in healthcare, has placed enormous pressure on ASCs to recruit, train, cross-train, and retain qualified personnel. The challenge is further exacerbated by competition with larger health systems that often offer higher salaries, signing bonuses, and more extensive benefits, something many independent ASCs struggle to match.
Staffing shortages don’t just affect internal workflows, they have a direct impact on patient access and safety. Canceled or delayed cases, increased wait times, and overburdened clinical teams can reduce efficiency and, ultimately, compromise the patient experience. Additionally, understaffing may lead to burnout among remaining employees, creating a cycle that’s difficult to break.
Beyond the day-to-day disruptions, the staffing crisis also affects an ASC’s ability to expand services, take on more complex cases, or scale operations. It limits flexibility, adds financial strain through reliance on costly temporary staffing solutions, and affects compliance and quality metrics that are critical to accreditation and reimbursement.
Progressive ASCs are addressing this hurdle through creative staffing models, cross-training programs, stronger employee engagement strategies, and partnerships with local nursing schools. While these initiatives offer some relief, the broader solution likely requires systemic changes in how healthcare workers are trained, supported, and valued across all care settings.
While ASCs continue to lead in delivering efficient, patient-centered surgical care, staffing remains the single greatest challenge to sustainable growth and high performance. Until this hurdle is addressed, it will remain a limiting factor in the sector’s ability to fully meet the rising demand for outpatient surgical services.
Cheraire Lyons, PhD. Vice President, Revenue Cycle, Alliance Spine and Pain Centers (Atlanta): Ambulatory Surgery Centers (ASCs) are currently grappling with several major challenges, including persistent staffing shortages, difficulties in employee retention, and escalating operational costs. These staffing issues are compelling ASCs to modify their operating hours, which in turn restricts patient access to care. Additionally, ongoing changes in payer utilization and reimbursement policies are introducing stricter regulations, further affecting the quality and availability of patient care. Compounding these issues is the growing financial burden placed on patients, as more healthcare costs are shifted to their responsibility, making access to necessary procedures increasingly difficult.
Carrie Marut. Administrator, Mentor Surgery Center (Mentor, Ohio): The biggest hurdle our ASC has to overcome is really no surprise to anyone out there that provides services that require anesthesia. We in the healthcare field know that reimbursement for this service is down and cost of individuals providing the service is up. We have been working hard with our doctors to do a better job of stacking cases in each OR. By doing so, we are running less rooms, and the rooms we are running are going a little longer in the day. This allows us to have less anesthesia providers and a better opportunity for them to bill for better reimbursement in volume rather than by case. Our surgeons have been very accommodating because they know that this helps with the bottom line.
Sangyoon Jason Shin, DO. Regional Ambulatory Care Medical Director, Mount Sinai Health System (New York City): One of the most significant challenges in Ambulatory Surgery Center (ASC) operations is ensuring consistent and reliable staffing, particularly within anesthesiology, where coverage variability can directly impact scheduling efficiency and patient throughput. Equally important is the need to maximize utilization of existing assets – both physical and human, by aligning block assignments, case mix, and staff deployment to true demand. In addition, maintaining high engagement, cross-training flexibility, and predictable scheduling across nursing, anesthesia, and procedural teams will be essential to sustaining productivity, improving patient experience, and supporting growth across our existing ASC network.
Alaa Abd-Elsayed, MD. Medical Director, UW Health Pain Services, UW Pain Clinic (Madison, Wis.): Decreasing reimbursement, staff shortage and the increasing overhead cost. The numbers do not add up.
Vijay Bachani. President and Chief Growth Officer, New York Bariatric Group (New Hyde Park, N.Y.): One of the biggest hurdles for our ASCs has been payor contracting. Payors like to compare what they are paying the other ASCs whereby they should be looking at how much money they are saving by having the cases done at the ASC vs. the hospital. For one of our payors, it took almost two years to get a contract. The key is to be persistent and ensure you are talking to the right people.
Justin Marburger. Regional Surgical Director, Maximus Plastic Surgery Center and Chrysalis Cosmetic Surgery Center (San Antonio, Texas): The greatest challenges currently facing our surgery centers are margin pressure and rising operational costs. Expenses related to labor, supplies, utilities, and maintenance continue to increase, while reimbursement rates have not kept pace. As a result, stand-alone centers often struggle to make necessary capital investments—such as acquiring new technology or upgrading facilities—without the financial support of a larger hospital system. Compounding these pressures, the recruitment and retention of skilled nurses, surgical technologists, anesthetists, and support staff remain ongoing challenges, particularly as hospitals frequently offer more competitive compensation and benefits packages.
Randy Robbins, MD. President, Valiant Anesthesia Associates (Dallas): Our practice provides care at multiple ASCs and I am the medical director of one. I think one of the biggest hurdles we face on a week-to-week basis is operational efficiencies and anesthesia coverage/concerns/stipend requests. The anesthesia landscape has changed so drastically since 2020 nothing that worked then is working now, and we are forced to think outside the box and ask physician partners to find a way to be efficient and reasonable in their expectations. Sometimes this is an easy conversation, but often times it requires significant explanation and struggle to find a real solution.
Angela Durham. Vice President, Ancillary Services, US Heart and Vascular (Franklin, Tenn.): Our greatest hurdles involve system connectivity to enable efficient workflows, reduce duplicative or redundant touch-points, and create accessibility and visibility into core data elements. While some functionality is standard for an ASC of any specialty, each speciality presents unique needs for systems integration and interfaces. When vetting technology solutions that enable scalability, connectivity, and accessibility to data points, we found that the exercise of mapping patient journey workflows, stakeholder touch-points, technology intersections, and existing process pain points enhanced our vendor discussions by providing clear visibility into where value can be created. Selecting the most cost-effective system that minimizes staff re-work and streamlines workflows has significant downstream impacts on cost, revenue, and volume leakage reduction resulting from disparate systems.
Helen Lowenwirth. Administrator, East Side Endoscopy (New York, N.Y.): While the market for RNs has settled down a bit, we, as do all ASCs, whatever the specialty, rely on specialized medical assistants and surgical technicians to assist the physicians during procedures and to reprocess and sterilize the equipment. There are no formal education programs and the post high school programs that did exist suffered badly post covid. The ASC market has excellent opportunities for entry-level support staff which serve as platforms for long term career opportunities. We have to resort to “on the job training” which may pay off in the long run, but in the near term is costly.
Benjamin Levy, MD. Gastroenterologist, Clinical Associate, Medicine, University of Chicago (Chicago): In general, ambulatory surgical centers nationally are working hard to expedite care for positive Cologuard and FIT tests. Also, we are trying to educate the public nationally about the new colorectal cancer screening age of 45 because we are seeing an increase in early onset colorectal cancer cases. Gastroenterologists are removing significant polyps (tubular adenomas and sessile serrated adenomas) with colonoscopies at ASCs in patients between the ages of 45-49 with the goal of preventing colorectal cancer. Our aim nationally is to improve colorectal cancer screening rates in this age group and in patients older than 50, too.
Michael R. Redler, MD. Orthopedic Surgeon, Connecticut Orthopedics; Clinical Instructor, Yale School of Medicine; Assistant Clinical Medicine Professor, Frank H. Netter School of Medicine Quinnipiac University (North Haven, Conn.):
I think that one of the biggest hurdles or challenges that our ASC has to overcome is the balance between doing higher acuity cases as an outpatient and the increased costs of the technology associated with these cases. Most ASCs that do total joint replacements have carve outs to allow for the cost of the implants. Repairing massive rotator cuff tears or ACL tears that require augmentation for best outcome can sometimes be a more challenging proposition.
The AAOS recommends augmentation for large to massive tears and recurrent ACL tears and the studies demonstrate their efficacy. The cost associated with these technologies may not always be reimbursed by the third party payors. That may often leave the ASC in a quandary in terms of doing what is truly best for the patient and what will be covered. The insurance companies are still saving money when these cases are performed in an outpatient setting and because of the decreased likelihood of reoperation and repair failure. While there are some codes used for implantation of a bioinductive implant, they may not be universally accepted. Additional codes that will cover these technologies hopefully will be on the horizon.
Patty Shoults. Corporate Director Ambulatory Surgery, Ambulatory Surgery Centers, AdventHealth (Altamonte Springs, Fla.): Access to reliable and affordable anesthesia services continues to be a significant challenge for our ASCs. The ongoing shortages are not only driving up operational costs but also threatening our ability to maintain consistent surgical volumes and high-quality patient care.
Alejandro Badia, MD. Founder and Chief Medical Officer, OrthoNow (Doral, Fla.): My particular ASC in Miami is having major issues with our national corporate partner, perhaps an indication that the pendulum will be swinging back to all physician-owned surgery centers. Besides the fact that they can never be an actual partner since they don’t book surgeries and perform cases themselves, they have eroded culture and focused more on growing the national network rather than our own particular center. The illusion that a large national company could get us better contracting is something colleagues need to be aware of.
Patrick Garman. Past President, Pennsylvania Ambulatory Surgery Association; Executive Administrator, Spartan Health Surgicenter (Monroeville, Pa.): The biggest challenge that I’m facing in my ASC, and for a lot of ASCs, is anesthesia coverage. The cost of anesthesia has risen dramatically over the past 2-3 years and ASCs now must subsidize this service line. Anesthesia has seen declining reimbursement rates and rising, unsustainable CRNA compensation increases. This necessary specialty now requires ASC and hospital subsidy to provide service, which is necessary to conduct surgeries.
Megan Friedman, DO. Chair and Medical Director, Pacific Coast Anesthesia (Los Angeles, Calif.): One of our biggest hurdles is navigating fair-market stipend support for anesthesia in an environment of declining reimbursements—both for anesthesia and surgical procedures—and shifting case volume. Many ASCs rely on consistent, high-quality anesthesia coverage, but daily caseloads don’t always align with resource demands, especially when schedules are built around surgeon convenience rather than utilization efficiency.
At the same time, some surgeon-owners aren’t consistently using their block time, despite expectations to contribute a certain percentage of cases to the center. The real challenge is balancing operational fairness, case accountability, and financial sustainability—while continuing to deliver safe, timely care for patients.
Alex A. Andrade. Chief Operating Officer, Medical Associates P.C. Iowa (Dubuque, Iowa): One of our biggest hurdles is adapting to a new era of clinical workforce expectations. Today’s nurses and techs seek predictable weekly hours and greater control over their schedules. Meeting these expectations while maintaining throughput, quality, and financial performance requires a strategic redesign of how we deploy talent to sustain patient access and engagement in a competitive environment.
Omar Khokhar, MD. Managing Partner, Illinois GastroHealth (Bloomington, Ill.): Staffing on all levels. Nurses, technicians, front office. We’re constantly behind the curve and this is a priority for 2026.
Faisal Rahman, PhD. Member and Owner, Munster Surgery Center LLC (Munster, Ind.): I feel the biggest hurdle facing us is to find the right surgeons to do ortho spine cases and be reimbursed. Revenue Cycle Management and staffing seems to be the issues for most surgery centers.
Angie L. Jiménez. Chief Executive Officer, Puerto Rico ASC Holding Co. Inc. (San Juan, Puerto Rico): One of our biggest challenges continues to be optimizing collections. As costs rise and reimbursement models grow increasingly complex, ensuring timely and accurate collections requires continuous attention.
We’ve been focusing on strengthening our revenue cycle processes—improving front-end verification, enhancing communication with payers, and providing ongoing staff education. By combining data analysis with team accountability, we are gradually seeing stronger performance and fewer denials.
It’s an ongoing effort, but one that’s critical to maintaining financial health and sustaining high-quality patient care in today’s ASC environment.
John Prunskis, MD. Medical Director and Principal, DxTx Pain and Spine (Barrington, Ill.):
My biggest hurdle in the ASC world is helping employers and patients understand the cost savings they receive compared to an HOPD, as well as the lower infection rates at ASCs versus hospitals.
Many employers and patients are unaware of these savings and benefits, however, they should be.
I would appreciate anyone sharing ideas for how to better achieve this goal.
Insurance companies may not have much incentive to make these cost differences widely known, but employers and patients certainly do.
Nyleen Flores. Administrator and Chief Operating Officer, Lake Oconee Orthopedics (Greensboro, Ga.): Our biggest hurdle right now is payer reimbursement and contract renegotiation. Depending on the location of an ASC and its proximity to other centers or hospitals with Hospital Outpatient Departments (HOPDs), reimbursement disparities can be striking.
Each ASC offers something unique — from specialized procedures to superior patient experience and efficiency — yet payers often fail to recognize that value. Reimbursements for ASCs continue to significantly lag behind those for hospitals and HOPDs, despite us providing the same procedures, often at lower cost and with higher patient satisfaction.
This imbalance makes it difficult to remain competitive, particularly in areas where multiple ASCs or hospital systems are clustered. The ongoing fight for fair, site-neutral reimbursement remains one of the greatest challenges facing ASCs today. The risk of adopting higher acuity cases is not being met with the appropriate reimbursement level needed to maintain sustainability – particularly as it relates to implant reimbursements.
Dariya Golan. Chief Executive Officer, Advanced Surgery Center of Clifton (Clifton, N.J.): One of the biggest challenges our ASC is currently facing is hiring qualified endoscopy technicians. The demand for skilled endo techs is high, yet many candidates lack the level of training we require to uphold the exceptional standards of care we provide to our patients. Proper handling of scopes is also critical. It’s not only for patient safety but also to minimize avoidable repairs and associated costs.
To address this, we’ve begun investing in the development of our own team members. We see potential and a desire in some people to grow into this role. By cultivating homegrown talent, we’re not only filling a vital need but also reinforcing our commitment to excellence. This approach allows us to maintain tighter quality control and ensures our standards remain uncompromised.
Myra Ray. Manager of Surgical Services and Outpatient Infusion, Franciscan Healthcare (West Point, Neb.): The biggest hurdle to overcome currently is accurate surgeon documentation to support reimbursement. Insurance companies scrutinize documentation. Having coders that are well versed in documentation requirements to support charge capture is non-negotiable. The clinical documentation specialist can help leadership to design templates that assist the surgeon in ensuring that their documentation supports the associated procedure billing.
Sheel Patel, MD. Anesthesiologist and Interventional Pain Specialist, APAC Centers for Pain Management; Chief Clinical Officer, Dx/Tx Pain and Spine (Barrington, Ill.): Increasing patient responsibilities. We have seen an increase in copays and coinsurance leaving the patient with a much larger balance than the previous norm.
Niazy Selim, MD. Surgeon, Selim Surgery Center (Fresno, Calif.): Man, this is the million dollars question! There are so many hurdles that make ASC business so volatile and difficult to maintain nowadays:
1- Lack of chain supply necessary items now and then without a proper justification.
2- Ridiculous expiration dates and waste of supplies.
3- The famous and ridiculous “pre-authorization” by insurance companies
4- Insurance companies dragging their feet in paying what is owed
5- Unnecessary denials
6- Lack of nursing
I couldn’t choose one item over the others because I believe all items are equally important. It is the perfect Swiss cheese holes aligning together to destroy the already fragile American healthcare industry.
Brett Maxfield. Director, Surgical and Anesthesia Services, Madison Avenue Surgery Center (Albany, N.Y.): Our biggest hurdle is probably very similar to just about everyone else out there. Currently, we are trying to plan and prepare now in order to maintain profitability in this era of decreasing reimbursement and increasing expenses. The 15% reimbursement cut to CRNA Anesthesia reimbursement by United Healthcare is a perfect example of a decrease in reimbursement that will directly affect our ability to provide high-quality care while maintaining profitability.
Lee Mathew. Administrator, SurgCenter of Greater Dallas and Baylor Surgicare Carrollton (Carrollton, Texas): Our primary challenge is maintaining consistent case volume and workforce stability amid an increasingly competitive and evolving healthcare landscape. Sustaining growth while managing volume fluctuations, alongside recruiting and retaining a skilled workforce, requires ongoing strategic focus, operational agility, and strong leadership alignment.
Andrew Lovewell. Chief Executive Officer, Columbia Orthopaedic Group (Columbia, Mo.): Our biggest hurdle right now is managing the rising cost structure while reimbursement continues to tighten. Implant pricing, staffing costs, and payer pressures are all climbing faster than our ability to offset them through efficiency gains. At the same time, we’re navigating increasingly complex payer authorization and contracting environments, particularly for high-acuity outpatient cases, such as total joints and spine. The payers are also creating arbitrary policies to reduce reimbursement for anesthesia services that directly impact all ASCs. Overall, the demand from the ASC and private practice space for payer reform and accountability remains a major priority.
Manuj Agarwal, MD. Co-Founder and Interventional Radiation Oncologist, Prostate Cancer Institute of America (Wayne, P.A.): I don’t personally operate an ASC; through the Prostate Cancer Institute of America (PCIA), I help centers establish innovative, profitable service lines—most notably prostate brachytherapy. Prostate cancer is the leading cause of cancer in men and represents a high-volume opportunity for ASCs to deliver a curative, same-day treatment performed in under one hour, combining excellent patient outcomes with strong financial performance.
One of the biggest hurdles for ASCs today is adding new procedures that are both clinically meaningful and operationally efficient. At PCIA, we provide the clinical expertise, infrastructure, and turnkey implementation to make that possible—helping ASCs expand their capabilities while advancing access to high-quality cancer care.
