Marc Greenberg, MD, a minimally invasive spine surgeon at Providence, R.I.-based University Orthopedics, has operated in some of the most complex environments in spine surgery, but when he talks about what makes a patient experience better in 2026, he doesn’t start with the surgeon.
He starts with the parking garage, the front desk, the four-hour delay that turns a planned procedure into a day-long ordeal, and the quiet anxiety of walking into a hospital where no one seems to know what happens next.
“At a larger hospital, it means you might wait four hours for your surgery to start and start later than expected,” Dr. Greenberg said. “It means you have to pay $30 to go park.”
Ownership is the patient experience advantage
Dr. Greenberg said orthopedic and spine ASCs are pulling away not because they do radically different surgery, but because they run a radically different system around the surgery. In his view, the best ASCs operate almost like small teams with shared stakes, a structure that naturally creates accountability.
“I think ASCs really show, in almost an egalitarian way, when people have ownership and a stake in the product and the experience,” he said.
That ownership becomes visible in the details patients remember. In an ASC, the experience doesn’t blur into a massive enterprise where no one knows who’s responsible for what. It’s personal, immediate and, critically, fixable.
“If you tell me at my surgery center that the front desk person was not nice, I know exactly who that person is,” Dr. Greenberg said.
It’s not the surgeon — it’s everything else
ASCs don’t necessarily win because they have better surgeons, he said. Often, the surgeon is the same person working in two different settings. What changes is everything built around them: patient preparation, communication during surgery, the flow through recovery and the consistency of the staff who guide patients through it.
In a large hospital, the patient experience can feel like it belongs to no one. In an ASC, he said, it belongs to everyone, and the structure forces the kind of feedback and iteration that big systems struggle to do quickly.
“I think that really allows us to not only work one-on-one with staff and to make the experience we want, but it also holds everyone accountable,” he said.
The tech that’s actually helping patients in 2026
When Dr. Greenberg talks about technology that meaningfully changes patient confidence, he doesn’t start with AI or flashy platforms. He leads with the tools that shrink incisions, speed recovery and reduce the misery that patients associate with spine surgery.
“On the spine side, a lot of the minimally invasive options, like endoscopic spine, we’re doing at our surgery center, and that is a slam dunk,” he said.
The value, he said, isn’t always a six-month outcome difference. It’s the day-to-day experience of recovery, the version where the first two weeks aren’t a personal crisis. He framed it like a travel decision: same destination, totally different ride.
“If you have the option to be miserable for two weeks after surgery, or you can feel really good for those two weeks and still have the same outcome at six months, to me it’s the difference between going to Bora Bora flying first class or going in coach,” Dr. Greenberg said.
Beyond smaller incisions, he said the best ASCs are also refining the recovery experience itself, including how pain is managed from the start.
“Being conscientious of pain protocols is probably the other thing that allows people to do better in ASCs,” he said.
When the tools turn into hype
Still, Dr. Greenberg is not a believer that every new tool automatically improves care. He said many technologies are clinically fine, but the question leaders should be asking is whether the price makes sense for the outcome.
“Robots in spine that help with pedicle screw placement add a huge cost,” he said. “You end up with the same placement as navigation or freehand, but it’s a million dollars.”
In a cost-conscious environment, he said spine robotics has sometimes functioned more like marketing than measurable improvement. If the gain isn’t meaningful, the return-on-investment argument collapses quickly.
Even minimally invasive approaches, he cautioned, can drift into the hype zone when surgeons try to force too much through too small an opening. In some cases, he said, the “least invasive” option isn’t actually the most efficient one.
Dr. Greenberg said some endoscopic techniques are being pushed beyond their practical limits, with surgeons trying to do too much through incisions that are simply too small. He pointed to endoscopic fusion as an example, noting that even when the procedure is technically impressive, it doesn’t always reduce the number of incisions compared to more established minimally invasive approaches.
The best ASCs run a feedback loop, not a script
If there’s one differentiator Dr. Greenberg kept returning to, it was the speed of improvement. The best centers don’t aim for perfection on Day 1, they build a system that can learn fast, fix fast and stay accountable to the experience they’re trying to deliver.
“I think it truly is building a team and having a continuous feedback loop,” he said.
That loop includes patient feedback, both direct and anonymous, and staff feedback without layers of management filtering the truth. In an ASC, he said, the structure makes honesty easier and fixes faster.
“They literally will just tell me, like, ‘Hey, like, what you’re doing is stupid,’” Dr. Greenberg said. “Well, what’s the solution? What’s fixed? This allows us very fast improvements and cycles of improvement.
Recovery in 2026 is smaller incisions — and bigger access
As minimally invasive spine expands into ASCs, Dr. Greenberg said recovery looks different today than it did even a few years ago, partly because surgeons now have more incentive to reduce length of stay and get patients home safely the same day.
“Truly, you can do a discectomy now through a 7-millimeter incision,” he said.
That incision size changes the pain experience in ways patients immediately feel. It also expands who can be served in an outpatient setting, including patients who historically might have been excluded based on body type or complexity.
Dr. Greenberg said newer minimally invasive techniques are expanding outpatient spine access to more complex patients, including those who previously might not have been considered for an ASC. By keeping the incision size consistent, surgeons can send more patients home safely the same day.
And for some patients, the result is almost hard to believe, even as they leave.
“You literally couldn’t see it,” he said. “I put a Band-Aid on it.”
When surgery isn’t the answer, the ecosystem still matters
High-performing ASCs, Dr. Greenberg said, aren’t just surgical machines. The strongest centers build an ecosystem where patients can stay in one place for imaging, pain management and nonoperative treatment, and still feel like they’re being taken seriously, even when the next step isn’t a procedure.
“I really want you to have exhausted every other option,” he said.
In his model, pain physicians and nonsurgical interventions aren’t separate from the ASC experience, they are part of the same continuity that reduces fear and builds trust. Patients aren’t bouncing across unfamiliar sites. They’re returning to the same environment, the same staff and the same routines.
“It’s not a scary place you’re going for that big surgery,” Dr. Greenberg said.
That familiarity, he said, is what helps patients feel supported even when surgery is not the plan, and it reinforces that ASCs can deliver a complete experience, not just a procedure.
“You don’t just have to have surgery to be a part of it,” he said.
A rare healthcare expansion that could help people
Dr. Greenberg expects ASCs to keep expanding, and he believes cost neutrality will matter more and more as outpatient care scales up. But unlike many healthcare shifts that feel purely financial, he thinks ASC growth has the potential to improve care in a way patients can actually feel.
“For once in medicine, I actually think that this expansion will be a good thing for people,” he said.
He pointed to consolidation and shrinking choice as a pressure point, especially in markets where health systems own most of the available access. Even strong systems, he said, can become problematic when patients effectively have nowhere else to go.
In 2026, Dr. Greenberg’s view is that the future of orthopedic and spine ASCs won’t be decided by who has the newest device. It will be decided by who builds the tightest system, one where patients feel known, teams feel accountable and improvement happens fast enough to keep up with what patients expect.
