Surgery centers spent 2025 absorbing rising labor, supply and anesthesia costs against largely flat reimbursement, and the share of ASCs expecting to pay anesthesia stipends jumped from 28% in 2024 to 44% in 2025. For many centers, there’s less room to absorb another increase.
Shakeel Ahmed, MD, has spent about 25 years developing ASCs. The founder and CEO of St. Louis-based Atlas Surgical Group, told Becker’s that there are three line items ASC leaders should be watching most closely if they want to protect their margins.
“The first thing I would consider is to improve your capacity and be more productive with it,” Dr. Ahmed said. “If you have two ORs running, and each case contributes $1,000, and there’s let’s say about 250 OR days per room. By adding two cases per day, you’re looking at half a million dollars in free cash flow … that’s by adding two cases a day. So, increasing existing capacity is your biggest point.”
Dr. Ahmed also emphasized that supply and implant costs can erode the margin on a case. The second line item on his list was the cost of goods.
“This has been a big concern for me, and I write about that all the time,” he said. “Surgeons need to have skin in the game. If they don’t, they will always, always treat the facility as a stepchild, and they will always ask for the shiniest, newest object out there, even though that may not have the kind of performance margin that they touted to have.”
“So, if they have skin in the game and they’re part of the ASC network as an owner or as an operator, long-term operator, cost cutting on the margins would be my second biggest thing,” Dr. Ahmed continued.
Labor is where ASC budgets have grown fastest. The share of ASCs reporting operating budgets of $3 million or more rose from 32% in 2022 to 43% in 2023, with much of that spending tied to staff. For Dr. Ahmed, staffing is the third item on the list and the one that decides whether a center succeeds.
“Staffing makes you, and staffing breaks you,” he said. “If you have the right staff running your ASC, you have hit gold. If you don’t, that’s going to sink your ship. That’s your Waterloo right there.”
On anesthesia, another consistent ASC cost calculation, Dr. Ahmed acknowledged the vastness of both provider shortages and rising compensation, which have pressured ASC schedules and margins as centers take on more complex cases, and the reimbursement math has become harder to make work.
“I think one of the biggest issues facing ASCs is anesthesia, and I wish there was a magic wand that we could all shake and make this issue disappear,” Dr. Ahmed said. “But that’s just something that is here to stay.”
“I read about surveys online, and almost 70% to 80% of ASC leaders around the country identify anesthesia as the biggest financial challenge for us,” he said. “Availability is an issue. Cost is an issue. Reimbursement is an issue. So I’m hoping that’s something that we eventually could fix.”
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.
