ASCs have taken center stage of many hospital and health systems’ growth and development strategies in recent years as they look to expand access and lower costs while aligning with value-based initiatives.
This includes academic health systems, some of which also utilize ASCs for data collection, innovation and training and development.
While ASC leaders at academic health systems often have more access to resources, capital and research than those at smaller, independent ASCs, they are not entirely immune from the ASC industry’s complex regulatory environment or uphill payer battles.
Jessica Pfister, senior director of operations of ambulatory services and Rachel Carpenter, BSN, RN, associate director of ambulatory surgical services at Ohio State Wexner Medical Center in Columbus recently joined Becker’s to discuss their organization’s experience building an ASC network from the ground up.
Editor’s note: Responses have been lightly edited for clarity and length:
Question: How has your organization’s approach to ASC development changed over the last five years?
Ms. Pfister and Carpenter: The Ohio State University Wexner Medical Center entered the ambulatory surgery center space relatively recently, with our first ASC opening in August 2021 at Outpatient Care New Albany. The facility launched with four endoscopy suites and four operating rooms, and initially focused on GI and GU services. As a new entrant to the ASC environment, we experienced a significant learning curve — most notably a six- to nine-month period to secure reimbursement approval from a majority of payers, which limited early case volume and utilization.
Over time, we recognized opportunities to improve operating room utilization and financial performance. In response, we expanded access to additional service lines and began intentionally aligning procedures to the ASC that were clinically appropriate and operationally well-suited for the outpatient setting. This shift helped us better balance case mix and increase utilization but has resulted in a large number of surgery lines operating out of four ORs.
Our second ASC, Outpatient Care Dublin, opened in 2022 and was designed with a more defined service identity, focusing primarily on orthopedic surgery. This experience reinforced an important lesson for us: successful ASC development requires clear service line strategy and a strong sense of “home” for surgeons, rather than a one-size-fits-all approach.
Five years later, we are working toward ensuring the ASCs have a targeted case mix and an intentional surgeon engagement strategy.
Q: What challenges and/or advantages come with developing ASCs as an academic health system?
JP and RC: One of the greatest advantages of developing ASCs within an academic health system is the strength and expertise of our talented teams. Ohio State is nationally recognized for world-class care and highly specialized, renowned surgeons, which support surgeon recruitment, patient trust and long-term growth in the ambulatory setting. The ASC provides a more personalized experience for both patients and surgeons in a welcoming, community-focused setting, with free parking, easy building access and a smaller footprint that allows for simple, intuitive navigation.
At the same time, there are unique challenges. Our surgeons often practice across multiple locations throughout the city, and our ASCs are located approximately 20 miles from the main campus. This geographic separation introduces logistical complexities related to surgeon scheduling, staffing models, and case coordination. Furthermore, patient eligibility must align with the ASC’s scope of care, which inherently limits the number of patients who can be appropriately treated in this setting.
As an academic medical center, we must approach ASC development as part of an integrated surgical ecosystem rather than standalone entities. Our goal is not solely ASC financial performance, but strategic utilization — shifting lower-acuity, appropriate cases to the ambulatory setting so that main campus operating rooms can be reserved for higher-acuity, complex cases. This system-level view adds complexity but ultimately strengthens access, capacity management and patient care across the enterprise.
