As ASCs face mounting pressure from rising costs, stubborn reimbursement and workforce constraints, having leaders who understand the ASC business model has become critical.
Tina DiMarino, CEO of ASC management company Custom Surgical Partners, joined Becker’s to discuss the biggest obstacle to ASC growth and why ASC-minded leadership is essential for long-term sustainability.
Editor’s note; This interview was edited lightly for clarity and length.
Question: Looking ahead to 2026, what do you see as the biggest obstacle to ASC growth?
Tina DiMarino: It’s interesting, because I’m actually getting an incredible number of calls right now for new ASC development. From an obstacle standpoint, it really comes down to balancing expenses with reimbursement.
Payer contracting is a major challenge — making sure you can secure strong contracts. In some regions, payers won’t even return calls, which is incredibly difficult. Anesthesia is still challenging as well, particularly finding the right model that aligns with a center’s specialty and keeps costs sustainable.
Another big issue is case costing and vendor management. With inflation, it’s become critical to shop vendors carefully and truly understand cost per case. You really have to get into the weeds on pricing — supplies, implants, contracts, all of it.
Ultimately, the biggest challenge is having the right people on your team who understand how important these details are. These costs add up quickly.
Q: Are there other specific expenses ASCs are struggling with when it comes to balancing expenses and reimbursement?
TD: Staffing is a big one — both staffing and anesthesia. It all starts with who you hire. If you don’t hire ASC-minded leadership, that’s a huge challenge.
Finding experienced ASC leadership can be difficult, but when you find the right person, they set the center up for success long-term. That’s incredibly important.
Q: How would you define “ASC-minded” leadership?
TD: Someone with prior ASC experience and a strong track record. We don’t recommend hiring leadership from the hospital environment. Hospitals have much deeper pockets, and the mindset is very different.
In an ASC, you’re operating from one small bucket — everything comes out of that bucket, including owner margin. That requires a fundamentally different approach.
