Becker's ASC Review

9 THOUGHT LEADERSHIP Where ASCs are finding hidden savings By Patsy Newitt F rom surgeon preference cards that haven't been touched in years to GPO contracts leaving money on the table, six ASC leaders joined Becker's to discuss the biggest cost reduction opportunities in their centers without touching staffing or quality. e answers ranged from implant pricing spread to revenue cycle leakage quietly draining dollars that were already earned. Editor's note: Responses have been lightly edited for clarity and length. Question: Where are you finding the most room to reduce costs without touching staffing or quality? Scott Freer. Clinical Administrator of ASC Bala Cynwyd (Pa.): No. 1. Implant and supply cost variation: is is almost universally the biggest untapped lever. Surgeon preference cards are oen years out of date, and implant pricing is negotiated surgeon-by-surgeon rather than at the facility level. e spread between what two surgeons pay for a functionally identical implant can be 30% to 40%. Most ASCs don't have anyone whose job it is to reconcile that. A single spine or joint surgeon doing meaningful volume can represent $200,000 to $500,000 in implant spend annually with almost no price discipline applied to it. No. 2. Preference card waste: Related but distinct — the gap between what gets opened and what gets used is enormous in most ORs. Studies have pegged unnecessary surgical supply waste at 15–25% of total supply spend. Nobody likes touching preference cards because surgeons push back, but a structured card review process with physician champions can generate six figures in savings at a mid-sized ASC without changing a single clinical outcome. No. 3. Vendor contract consolidation: Most ASCs have accumulated vendors the way people accumulate subscriptions — one at a time, without ever auditing the total picture. GPO utilization is oen 60% to 70% when it could be over 90%. e facilities leaving the most money on the table are the ones with strong surgeons who have personal vendor relationships that bypass the GPO entirely. No 4. Sterilization and instrument tray rationalization: Oversized instrument trays mean longer processing time, more water, more chemicals, more staff time in sterile processing and accelerated instrument wear. Tray rationalization — cutting unused instruments from standard sets — is tedious and nobody volunteers to lead it, but the downstream savings in processing cost and instrument replacement are real and durable. No. 5. Revenue cycle leakage; is isn't a cost reduction per se, but the net effect is identical. Authorization denials, unbilled implants, coding gaps on complex cases and payer underpayments that never get appealed are quietly draining revenue that was already earned. Most ASCs are recovering 85 to 92 cents on the dollar when best-in- class is closer to 97 to 98 cents. at gap on $10 million in revenue is $500,000 — $1.3 million sitting on the table. No. 6. Energy and facility overhead: Smaller than the others but oen completely unmanaged — OR suites running HVAC at full surgical spec during non-case hours, equipment le in standby unnecessarily, lighting systems never updated. Not transformational, but $20,000 to –$50,000 per /year in savings that require a one-time fix. Megan Friedman, DO. Chair and Medical Director of Pacific Coast Anesthesia Consultants (Los Angeles): e greatest opportunity is in operational efficiency, not labor cuts. Turnover time and room utilization matter, but schedule integrity is where the real savings are. Even small improvements in scheduling efficiency compound into meaningful financial impact over time. Reducing same- day cancellations, tightening block discipline and ensuring full, appropriately built OR days that match staffing resources can both unlock capacity and maximize use of resources without adding cost. e focus should be on eliminating wasted OR time, not reducing clinical resources. Bonnie Greenblatt. Director of Ambulatory Surgical Services of Michigan Institute of Urology (Utica): e area we have been focusing on primarily is supply chain optimization. Working with our GPOs and finding purchasing strengths to lower our costs, streamlining options to avoid stocking multiple items that serve the same purpose and utilizing an inventory management system have proven effective in lowering our costs. Kathleen Hickman, RN. Administrator and Clinical Director Dutchess Ambulatory Surgical Center (Poughkeepsie, N.Y.): Supply chain is one area where ASCs can become complacent. We order from the same vendors and develop a comfort level but exploring other options can prove to be very beneficial in terms of pricing. We oen need to stay with a specific vendor for specific types of cases, but oen other less frequent purchases can be negotiated between vendors to achieve the best price. Also, talk to every vendor regarding shipping costs. Oen vendors will oen consider compensating for high shipping costs or set up fees for capital equipment. Tracy Hoe-Hoffman, RN. Administrator at Heartland Surgery Center (Kearney, Neb.): e biggest opportunity to reduce costs in an ASC isn't people — it's everything around them that hasn't been optimized yet. We're finding the most meaningful savings in supply chain management, inventory control, and vendor alignment. Standardizing products where clinically appropriate, tightening on-hand inventory, and renegotiating service agreements can drive significant cost reduction without ever touching staffing or compromising quality. It's also about being intentional — using data to guide decisions and partnering closely with physicians to ensure clinical outcomes always come first. When you focus on eliminating waste instead of reducing resources, you can lower costs while actually strengthening both quality and the team environment. Neeraja Kikkeri. Owner and CFO at North Texas Team Care Surgery Center: Best use of OR time, making sure we run on time and making the best use of the OR schedule. Michael Warne. CEO of Associated Gastroenterologists of Central New York (Camillus): Tighter communication with the referring practices that feed our ASCs. When the relationship is open and operational rather than transactional, you get better case prep, fewer surprises, more efficient block utilization, less waste across the board. at alignment doesn't show up as a line item, but it shows up in the margins. n

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