Becker's ASC Review

7 THOUGHT LEADERSHIP The assumptions ASC leaders should leave behind By Carly Behm F rom assumptions about surgical volume to the role of anesthesiologists, ASC leaders discuss ideas they've unlearned in recent years. Note: ese responses were lightly edited for clarity. Question: What's one assumption about your patients, your practice, or your field that you've had to unlearn in the last two years? Sean Gipson. CEO and Division president of ASCs at Remedy Surgery Center (Hurst, Texas): e ASC assumption that quietly broke is more volume equals more profit. For years, ambulatory surgery centers operated under a straightforward premise: increase case volume and profitability will follow. But over the past two years, that assumption has quietly unraveled. e ASC leaders who are still measuring success primarily by case growth may be missing a more uncomfortable reality: not all volume is good volume, and some of it is quietly unprofitable. Several converging pressures have disrupted the traditional volume- driven model. One of the first factors is that the payer mix is shiing quickly. Commercial reimbursement, the previous financial backbone of ASCs, is under increasing pressure. At the same time, Medicare and Medicare Advantage volumes are rising and the result, even as total cases increase, is revenue per case is declining. Another factor is that the wrong cases are moving the fastest. e industry anticipated a migration of higher-acuity procedures into ASCs. While that is happening, the fastest growth has come from lower-acuity, lower-reimbursing cases, diluting our overall margins. Additionally, labor costs are no longer variable. Staffing was once a lever that could flex with volume. Today, labor costs are structurally higher and far less responsive. Premium pay, contract labor, and retention investments mean that incremental cases don't carry the same margin they once did. Supply costs that come with higher acuity cases are eroding contribution margins. Implants, pharmaceuticals, and disposable supplies have seen sustained cost increases and reduced availability in many cases. Without aggressive supply chain management, case-level profitability can disappear, even in high-volume environments. roughput does not equal profitability. Many ASCs still optimize speed and block utilization without fully understanding profitability at the case or surgeon level. High utilization of low-margin blocks can create the illusion of performance while masking financial underperformance. It's painful at the end of a large-volume day that results with the same margin on a two-procedure spine day. e new operating reality is high-performing ASCs are shiing away from volume as the primary success metric and instead, focusing on case mix index optimization, payer contracting and alignment strategies, profitability by surgeon, service line and block time and cost discipline at the case level. is is a much more complex operating model, but it is also a more honest one. Operators that do not understand their numbers on this complex level are going to be le behind in today's competitive industry. e bottom line is that the ASC market hasn't lost its growth story, but it has lost its simplicity. Leaders who continue to chase volume without interrogating their margins are at risk of scaling inefficiency. ose who adapt by aligning growth with profitability will define the next phase of ASC performance. Because in today's environment, more cases don't guarantee better outcomes, financially or operationally. Megan Friedman, DO. Chair and Medical Director of Pacific Coast Anesthesia Consultants (Los Angeles): One assumption I've had to unlearn is that our role as anesthesiologists is limited to clinical care inside the operating room. In reality, being a strong clinician is no longer enough. Anesthesia sits at the center of perioperative operations, with visibility across the OR, GI, cath lab and other procedural areas. We see, in real time, how cases move, where delays occur, and where inefficiencies exist. Over the past two years, it's become clear that when anesthesia is not actively involved in operational planning, decisions are made without a full understanding of how the system actually functions. e highest- performing environments are the ones that leverage anesthesia not just for patient care, but for throughput, scheduling alignment, and day-to- day operational decision-making. e shi is recognizing that anesthesia is not just a clinical service. It is a key operational partner, and being effective today requires both clinical excellence and active engagement in how the system runs. Nikolas Jannetta. Director of Operations at National Spine and Pain Centers (Miami): A healthy financial margin and a full patient schedule makes a healthcare practice successful. At least, that has always been the assumption. As director of operations for multiple interventional spine centers and associated ASCs in the Southeast, establishing a scalable business model that prioritizes best-in-class clinical outcomes is the principal focus. Leveraging advanced technology to enhance physician decision-making is the first step toward the goal of making both our patients and our financial margins healthier. When met with operational knowledge or performance gaps, incorporating an automated systems-based approach can increase detection and response time to suggest proper evaluation or action, alerting physicians to potential unseen operational or knowledge gaps, without over-burdening the team or requiring increased labor costs. e deliberate design of an autonomous yet collaborative administrative engine empowers physicians while preserving their unwavering autonomy over decision-making. While physicians are still at the core of every decision-making process, their abilities and clinical outcomes are enhanced by partnering with the power of technology, without compromising financial margins. Paul Lynch, MD. Founder and CEO at US Pain Care (Scottsdale, Ariz.): One assumption I've had to unlearn is that standardizing physicians leads to better outcomes and efficiency. For years, we've tried to make doctors practice the way we think they should — same protocols, same workflows, same expectations. What we've learned at US Pain is that this approach oen suppresses performance rather than improving it. Physicians aren't interchangeable units — they have different strengths, philosophies, training and clinical instincts. When you force uniformity, you lose the upside of what makes great doctors great. Instead, we're starting to build systems around the individual physician. Using tools like predictive modeling and behavioral profiling, we can understand how each doctor naturally practices — and then design the clinic, staffing, service lines, and even scheduling around that. e result

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