Becker's ASC Review

9 THOUGHT LEADERSHIP Building 'excellence centers': Dr. Manuj Agarwal on scaling high quality in ASCs By Kelly Gooch T he Prostate Cancer Institute of America was founded in 2022 by Ajay Bhatnagar, MD, and has since grown into a national network collaborating with ASCs to deliver low-dose rate brachytherapy (also known as radioactive seed therapy) to patients. Becker's recently spoke with PCIA co-founder Manuj Agarwal, MD, about the network's trajectory. He discussed PCIA's origin story, what's on the horizon, and his advice for leaders in the ASC space looking to build and scale their own networks. Editor's note: Responses have been lightly edited for length and clarity. Question: When you and Dr. Bhatnagar decided to launch PCIA, what were the critical unmet needs you identified and how did those shape the network's foundational governance and early operating model? Dr. Manuj Agarwal: e idea for PCIA started with a simple observation. Prostate brachytherapy was a proven curative, minimally invasive therapy that was being underutilized across the country. And it wasn't because patients didn't want it. It was because there were too few skilled interventional radiation oncologists, and most practices and hospitals and health systems have shied toward more expensive, prolonged forms of external radiation. My partner and I have trained with some of the pioneers in the field, and we saw firsthand how effective brachytherapy could be, and we knew that there was a way to bring this back to the community setting, closer to where patients live without compromised quality. So we built PCIA around physician-led turnkey models that empower urologists and ASC partners to perform these procedures under their own roof, with our clinical technical and compliance infrastructure around them. In the beginning, it was really about proving the concept, showing that this highly specialized therapy could be safely delivered in the ASC environment. And the first challenge was navigating, step by The trends demanding ASCs' attention By Francesca Mathewes I n a Nov. 7 episode of Becker's Spine and Orthopedic Podcast, Earl Kilbride, MD, an orthopedic surgeon at Austin (Texas) Orthopedic Institute, discussed the issues shaping healthcare and ASCs in 2025. Here are three key trends identified during the discussion: 1. Consolidation: "I'm in a six-man, small, independently owned private practice group, so one of the biggest threats to our survival is consolidation, whether that be with private equity or under the employed model," Dr. Kilbride said. ASC chains control about 33.5% of freestanding ASCs, with the remaining 66.5% still held by independents, according to VMG Health. But that number may soon start to slip. While ASC deal volume dropped by 50% in the first half of 2025 compared to the same period in 2023 and 2024, this decline may understate real activity because smaller transactions involving independent ASCs and joint ventures often go unreported. According to another survey from VMG Health, 59% of independent ASCs would consider a strategic partnership rather than a full sale. Among those open to partnerships, 71% would consider working with a health system, 31% with a management company and 29% with a private equity group. 2. Reimbursement: While CMS has not yet finalized its final payment rules for ASCs in 2026, reimbursement remains a key trend to watch for ASCs who also deliberate the addition of new service lines and all of the equipment, staffing and facility investments required to continue growing. Dr. Kilbride added that CMS' decisions often influence those of commercial insurers. "Whenever Medicare goes down, a lot of the commercial contracts are tied to some sort of Medicare factor, and so certainly that threatens the livelihood long term of any physician, much less a small private practice group," he said. 3. AI and emerging technologies. The ASC industry is rather fragmented when it comes to new technologies, particularly AI. Some ASC leaders are heavily invested in AI and already in advanced stages of its development or implementation within organizations. The University of Maryland in Baltimore, for example, recently said they plan to develop the nation's first AI-powered, "smart" ASC. On the other end of the spectrum, nearly one in four ASCs still rely on paper charting rather than electronic health records, according to the Ambulatory Surgery Center Association's July 2025 survey. As ASC leaders consider how they will incorporate AI into their practice, Dr. Kilbride emphasized the importance of interoperability. "How do we use AI in medicine? Is there a way that it can make us more efficient and work smarter, not harder?" he said. "We have to make sure that we vet a lot of the information that's coming through in the AI platforms. And how do you incorporate that into, say, your EMR? How do you incorporate that into say, patient education and things of that sort?" n

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