From block time hoarding to implant cost blindness, a select few wedges drive the gap between a busy ASC and a profitable one.
Operational inefficiencies, misaligned physician incentives and a volume-first mindset are quietly eroding margins at centers where the OR looks full but the bottom line tells a different story.
Forty-one ASC leaders, administrators and physician partners joined Becker’s to discuss the one thing they wish surgeons truly understood about running a profitable ASC.
Like what you see here? Join us at Becker’s 32nd Annual: The Business and Operations of ASCs in Chicago. Learn more here. All of the contributors to this article will be speaking at the event.
Editor’s note: Responses were edited lightly for clarity and length.
Question: What’s one thing you wish physicians/surgeons understood about running a profitable ASC?
Elisa Auguste. Administrator of Precision Care Surgery Center and Vice President of the New York State Association of ASCs (East Setauket, N.Y.): Flexibility is everything.
It shows up in three key areas:
1. Supplies and implants. Defaulting to the same products and techniques you’ve always used is the path of least resistance, but it’s rarely the path to profitability. Alternative products and approaches can match or even improve patient outcomes while increasing efficiency and saving the facility money. In a hospital setting, cost isn’t top of mind for a surgeon, but when it’s your center, it has to be.
2. Block time. Holding onto block time “just in case” hurts the bottom line. If another high-volume surgeon can fill that time, let them. The center wins, and so do you as an owner.
3. Ownership. Everyone wants a piece of an ASC for the autonomy and financial upside, but gatekeeping ownership is one of the fastest ways to stall a facility’s growth. Surgeons without a financial stake have little reason to keep bringing cases your way. Broadening ownership ties more surgeons to the center’s success, and that’s what keeps the case volume, and the profits, coming.
Vijay Bachani. President and Chief Growth Officer of New York Bariatric Group (Roslyn Heights, N.Y.): The margin for error in an ASC is much smaller than in a hospital, and physicians do not always feel that until they are on the ownership side. On-time starts, case costing, and cancellation discipline are not administrative details; they drive whether the case is profitable or not. Anesthesia is a good example. Per diem and outside anesthesiologists have become very expensive, and if we do not give enough notice on a cancellation, we still have to pay them. Running a tight ship is not a cultural preference; it’s the difference between making money and losing it.
Peter Bravos, MD. Chief Medical Officer of Sutter Health Surgery Center Division (Sacramento, Calif.): Many physicians assume that a full OR schedule automatically means an ASC is performing well financially, but that is often not the case. A day can feel busy and still lose money when rooms run over, turnovers are slow, implant costs are poorly controlled, or anesthesia coverage extends into overtime.
ASC performance depends not simply on volume, but on disciplined management of patient selection, implant costs, case duration, staffing models and throughput. Financial success is ultimately created through consistent operational execution across the entire perioperative team.
Physicians with equity ownership in an ASC often learn these dynamics quickly because they directly experience the financial consequences of operational inefficiency. By contrast, physicians without ownership may have less visibility into the operational and economic factors that shape ASC performance behind the scenes.
Faisal Chaudhry, MD. Administrator of Des Peres (Mo.) Square Surgery Center: One thing I wish more physicians understood is that ASC profitability is driven far less by raw volume and far more by operational alignment. A center can be extremely busy and still underperform financially if there’s excessive implant variation, fragmented block utilization, inconsistent throughput, or unnecessary workflow complexity.
Physicians often view throughput as purely an operational metric, but in reality, it’s a cultural and leadership metric. The highest-performing ASCs I’ve seen aren’t necessarily the ones with the newest equipment or largest footprint — they’re the ones where surgeons collectively buy into predictability: accurate scheduling, on-time starts, thoughtful case sequencing, standardized preferences when clinically appropriate and accountability around turnover expectations.
That alignment matters even more today because labor has become one of the defining pressures in ASC performance. Last-minute schedule changes, extended room downtime or inconsistent utilization patterns create staffing inefficiencies that quietly erode EBITDA over time.
The best physician partners understand that operational flow is just as important as case volume. When physicians and operators truly work together around efficiency, standardization and patient flow — without compromising clinical autonomy — that’s where scalability, sustainability and long-term margin strength really come from.
Shannon Cliett. Chief Operations Officer of US Pain Care: Optimization isn’t optional anymore — it is the margin. The biggest hidden cost in an ASC isn’t on any line item; it’s the workflow you haven’t automated yet. Every block schedule built without AI-driven optimization leaves room time on the table. Every patient called and re-called instead of guided through a portal is staff hours you’re paying for twice. And EMR data sitting unused is profitability you can’t see — case costs, supply waste and surgeon-level margins are all hiding in there.
Physicians often view machine learning, AI, and fully implemented EMR and patient portal tools as overhead. As Paul Lynch, MD, CEO of US Pain Care, recently put it in Becker’s ASC, underusing technology and AI is “the biggest financial mistake ASCs are making right now.” The real overhead is the burnout, turnover, and missed revenue that comes from running a 2026 ASC on 2010 workflows. The centers that thrive over the next decade won’t be the ones with the best surgeons alone — they’ll be the ones whose surgeons understood that the technology stack is the business.
Brenna Couch. Purchasing and Operations Manager at the Surgery Center of Athens (Ga.): One thing I wish physicians and surgeons fully understood about running a profitable ASC is that time and money are truly interchangeable.
From an operational standpoint, efficiency begins long before a case starts and continues well after the patient leaves the OR. While surgeons often focus on their time from incision to closure, the reality is that every minute surrounding that window has a direct financial and operational impact.
Incomplete or inconsistent documentation requires significant administrative follow-up. Cases that are not accurately posted can disrupt scheduling and staffing. Certain patient populations, such as pediatrics, require additional recovery resources. Sterilization turnaround times, room readiness and staffing coordination all play critical roles in maintaining flow.
When these elements are not optimized, the result is increased labor hours, delays and inefficiencies that ultimately affect the ASC’s financial performance. A shared understanding of the full scope of time investment — across the entire perioperative process—allows for better collaboration and a more efficient, profitable operation for everyone involved.
Whitney Courser. Chief Operating Officer of NueHealth (Leawood, Kan.): ASC profitability is ultimately determined at the case level, and the financial reports most centers rely on today are too fragmented and too delayed to manage performance effectively in the current environment. Knowing your margin per OR minute, understanding true case cost and revenue performance at the procedure and surgeon level, and seeing how that compares to peers in real time is the level of visibility required to protect and grow margin over the next decade. The financial pressure facing ASCs is not going away and only makes that visibility more critical going forward. Every surgeon and center should be building this analytical foundation now. Those that do will be far better positioned to adapt competitively and compound profitability over time than those still running their business off basic financials.
Daniel Decker, MD. Co-Founder of Vitality Plus Urology Clinic (Mountain Home, Ark.): A profitable ASC is not necessarily aligned with what is best clinically at an ASC. Physicians and surgeons best suited for ASCs will have the utmost priority on clinical care. ASCs will optimize clinical outcomes through improved efficiencies, focused communication, and a unifying team approach for superior patient experience and results.
Unfortunately, in the current ASC system metrics, good clinical outcomes do not always equal a profitable ASC. The common theme across all specialties in ASCs is that case selection matters for profitability more than clinical outcomes. That is, for physician/surgeon profitability at ASCs, their clinical decisions and case selection must factor in numerous different payor contracts along with vendor contracts and constant inherent variabilities. Also, the timing and urgency of cases must factor in prior authorizations, payor delay tactics, and peer reviews beyond the numerous clinical considerations.
In an age of medicine with what seems to be an exponentially expanding range of clinical variables to balance, the added “profitable considerations” could compound burnout and moral injury. ASCs, which often are outlets for increased physician/surgeon autonomy, could create an opposite effect if profitable ASC concerns solely prevail. Balancing clinical decisions versus profitability at ASCs can be a challenge as is. Ideally, this system would be changed so that clinical outcomes are more aligned with profitability and not in the current state of often apposition. Site neutrality and value-based care hold potential but remain an elusive reality.
Jeff Dottl. Principal for Physicians Surgery Centers (Ventura, Calif.): If I had to pick one thing I wish physicians understood about running a profitable surgery center, it would be that when they get upset at something, it is better to discuss it with management instead of pulling their cases away from the surgery center where they own a share. Physicians, especially physician partners, have a significant amount of control over what happens at their surgery centers. They should act like it when something doesn’t go as expected and work with the management team to correct the issue. ASCs, unlike hospitals, have very little bureaucracy to wade through and make meaningful (and often helpful) changes.
Bruce Feldman. Administrator of Bronx Ambulatory Surgery Center (New York City): The key KPI to know is your case costs. In today’s ASC environment, it is no longer about the number of cases your facility is doing each month, but rather the type of cases your facility is doing. You really need to know your cost (supplies, labor, overhead, etc.) for each case performed by type as well as by surgeon. This is especially applicable when implants are involved, as many third-party payor’s reimbursement for implants is below the actual cost paid for the implant, which could translate to shrinking profit margins. This is especially true in the area of orthopedics and spine which have a heavy reliance on the use of implants (joint replacements).
Megan Friedman, DO. Chair and Medical Director of Pacific Coast Anesthesia (Los Angeles): One thing I wish physicians and surgeons understood is that profitability in an ASC is not simply about cutting labor costs or trying to squeeze in one more case at any cost. Sustainable profitability comes from operational planning, efficient scheduling, and understanding cost per case across the entire day. Capturing an additional case does not create value if it results in overtime, staffing inefficiencies, or workflow disruption that outweighs the revenue generated. Strong anesthesia partners are critical because we have similar financial incentives as the center and a unique view across the entire perioperative system. We see scheduling patterns, pre-op bottlenecks, turnover opportunities and resource utilization in real time, making anesthesia an operational partner, not just a provider for individual cases.
Michael Gale. Administrative Director of Sentara Obici Ambulatory Surgical Center (Suffolk, Va.): Understanding that supply costs require their support when dealing with surgical suppliers. And that maintaining on time starts for the surgery day is important even though it’s “their” block time. In order for the physician-surgeons to be useful in the perpetual struggle to keep COGs down, they need to be willing to learn what I’m up against. Reimbursement, labor and cost of goods are all factors. But negotiating with surgical suppliers requires the physician-surgeons to have a baseline understanding of how significant big-ticket items like implants versus the available alternatives can be when considering one vendor over another. The surgeons can be powerful allies for me. Better clinical outcomes, efficiency and improved function are also important considerations. And should be part of the discussion. Presenting a unified front to the vendor is the goal. The better I am at hammering out a capitated pricing structure with multiple vendors for a procedure class, the more choice the physician-surgeon ends up with on those supplies.
The advantages of an on-time surgery day are obvious. There are significant disruptions to patient wait times, labor expenses, morale and discipline when we are chronically late at the beginning of the surgery day. And, in many cases, physician surgeons have surgery later in the day at a hospital and have a hard lid on their day at the ASC, no matter what the length of their block time is. We may have to reschedule our end-of-day cases for this reason, etc.
Sean Gipson. CEO and ASC Division President of Remedy Surgery Center (Houston): One of the biggest misconceptions physicians and surgeons have about running a profitable ASC is believing that profitability is primarily driven by surgical talent or case volume alone. Clinical excellence is essential, but it is not what determines whether an ASC consistently performs well financially. Operational discipline does. The highest-performing ASCs are not necessarily the busiest centers or the ones performing the most complex procedures. More often, they are the organizations that have built highly efficient, standardized, and predictable operations.
In today’s environment of reimbursement pressure, staffing shortages, and increasing payer scrutiny, operational efficiency has become just as important as surgical expertise. Small inefficiencies compound quickly in an ASC setting. Things like late starts, excessive turnover time, unnecessary implant variation, inconsistent scheduling, overtime staffing costs, poor charge capture and last-minute cancellations. Individually, these issues may appear minor. Collectively, they can significantly erode margins.
Many physicians are surprised to learn that a high-volume surgeon is not always the most profitable surgeon for an ASC. A surgeon with predictable case times, efficient workflows, standardized supply usage, and strong scheduling discipline can often contribute more to the bottom line than someone performing a greater number of cases with higher variability and resource utilization.
The most successful ASCs operate with a mindset like high-performing service industries or advanced manufacturing systems. They focus relentlessly on reducing variation, improving throughput, standardizing processes, and creating repeatable outcomes; all while maintaining exceptional patient care.
This becomes even more important as higher-acuity procedures continue migrating to the outpatient setting. Spine, orthopedics, cardiovascular, and total joint programs require ASCs to balance clinical complexity with operational precision. The centers that succeed will be those capable of demonstrating high-quality outcomes, lower total cost of care, operational predictability, positive patient experiences, and strong financial stewardship.
Another hard truth many organizations eventually face is that not every case is a good ASC case financially. Sustainable profitability sometimes requires saying no to poorly reimbursed procedures, renegotiating payer contracts, or reevaluating physician preference items that unnecessarily increase costs without improving outcomes. Ultimately, profitable ASCs are rarely built through volume alone. They are built through disciplined execution. As the ASC industry continues evolving, the organizations that thrive will be those that understand that operational excellence is no longer a support function; it is a strategic advantage.
Tara Good-Young. CEO of PDI Surgery Center (Windsor, Calif.): Strategic scheduling for a cash-flow-positive case and payer Mix is a team sport with their ASC financial and scheduling partners. Physicians and surgeons need to be aware of not just the mix, but case costs and payer behavior. These details determine the time value of money and whether margins materialize.
Higher gross reimbursement diminishes when cases require expensive implants, long PACU time, plus come from insurers that pay slowly or demand repeated prior authorizations. The net contribution per case = revenue after variable costs, denials and administrative effort; this metric should guide strategy.
Payer behavior matters as much as rate. Slow payments increase working capital needs, while frequent prior‑auths, denials and resubmissions consume staff time — raising overhead. Those costs erase the higher rate advantage; stay advised on average days‑to‑pay, denial rates and staff hours per claim. Strategically reserve prime blocks for procedures with the best net contribution and predictable authorization requirements and prioritize referrals from payers that pay promptly and cleanly.
Aligned incentives reward physicians, owners and staff for improving net contribution rather than just raw volume. Use case‑level margin data in payer negotiations and scheduling decisions, and model the time value of money when assessing contracts. When surgeons and the ASC operational team optimize together for case mix, payer behavior and cash flow, efficiency gains and clinical excellence translate into sustainable profitability.
George Hanna, MD. President and Director of Pain Management at VIP Medical Group: One thing physicians and surgeons must understand is that ASC profitability is no longer just an operations issue — it is also a payer strategy issue. You can run an efficient center, have strong surgeons, manage supplies carefully, and still be materially impacted by insurer behavior that restricts access to care.
We are seeing insurers increasingly pressure ASCs around which physicians can perform cases and what types of care they will tolerate in the facility setting. Policies that penalize or threaten in-network ASCs for working with out-of-network physicians are especially concerning. In practice, that can bully facilities into refusing appropriate cases or limiting physician participation, even when the care is clinically sound and the ASC is the most efficient setting for the patient.
That is a major threat to the ASC model. ASCs exist because they provide high-quality, lower-cost, physician-led care outside the hospital environment. If insurers can use contracting leverage to dictate which physicians can operate, which cases can be performed, or which independent practices can access the ASC setting, then the system loses competition, patients lose options, and independent surgeons are pushed further into consolidation.
So my answer is this: physicians need to understand that ASC profitability depends on more than case volume. It depends on protecting the integrity of the ASC model itself — physician autonomy, patient access, fair reimbursement, and resistance to payer tactics that undermine independent surgical and procedural care.
Donna Hayden. Director of Supply Chain Operations at Duly Health and Care Lombard (Ill.) ASC: Physician engagement is critical in driving cost efficiency, particularly around implant and supply standardization. Establishing alignment among providers to utilize a preferred vendor for the majority of implant needs can significantly reduce variability and lower the overall cost per case. While recognizing that clinical exceptions will always exist, minimizing unnecessary variation is essential. Consistent adherence to agreed-upon standardization strategies enables organizations to leverage volume, strengthen vendor partnerships, and achieve more sustainable cost control without compromising patient care.
Kathleen Hickman, RN. Administrator and Clinical Director of Dutchess Ambulatory Surgical Center (Poughkeepsie, N.Y.):
- Physicians and surgeons need to understand vertical vs. horizontal block utilization. Many surgeons do not monitor their surgical blocks and often have ½ days. If multiple surgeons have the same pattern, the ASC is not operating in an efficient and profitable manner. They need to monitor their schedules and block usage and only request enough block time that they can fully utilize.
- Adding specialties and cases may look good in terms of schedules, but profitability is an important focus. With the lean margins ASCs typically face, as well as the decrease in reimbursement and increase in materials costs, ASCs need to strategically analyze all specialties and cases before adding to the ASC.
Marcelo Hochman, MD. Independent Physician and Former President of Independent Doctors of South Carolina (Charleston): I wish doctors would look at alternative business models regarding ASCs. Specifically, running an ASC on an all-cash or direct-to-employer contracts (not traditional third-party/insurance payments) is a tremendous opportunity. This allows extremely transparent pricing (all encompassing price-surgeon fee, anesthesia, facility fee) so patients/companies can shop and choose. It removes the bureaucratic layers that inflate pricing. By closing the gap between who is receiving services (patient/employer) and paying for those services (same), we get closer to a traditional, true”‘fee for service” model, which has been proven over and over again to reduce costs, increase quality and satisfaction.
Narasimhan Jagannathan, MD. Division Chief of Anesthesiology at Phoenix Children’s: One of the biggest misconceptions is that an ASC becomes more profitable just by doing more cases. Volume definitely matters, but only doing more cases doesn’t automatically mean better financial results. Long-term success comes from making sure the right patients are treated in the right setting, keeping care processes consistent/efficient, and reducing unnecessary variation. Carefully selecting patients, using standardized perioperative processes, and staying focused on safety can lead to better outcomes and smoother operations. Investing in quality, efficiency, and family-centered care helps drive clinical outcomes and financial successes.
Neal Kaushal, MD. Executive Director of General GI and Endoscopy at OU Health (Edmond, Okla.): One thing I wish more physicians and surgeons understood about running a profitable ASC is that profitability is not simply about case volume — it is about operational discipline.
A busy ASC is not automatically a profitable ASC. The financial health of the center depends on the right case mix, efficient room utilization, disciplined supply and implant management, appropriate staffing models, strong payer contracts, and consistent physician alignment around workflow. Small inefficiencies that may seem insignificant at the individual physician level — late starts, preference card variation, poor block utilization, inefficient turnover, inconsistent documentation, or unmanaged supply costs — can have a major cumulative impact on margins.
Physicians often think of the ASC primarily as a clinical environment, but ownership requires understanding it as a business platform as well. The most successful centers are those where physicians remain deeply committed to quality and patient experience while also recognizing that every operational decision has financial consequences. Profitability is created when excellent clinical care and disciplined business operations move in the same direction.
Earl Kilbride, MD. Orthopedic Surgeon at Austin (Texas) Orthopedic Institute: ASC profitability follows a very specific formula. It merely is volume and contracts. Most surgeons know their volume. Most surgeons don’t know their contracts. Many procedures can flip from being underwater to profitable with good information. Without it, the opposite can occur. A good administrator will make this part of their daily schedule, but it’s the partners’ responsibility to educate themselves and each other to protect the interest of the ASC and optimize its financials.
Ira Kornbluth, MD. President of Clearway Pain Solutions (Annapolis, Md.): ASC profitability depends primarily on scheduling efficiency, optimized staffing, tight procurement processes and case mix.
Scott Kulstad. CEO of St. Paul (Minn.) Eye Clinic: In an ASC, profitability isn’t about doing great surgery — it’s about doing great surgery within a highly disciplined, efficient system where every minute, supply choice, and scheduling decision compounds.
- Minutes matter, Part I: Start on time, every case and be realistic (and consistent) about case duration.
- Minutes matter, Part II: Help fill your block time — or release it.
- Variation is expensive, Part I: Small variations in physician behavior have outsized impact.
- Variation is expensive, Part II: Standardize supplies where clinically appropriate.
- Not all cases are equal: A busy day doesn’t necessarily mean it’s a profitable day.
- Be mindful of high-cost items that may not be reimbursed.
These tenants are not purely administrative. They represent the economic engine of the ASC and are often physician-dependent behaviors.
Jessica Lam, PhD. Practice Manager at Pacific Coast Anesthesia (Los Angeles): One thing many physicians and surgeons do not fully appreciate is that anesthesia in an ASC functions as a coverage model, not simply a per-case service. Unlike nursing labor pools that can often flex more easily, anesthesia coverage has to be planned in advance to support room availability, turnover demands, add-ons, and workflow variation throughout the day.
This is why strong operational planning and partnership with anesthesia leadership are so important. Anesthesia has a unique view across the entire perioperative system and sees scheduling patterns, bottlenecks, staffing needs, and resource utilization in real time. The most successful centers are not necessarily those focused only on adding volume, but those that build efficient schedules and protect operational consistency across the day.
Benjamin Levy III, MD. Gastroenterologist at University of Chicago Medicine: An important area of ASC management for increasing productivity and profitability is ensuring that endoscopy schedules are completely full each day. Physicians can help by carefully explaining colonoscopy prep instructions during gastroenterology clinic visits. Also, gastroenterologists should ensure referring primary care physicians provide colonoscopy prep handouts for directly scheduled procedures. We can prevent many ASC cancellations by increasing adherence to colonoscopy prep instructions. When cancellations occur, endoscopy center schedulers should use a wait list to fill remaining spots with colonoscopies and EGDs (depending on the available lead time). Hopefully, in the future, AI software can help fill last-minute endoscopy cancellations with urgent EGDs from the wait list.
Xi Luo, MD. Clinical Associate Professor in the Department of Anesthesiology & Pain Management at UT Southwestern (Dallas): Running a profitable ASC is less about minimizing staffing costs and more about preserving predictable throughput. Facilities often see profitability through the lens of maximizing case volume through lean staffing. However, sustainable profitability is usually driven by operational reliability.
Behind the scenes, ASC success depends heavily on coordination between nursing, surgeons, and anesthesia teams. Shared decision-making around patient selection, case complexity, scheduling, and block utilization directly influence whether a center operates efficiently or accumulates delays, day of cancellations, overtime, burnout, and turnover.
Staffing models designed purely around minimum labor expense often become fragile during periods of workforce uncertainty and disruption. Moderate and predictable staffing, while sometimes appearing less efficient on paper, may better preserve workforce stability, morale, retention, and ultimately throughput and scalability.
Not all efficiency strategies apply equally across all cases. Split-flow rooms and compressed turnover models work best when case duration is short, predictable and turnover savings can be captured consistently throughout the workflow. Maintaining block predictability and honoring scheduling expectations often creates more durable profitability than maximizing utilization metrics alone. Ultimately, ASC profitability is not simply a financial exercise; it is an operational exercise in maintaining reliable throughput while preserving the workforce required to sustain it.
Paul Lynch, MD. Founder and CEO of US Pain Care (Scottsdale, Ariz.): Revenue is vanity; margin is sanity. The biggest blind spot I see with surgeons is the assumption that a busy OR is a profitable OR. It isn’t. A center can run at full capacity and still lose money if the case mix carries the wrong cost structure. Every case has two numbers that matter: what we collect and what it costs us to deliver it. A $4,500 case with $3,200 in supplies and an hour of turnover is a worse business than a $2,000 case with $300 in supplies and a 15-minute turnover. Volume amplifies whichever direction your margin is already pointed.
At US Pain Care, which is 100% physician-owned, we’ve made cost containment a core focus rather than an afterthought. Our supply costs are among the lowest in the business, and every dollar we squeeze out of preference cards, vendor contracts, and turnover time drops straight to the bottom line for our partners — who are the same surgeons standing at the table. That alignment changes behavior. When the physician holding the scalpel is also the one signing off on the implant contract, suddenly the $40 disposable that nobody actually uses comes off the tray, and the “we’ve always done it this way” preference card gets rebuilt from scratch. That’s how you build a profitable ASC: not by chasing more cases, but by making sure every case you do leaves more money in the room than it took to deliver.
Justin Marburger. Director of Surgical Services of Plastic and Cosmetic Surgery Center of South Texas (San Antonio): One of the biggest misconceptions about ASC profitability is that financial success is driven primarily by cost reduction. In reality, the most sustainable and profitable ASCs are built through investment in people, culture, operational consistency, and physician support.
Financial discipline is important, but the most successful ASCs understand that sustainable profitability comes from investing in the people and infrastructure necessary to consistently deliver exceptional care.
That starts with investing in staff. Paying employees what they deserve, supporting their professional growth, and creating a culture of accountability and respect are critical to long-term success. Retaining experienced staff ultimately costs far less than constantly rebuilding teams. Experienced teams operate more efficiently, communicate more effectively, strengthen patient confidence, and create a more consistent experience for surgeons.
Equally important is creating an environment where physicians — especially guest surgeons — feel welcomed, supported, and valued. Surgeons notice the operational details: whether the correct instrumentation is available, whether workflows are efficient, whether rooms turn over smoothly, and whether leadership responds when concerns arise. Those details directly impact physician confidence and ultimately influence where surgeons choose to bring cases.
I also believe strongly in prioritizing quality over quantity. Growth without the operational structure to support it can quickly damage culture, efficiency, staff morale, and patient experience. Sustainable ASC growth requires leadership teams willing to invest in the right people, proper equipment, communication, and continuous process improvement.
Issues will arise in every facility. The difference is whether leadership addresses them quickly, transparently, and consistently. Strong communication and accountability build trust among staff and physicians alike, while unresolved operational problems gradually erode confidence and culture.
In my experience, the most profitable ASCs are not necessarily the ones focused solely on maximizing volume. They are the organizations that create stability, invest in their teams, support their physicians, and maintain operational excellence over time. When those foundational pieces are in place, profitability becomes the natural byproduct of a strong and sustainable organization.
Brett Maxfield, CRNA. President and CEO of Maxfield Healthcare Solutions: The one thing that I wish that surgeons had a better understanding of when it comes to running a profitable ASC is the impact that their schedule, and ability to follow a schedule, has on the bottom line and overall financial health and stability of the ASC. They are always very quick to look at staffing costs, procedure costs, administrative cost, etc., but often lack an understanding of how much their scheduling impacts all of those things. For example, scheduling five Anesthesia providers so you can have five starts in five rooms that are only utilized 20 to 60% is an enormous waste of resources. Continuously running behind has a huge psychological and emotional impact on staff, and can carry a large financial burden when it repeatedly causes overtime. Little things like this add up quickly to become a big problem, and often times, surgeons are so concerned with the convenience of their schedule that they don’t stop to think of the impact of their schedule.
Taif Mukhdomi, MD. Interventional Pain Physician at Pain Zero (Columbus, Ohio): An ASC is, first and foremost, an operational business. Developing efficient protocols and thoughtfully designing the entire patient journey: from check-in to discharge while clearly defining staff roles at each stage is critical to long-term success. Only after truly understanding the operational side can physicians fully optimize the medical business.
A moderately busy ASC with strong operational efficiencies can often outperform a higher-volume facility financially. Efficiency, standardization, and accountability ultimately drive sustainability and profitability.
Culture is also a financial variable. People talk. Medicine is a small world, and once culture deteriorates, rebuilding trust among staff, physicians, and patients becomes an uphill battle. High turnover, poor communication, and lack of alignment inevitably affect both patient experience and the bottom line.
While ASC margins can be very attractive, profitability is far from guaranteed. For younger physicians evaluating whether to buy into a surgery center, there is often more to consider than the allure of ownership itself. The more important questions should be: Will this center maximize my long-term financial upside? Is the operational model sustainable? And just as importantly, will this be professionally and personally fulfilling over time?
Sandra Oglesby, RN. Administrator of The Surgery Center at Tampa General Hospital’s Brandon Healthplex: One thing I wish physicians understood about running a profitable ASC is that collaboration is essential. Our ASC invests significant time and effort on the front end to ensure cases stay on the schedule; from verifying benefits to reviewing medical histories and coordinating anesthesia clearance. Physicians can support this work by recognizing that patient selection is critical to ASC success.
ASCs are designed for predictable, lower‑risk cases. When physicians schedule borderline patients, the entire system absorbs the impact: cancellations, delays, anesthesia refusals, extended recovery times, and financial losses. Understanding this helps protect both safety and efficiency.
Knowing your patient and understanding anesthesia guidelines are essential. ASCs run on tight block times and thin margins, and avoidable or last‑minute cancellations directly affect profitability and workflow.
We are fortunate that our anesthesia medical director is consistent, experienced, and always willing to review cases ahead of time. This level of partnership is what keeps our facility running smoothly, safely, and profitably.
Neil Parikh, MD. Chair of the Innovation Committee at GI Alliance and Chief of Gastroenterology at Hartford (Conn.) Hospital: I’ve learned that sustainable ASC profitability doesn’t come from pushing people harder — it comes from designing systems where every team member is empowered to perform at the top of their license and feels ownership in the mission.
When physicians truly partner with staff, respect their expertise and invest in culture, communication, and workflow optimization, you see it reflected everywhere: patient satisfaction, safety metrics, turnover times, staff retention and ultimately financial performance.
Mick Perez-Cruet, MD. Professor and Vice Chair of Neurosurgery at Oakland University William Beaumont School of Medicine (Auburn Hills, Mich): Surgeons need to partner with fellow surgeons who will bring profitable cases to the ASC. Working together to make the ASC profitable is the key. Greed and self-interest have no place in effective ASC management.
Adamina Podraza, MD. Anesthesiologist of Anesthesia Consultants of Morris and Medical Director of Deerpath Ambulatory Surgical Center (Morris, Ill.): Profitability is not only based on case volume but also on optimizing block scheduling and efficiency of turnover. Having consistent staff is essential to optimize a routine which in turn leads to decreased costs and increased profit.
John Prunskis, MD. Medical Director and Principal at DxTx Pain and Spine (Chicago): Physicians and surgeons providing care in ASCs need to contact their Congressman and enator as well as CMS to support legislation that would remove co-pays and deductibles for patients having their care at an ASC. Even with waiving the co-pay and deductibles the savings to Medicare and all insurance companies would be substantial compared to the cost of care for identical procedures rendered in a hospital setting. Being in touch with your Congressman and Senator are critical elements of making sure that our patients have access to necessary, excellent and cost-effective care.
Melissa Rice. Administrator of Loyola Ambulatory Surgery Center at Oakbrook Terrace (Ill.): One thing I wish physicians and surgeons fully understood about running a profitable ASC is how tightly clinical decision-making is tied to financial performance. Case selection, supply choices, and scheduling patterns directly affect margins just as much as reimbursement rates do. For example, using higher-cost implants or supplies when equally effective alternatives exist, or allowing variability in preference cards, can quietly erode profitability over time. Similarly, block time that isn’t optimized or cases that run inefficiently can create unused capacity—one of the biggest hidden costs in an ASC. Profitability isn’t about limiting care; it’s about standardizing where appropriate and aligning clinical excellence with operational discipline.
Another key area is the importance of payer mix and contracting. Physicians often don’t see how reimbursement variability between commercial insurers, Medicare, and out-of-network cases can significantly influence overall financial health. Bringing in high-quality cases is critical but ensuring those cases are aligned with favorable contracts is equally important. Surgeons play a vital role here by helping facilities grow strategically recruiting cases that fit the ASC model, supporting bundled or value-based approaches, and understanding when a case may be better suited for the hospital setting.
Ultimately, the most profitable ASCs are those where physicians act as true partners in the business—not just users of the facility. When surgeons understand the impact of their choices and collaborate with administrators on efficiency, supply chain, and growth strategy, it creates a high-performing center that benefits everyone: physicians, staff, and, most importantly, patients.
Kayla Schneeweiss-Keene. Administrator at Mann Cataract Surgery Center (Houston): Running a profitable ASC is about far more than surgical volume and reimbursement. Physicians and surgeons must also understand the extensive regulatory requirements, accreditation standards, compliance expectations, and operational oversight required to safely and successfully operate an ambulatory surgery center.
Every ASC must maintain compliance with state and federal regulations, CMS requirements, infection control standards, quality assurance programs, credentialing processes, life safety regulations, and accreditation standards through organizations such as The Joint Commission, AAAHC, or Accreditation Commission for Health Care. Failure to properly manage these areas can place the ASC, physicians, staff, and patients at significant legal, financial, and operational risk.
Because of this, it is critical that physicians invest in experienced leadership and support ongoing education for their ASC administrator and Director of Nursing. Sending ASC leadership to conferences, regulatory trainings, and industry education programs is not an expense, but an investment in protecting the surgery center, maintaining compliance, improving efficiency, and ensuring long-term profitability. Regulations, payer requirements, and best practices are constantly evolving, and leadership must remain current to effectively guide the facility.
It is equally important that physicians empower their ASC administrator and operational leadership team to make and enforce decisions necessary for safe and compliant operations. While physician input and collaboration are essential, the administrator must have the authority to implement policies, maintain standards, address operational concerns, and guide what can and cannot be performed within the ASC environment. This structure helps protect the physicians, staff, and patients while ensuring the facility remains compliant, accredited, efficient, and financially sustainable.
Tammy Smittle, RN. CEO of Stonegate Surgery Center (Austin, Texas): One of the biggest challenges in running a profitable ASC is balancing surgeon preference with implant cost discipline. Many surgeons have long-standing relationships with implant reps and vendors they trust — and those relationships absolutely matter for clinical confidence, efficiency, and outcomes. But in today’s reimbursement environment, implant costs can quickly erase ASC margins, especially in orthopedics and spine where reimbursement is often fixed while supply costs continue to rise.
The most successful ASCs are not the ones that eliminate physician choice — they are the ones where surgeons and administration work together to understand the financial impact of implant selection, standardization opportunities, and pricing transparency. A great clinical outcome and a financially sustainable ASC have to coexist.
Leo Spector, MD. CEO of OrthoCarolina (Charlotte, N.C.): I wish they more clearly understood the difference between being a productive surgeon in a surgery center and being a productive owner-operator of a surgery center. Technical excellence in the operating room does not automatically translate into success in governance, strategy, or operations. To run a truly profitable and sustainable surgery center, surgeons need to learn to think and act like business owners in addition to surgeons — focusing on financial stewardship, operational efficiency, culture, and long-term growth — rather than approaching decisions solely through the lens of clinical practice. When surgeons embrace that owner mindset, the center is far better positioned to align incentives, invest wisely, and perform at a high level for the benefit of the patients – first and foremost – as well as the practitioners and the surgery center.
Teresa Tam, MD. Minimally Invasive Gynecological Surgeon and Owner of All for Women Healthcare (Chicago): The one thing I wish more physicians and surgeons understood about running a profitable ASC is that it is not simply about the volume of cases — it is about consistency, efficiency and proficiency.
OR efficiency is paramount. Filling your time blocks and minimizing room turnover time are critical drivers of profitability. A well-run OR schedule that maximizes every minute of block time will outperform a high-volume but disorganized one every time. Optimizing scheduling to reduce gaps and late starts is equally essential.
Equally important is fiscal discipline. Avoid purchasing unnecessary supplies and equipment. It is easy to get caught up in the latest technology or to overstock supplies, but lean, intentional purchasing goes a long way in keeping an ASC financially healthy.
On the revenue side, negotiating strong payer contracts and reviewing them regularly ensures you are being fairly reimbursed for the care you provide. This is an area that is often overlooked but can significantly impact the bottom line.
Strategic growth also matters. Recruiting high-volume, efficient surgeons who align with the ASC’s culture and mission is a key driver of long-term profitability.
Finally, and perhaps most importantly, is staff and culture. Retaining experienced staff is critical. Turnover is costly both financially and operationally. Incentivizing staff with performance-based bonuses tied to efficiency metrics motivates the team to take ownership of outcomes. And fostering a culture of ownership among physician partners creates accountability and pride that permeates every aspect of the ASC’s performance. In short: consistency breeds efficiency, and efficiency breeds profitability.
Faisal Rahman, PhD. President and CEO of APAC Partners (Crown Point, Ind.): I wish physicians/surgeons understood that the success of the center comes from the combined effort of all staff — staff will care about patients if they feel that the physicians/surgeons care about them.
Tricia Wollam. Administrator of Alliance Surgery Center (Traverse City, Mich.): One thing many physicians don’t fully see is that to be a profitable ASC, you must build it based on consistency of operation and not just on surgical volume. Profitability comes from all the small operational decisions that happen every day. Staff culture, efficiency, cost control and physician alignment all directly affect profitability and long-term sustainability for the ASC.
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.
