New year, new growth strategies for surgery centers.
These 42 industry leaders explain what growth looks like for their ASC in the next one to two years.
The executives featured in this article are all speaking at Becker's 2024 ASC conferences. This includes Becker's 21st Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference which is set for June 19-22 at the Swissotel in Chicago. This also includes Becker's 30th Annual The Business and Operations of ASCs which is set for Oct. 30-Nov. 2 at the Hyatt Regency in Chicago.
If you work at an ASC and would like to join as a speaker, contact Randi Haseman at rhaseman@beckershealthcare.com.
As part of an ongoing series, Becker's is talking to healthcare leaders who will speak at our roundtable. The following are answers from our speakers at the event.
Question: What does growth look like for your ASC over the next 12 to 24 months?
Jacob A. Rodman. CEO at Raleigh Neurosurgical Clinic: Growth for our ASC over the next 12 to 24 months will continue to focus on shifting cases out of the hospitals and into the ASC. We are also focused on partnering with fantastic spine and pain doctors in our area to continue to drive collaboration and improve patient outcomes collectively.
Manoj Mehta, MD. Medical director at Endoscopy Center of the North Shore: There are distinct shifts that are happening in the landscape of patient care that will drastically affect how we practice over the next year.
The first component is that hospital systems are squeezing the physicians for more and more productivity. The second situation is that, naturally, there is higher dissatisfaction for employed physicians within organized medicine. Third, is that patients are very much looking for physicians who will care for them one-on-one, without the overarching philosophy of volume and productivity over patient's satisfaction.
These patients have had enough and are frustrated that there are only a few giant healthcare systems in a given geographic area like Chicago. They turn to concierge practices or boutique private practices where they can get the individualized attention that any patient deserves.
All these factors have created tremendous opportunity in private practice, and I hope to see a significant resurgence of private practices as a result. Multiple gastroenterologists have left the big hospital system in our area and have gone into private practice, including one stellar local gastroenterologist joining my own outpatient facility. These factors lead to opportunities for greater patient's satisfaction, better medical care, more income, better work/life balance and reduced physician burnout. It's a win-win, except for the big hospitals.
Brian Cole, MD. Managing partner, associate chair and professor in the department of orthopedics at Rush OPH: Over the next 12-24 months, growth from existing ASC users will come from new allowable outpatient codes such as what recently occurred with shoulder arthroplasty. This will have an unfortunate impact on hospitals, similar to what happened following the movement of total hip and knee arthroplasty and spine surgery to the ASC over the last several years.
Beyond that, growth will simply happen by more optimally using our existing footprint of ASCs and through organic growth of new physicians that we will hire at Midwest Orthopedics at Rush.
Stephen Cummings, MD. Orthopedic spine surgeon at Tidewater Physicians Multispecialty Group Orthopedic: I never dreamed of being an outpatient surgeon during my training 10 years ago and yet since 2020, my total joint surgeries have steadily shifted to the ASC.
Our early goals were on patient selection and safety in the ASC setting. We have experienced excellent patient outcomes in the ASC with comprehensive multimodal pain management and regional anesthesia. Over time, we have expanded our indications to include older and heavier patients as well as patients with more stable comorbidities. With total shoulders coming off the inpatient-only list in 2024, we will have an immediate uptick at the ASC as these Medicare patients move from the hospital OR to ASCs.
We are also looking to improve efficiencies in our centers focused around system improvements and continued steady growth. Throughout the growth process, balancing staffing and anesthesia expenses continues to be a challenge and an excellent leader or leadership team is indispensable to manage and grow the ASC in the current labor environment.
Ken Rosenquest. COO at Constitution Surgery Alliance: When reviewing our existing ASCs, we observe strong year-over-year growth. Demographics across various specialties continue to favor ASCs. Centers with available capacity are expanding to meet the growing demand. However, new facility growth faces challenges such as high construction costs, elevated interest rates and lengthy development timelines.
The ASC space is becoming increasingly specialized, and its strategic and operational uniqueness underscores the need for an experienced, successful management partner. In addition, effectively navigating the payer contracting landscape is expedited with a committed, knowledgeable health system partner, offering a quicker path to full contract realization compared to navigating it alone.
Jami Osterlund, MSN, CNOR, CSSM, CAIP. Operating room nurse manager at Kelsey- Seybold Main Campus ASC: Growth within Kelsey-Seybold over the next 12 - 24 months includes opening four more ASC locations around the Houston area. We have two that should be open early 2024, and two either currently under construction or about to break ground. These additional ASCs will allow us to grow our volume and provide more convenient locations for our patients to have surgery.
Ronald Bullen. Executive director at ProHealth Care Moreland Surgery Center: Growth looks favorable by three to five percent due to continued payer pressure in the market to perform procedures in the appropriate site of care. Bigger payers like UHC are incentivizing providers to shift select procedures from hospital outpatient to ASC. Payers have gathered enough historical data now to promote the value of an ASC setting with owner and non-owner providers. Being positioned as a multi-specialty ASC allows us the opportunity to capture these growth opportunities.
Ramis Gheith, MD, MS, BSN, FASA. Medical director at Interventional Pain Institute: I envision increased market share in our area, geographical expansion, brand recognition, and more partnerships and collaborations, all increasing patient acquisition and retention.
Additionally, we would like to improve upon our already positive feedback from patients. Satisfied patients are more likely to become repeat patients and recommend our practice to others.
Another key component to our growth is employee satisfaction and productivity. Happy and engaged employees are more likely to contribute to the success of the business. Low turnover rates and high employee productivity can be markers of a healthy work environment.
Randal Reynolds. Senior vice president of development and field operations at HealthCrest Surgical Partners, LLC: I am running six ASCs and in the process of developing three others. Growth for ASCs over the next 12 to 24 months will partially come from cases being moved from hospitals, which are higher cost sites of services, to the ASCs due to pressures from insurance companies as well as operating rooms that are overcrowded.
In addition, cases will come from specialties such as cardiology and interventional radiology where additional CPT codes have been added and reimbursements have improved in the past few years. Also, newly approved procedures for ASCs, such as total shoulders and new procedure codes for various specialties, should provide for some additional growth as well.
Mick Perez-Cruet, MD, MSc. Professor and vice chair of neurosurgery at Oakland University William Beaumont, School of Medicine: I expect steady growth as we are getting a new partner who is proficient in minimally invasive spine surgery. Minimally invasive spine surgery is perfect for the ASC setting. The patients love the efficiency and being able to recover in the comfort of their homes. Increasingly, we are doing more complex cases at the ASC, such as minimally invasive transforaminal lumbar interbody fusion and instrumentation using erector spinae plane block, which allows for excellent post-operative pain control.
Michael D. Burdi, MD. Partner at Community Orthopedic Medical Group: With more spine fusion cases and total joints being done outpatient, our ASC is poised for a 10 percent increase in cases over the next year. Our ASC has also done robotic total joint procedures and trialed or acquired multiple total joint robots in the last two years. Our biggest limitation at this time is scheduling time and space, so we are looking into options to increase operating hours.
Peter Passias, MD. Orthopedic surgery and spine surgery at NYU Langone Health: The growth of our ASC will be robust. We have a strong core that is committed to the success of our center. We have made an executed decision to start with small capacity but involve high volume surgeons to maximize our initial profitably and build a sustainable model. We anticipate an initial growth rate of 30 to 50 percent in the first three consecutive quarters followed by a 10 percent growth per annum until additional suites are added.
Michael C. Boblitz. CEO at Tallahassee Orthopedic Clinic: The market forces continue to demand TOC performs more cases in our ASCs. Employers and purchases remain frustrated with rising cost of care and seeking lower cost settings, and hospitals are challenged with managing their top priority, which is emergent and complex patients. This places more pressure on our ASCs to serve as a relief valve.
Our challenge is capacity constraints, so we have invested in a $15 million surgical center that specializes in only spine and joint replacement surgery. The new center replicates the traditional hospital environment via private rooms with private bathrooms for the extended stay patient. Over the past two years, we have invested in both the MAKO and the ROSA surgical robots to provide our physician experts with the complete range of solutions to be successful, and we will be adding a third robot, the O-Arm Spine Navigation system, before our new spine and joint replacement center opens in January 2025.
In the meantime, we are perfecting extended stay patients within our legacy six room orthopedic surgery center as well as supporting our other multi-specialty surgical center partners in planning to expand that facility as well with the addition of three new ORs.
Lastly, our current surgeons are near the 100th percentile in productivity, so we are aggressively recruiting new spine surgeons and hand surgeons to support our continued growth.
The ultimate aim is to outrun the ongoing Medicare cuts and rising inflation costs through continued double digit annual growth being realized through our robust strategic plan – vision 2030.
Janet Carlson, MSN, BSN, RN, CRN NE-BC. Executive director of ambulatory surgery centers at Commonwealth Pain & Spine: Growth is imperative to all relevant key performance indicators in my ASCs. It encompasses surgeons training for and learning new minimally invasive techniques and procedures to offer our patient population.
As we continue to migrate higher acuity cases out of the inpatient setting to the ambulatory site of service, all members of my clinical team will add new evidence-based best clinical practices for safe and reliable patient outcomes.
With the above mentioned migration, we will organically grow our clinical and support team to ensure safe staffing ratios and provide the available block time for surgeons to perform more case volume in our ASCs. I view growth as a metric closely aligned with process improvement; they work symbiotically benefiting our patients, surgeons, clinicians and support staff.
Ashley Hilliard, MBA, MSN, RN, CPAN. Administrator at Deerpath Ambulatory Surgery Center: As I look toward the next one to two years, I see a lot of growth on the orthopedic side. The addition of total shoulder arthroplasty and total ankle arthroplasty to the fee schedule has opened doors for growth. I have added one new ENT provider and this will help expand my ENT service to the community. Down the line further, I am hopeful to have general surgery come to my center. The future is looking bright for us!
Khawar Siddique, MD. Co-CEO at DOCS Health, DOCS Surgical Hospital: We had a record year in volume of cases performed and in revenue at DOCS Surgery Center. Our growth was driven by an increase in spine, orthopedic and pain management cases eligible to be performed in an ambulatory setting. This year, we expect to have another record year due to two reasons. First, we were able to re-negotiate a contract with a PPO payer that gives us better per-case revenue in spine and orthopedics. Secondly, surgeons are increasingly comfortable in moving their cases to an ambulatory setting. Given these two changes, we are planning to expand the number of ORs by either building another suite in the current facility or purchasing a pre-existing ASC.
Sap Sinha. COO at Allied Digestive Health. Our focus is on continuing to grow aggressively in our ASCs. There is an increase in colonoscopies in general because of the change in the age for mandatory colon checks for colon cancer from 50 to 45. Furthermore, we are also seeing an increase in chronic diseases such as IBD and IBS that also require procedures in the ASC.
John V. Prunskis, MD, FIPP. Medical director and principal at DxTx Pain and Spine: We will be seeing growth at our ASCs due to the minimally invasive innovative advanced pain procedures that not only treat post laminectomy syndrome, complex regional pain syndrome, diabetic neuropathy, but also sacroiliac joint degeneration, vertebrobasilar nerve pain consistent with Modic changes and treatments for lumbar spinal stenosis with neural claudication.
James Chen, MD. Orthopedic surgeon at DISC Sports & Spine Center: At DISC's ASCs, growth over the next one to two years will include the continued expansion of our total joint replacement and spine surgery programs through strategic partnerships and investment in resources designed for these larger ASC procedures. Our goal is to take a procedure-specific focus in increasing volume, improving safety and maintaining a top-quality patient experience.
Alfonso Del Granado, MBA, FACHE, CASC. Administrator and CEO at Covenant High Plains Surgery Center: Over the coming 12-24 months, our centers will continue to focus on increasing case complexity. While we will perform our share of quicker procedures in service lines such as GI, pain and ophthalmology, we expect a greater share of our OR time will be dedicated to longer procedures, including total joints, bariatrics and combination cases.
We are also about to break ground on an expansion project to add an operating room at one center and plan to add at least one or two large dedicated ORs to another center to facilitate performing total hips. Finally, we are in the initial stages of planning to add a new service line that will grow our business by about 20 percent, though we are not yet sharing the details. All told, the next couple of years hold the promise of strong financial growth.
Ken Rich, MD. President at Raleigh Neurosurgical Clinic: Due to restrictions on operating room space at one of our local hospitals, we are having to be more aggressive with moving cases to our ASC. The first two years, we were very conservative to make sure we didn’t have a lot of complications, but we’re finding out that we can do more complex things in the ASC safely and comfortably for our patients. We would like to see a 25 percent or more increase in cases in the next 12 months.
Nikhil Verma, MD. Director of the division of sports medicine and sports medicine fellowship at Rush University Medical Center: The transition of traditional inpatient procedures to the ASC in orthopedics continues to accelerate. As of Jan. 1st, total shoulder arthroplasty is now ASC eligible. With continued improvement in perioperative protocols and surgical techniques, we anticipate continued double digit growth in our orthopedic ASCs.
Aaron Johnson. CEO at Twin Cities Orthopedics: We’ve just opened another ASC with five ORs to accommodate our growing volumes. Our arthroplasty volumes continue to grow due to advancements in technology and anesthesia as well as Medicare adding total shoulder and ankle arthroplasty to their approved list. Robotic-assisted surgery continues to be a consideration for TCO, and we are looking to select a partner in the coming months. Finally, our longstanding value-based care program, which has been in place since 2012, continues to drive arthroplasty and complex spine cases to our ASCs as they are a higher-quality, lower-cost setting for our patients.
Erin Vitale. Director of nursing at Hoffman Estates Surgery Center: Our ASC is looking at an abundance of growth opportunities over the next few years. We are actively working on developing a joint program in the next few months, which in order to take on that project will include completely updating our central supply department. We are also looking to expand our general service line with the addition of laparoscopic inguinal hernias, and we are looking into the addition of the daVinci Robot.
Spine will also be a service line introduced to the ASC. With these exciting new services brings new physicians to our facility as well. As we expand, we look to introduce new, experienced staff. As a surgery center that historically started out as an eye facility, it is an exciting time to see our center expand and offer a multitude of services to our community. Not only will we grow financially, we will grow our services, our experience, our staff and our physicians; all the while maintaining the same thoughtfulness and quality care we have always provided patients.
Dean Lehmkuhler, MHA. Administrator at Northside Gastroenterology Endoscopy Center: The growth of our ASC will be significant after two years as we are planning to build a new endoscopy center with a projected opening of Jan. 31, 2026. The new center will allow for 50 percent growth over the next five years as we are increasing the size of the center and increasing from four procedure rooms to five procedure rooms with an ability to add a sixth room. We will also be programming a more efficient patient flow along with technological advances that we currently do not have in the center today.
Ben Seals. CEO at Thomas Eye Group: Our ASCs are expected to continue to grow procedure volume by 12 to 14 percent year over year. With this volume growth, we are expecting an additional four to six percent margin improvement as a result of procedure and payer rationalization. Thomas Eye is emerging from a period of tremendous investment, and we're excited to see the positive results these investments will generate for our customers.
Ali Ghalayini, MBA, CAPM, CPHQ. ASC administrator at Munster Surgery Center: As I envision the growth of our ASC over the next 12 to 24 months, my focus is centered on three critical areas: ownership and operational model, specialization in single-specialty services and addressing workforce dynamics.
Ownership and operational model: Our goal is to optimize our ownership and operational model to enhance our service delivery and patient care. The emerging trend in the ASC market indicates a significant growth in hospital-owned ASCs, which is attributed to patient migration from inpatient hospital settings and strategic initiatives by key players in the healthcare industry. We aim to explore and potentially adapt this model, leveraging the benefits of hospital affiliations while maintaining our unique identity and operational autonomy. This strategy will facilitate the expansion of our service offerings and integrate more seamlessly into the broader healthcare system, thus enhancing our market presence and operational efficiency.
Shift towards single-specialty centers: Another strategic direction is the shift towards becoming a single-specialty center. This model is proving to be more economical and allows for a greater focus and expertise in a specific field, attracting patients seeking specialized care. By concentrating on a single specialty, we can invest in targeted technologies and develop a team with specialized skills, thus improving patient outcomes and operational efficiency. This specialization will also enable us to distinguish ourselves in a competitive market where patients increasingly seek centers with a reputation for excellence in specific treatments or surgeries.
Workforce dynamics: Addressing workforce dynamics is crucial for the sustainable growth of our ASC. The difficulty in recruiting and retaining highly-skilled staff, especially in the face of less competitive salaries compared to larger hospitals, is a concern that needs immediate attention. We plan to implement strategies such as offering competitive compensation and providing continuous education and training opportunities. We aim to establish a positive work environment to both attract and retain top talent. By investing in our workforce, our goal is to guarantee the utmost level of patient care and operational excellence. Additionally, we are exploring technological solutions to streamline operational processes, thereby reducing the workload on our staff and improving overall efficiency.
In summary, by strategically enhancing our ownership and operational model, specializing in a single field and addressing workforce challenges, we aim to position our ASC for robust growth and success in the coming years. These focused strategies are intended to improve our service quality, operational efficiency and patient satisfaction, thereby solidifying our standing in the healthcare sector.
Daniel S. Mulconrey, MD. Spine and neck surgeon at Midwest Orthopaedic Center: There is opportunity for growth in the ASC over the next 12 to 24 months. In the next 12 months, OR availability and a flexible schedule are two immediate improvements to increase volume. This environment would be a stark contrast to the current hospital systems that lack the resources to provide an accommodating OR schedule. Improvements in surgeon access to the OR would drive higher volumes to the ASC. In the next 24 months, patients will push towards greater price transparency. With the rising cost of healthcare and larger deductibles, patients may demand a lower cost surgical option. This search for the lower cost option will increase the ASC volume.
Omar Khokhar, MD. Partner at Illinois GastroHealth: First, we need to continue to recruit aggressively to replace retiring physicians. Second, we are looking to expand our service lines to pain, neurosurgery and spine. Last, we need to meet patients where they are. Patients are increasingly preferring later hours and Saturday blocks, so we need precision staff to meet those requests.
Denise Mills, MN, RN. Clinical manager perianesthesia at Walters Surgery Center St. Joseph Medical Center: Walters Surgery Center is very unique; we also have an eight bed surgical observation unit in our facility. We have the largest surgical observation unit in the South Sound. We are able to keep surgical patients needing an overnight stay and discharge them the next day. Due to changes in CMS regulations and advancements in medicine we are seeing, many surgeries that typically would stay two to three days are going home the same day. Seeing many of our overnight stays decrease initially was challenging, but we have adapted by taking higher acuity complex cases and keeping them overnight. By using many evidence-based practice techniques, we are able to decrease the length of stay of these spine surgery cases and get the patient home the next day. This increases patient satisfaction by decreasing the amount of time they have to stay in the hospital. It also allows the surgeons the ability to care for more patients. Lastly, it allows the surgery center to grow, becoming an integral part of the community by caring for the people of the community and creating jobs in the community as well.
Allison Mattox. Manager for compliance and accreditation at Cardiovascular Associates of America: The future growth of ASCs appears promising, driven by various factors outlined by experts. These include the migration of care to ASCs due to their cost-effectiveness and patient-friendly environment. Additionally, expansions of historically hospital-based procedures, especially in cardiology, have gained CMS approval for ASC settings, fostering increased comfort among providers. The anticipation of health system partnerships to meet rising demand in this area further underscores the potential growth. Factors contributing to this growth include CMS payment rate increases, expanded coverage for procedures like cardiovascular and interventional radiology, and orthopedics-leading health systems reallocating ORs for acute cases. Other factors include the development of larger ASCs with multiple ORs and the increasing migration of procedures into outpatient settings. However, challenges such as finding adequate anesthesia coverage and managing rising costs in salaries, wages, benefits and supplies may temper this growth trajectory.
Nyleen Flores, CPMSM, CPCS. CEO at Total Surgery Center: We are focused on expansion within the orthopedic services service line.
Andrew H. Lovewell, MHA, MSHI, FACHE. CEO at The Surgical Center at Columbia Orthopaedic Group: Growth for our ASC over the next 12-24 months is tied directly to the growth of our practice and practice expansion. We plan to perform healthy, ASC-eligible total shoulder and partial shoulder replacements in our ASC now that Medicare has approved adding them. In addition, we are planning to start doing more pain procedures in our ASC as there is a high demand in our market. Our growth strategy for our practice and ASC both depend on us recruiting high quality physicians and providers to continue to deliver excellent care in our market.
Johnny Russell. Director for area operations at Sutter Health: In terms of growth, our center will begin offering total shoulder replacement surgery in 2024. It’s our priority not only to grow this line of business at the ASC, but to work with hospital partners to help ensure patients have access to the facility that’s right for them.
Alex Pham, MD. Chronic pain physician at SEVA Med Care: We plan on expanding our surgical volume by implementing marketing strategies and expanding our services. This includes the addition of gastroenterology, otolaryngology, cardiovascular and orthopedic specialities among others. Within the next 12 to 24 months, we hope to optimize operational efficiency while creating an intimate and individualized environment for our patients.
Sarah Sterling, CASC. Area director for greater San Francisco, Sutter Surgery Center Division at Sutter Health: In the coming 12 to 24 months, our ASCs growth strategy includes an aggressive physician recruitment plan, new service line development and expansion of facilities with additional operating rooms. This growth strategy will strengthen our position as a premier provider within the regions we serve and enables us to meet the rising demand for surgical services.
Adam Hornback. Administrator at North Texas Team Care Surgery Center: In the next 12-24 months, I expect to see much more in the way of direct contracting with third-party payers as well as more emphasis in surgical bundling with the large carriers. We have seen that they are finally seeing the benefit of using outpatient surgery centers for a lower cost option. The carriers continue to stress the importance of using ASCs as a viable alternative to the hospital.
Choll Kim, MD, PhD. Orthopedic spine surgeon at Excel Spine: My outpatient surgery practice will likely remain the same, at approximately 85 percent of all my surgeries. However, my colleagues continue to show great interest in performing more of their surgeries in the outpatient setting. Thus I expect continued, gradual, incremental increases in outpatient spine surgeries at our institution. With the recent purchase of my hospital by UC San Diego Health, we expect overall growth of the facility to increase as well, including outpatient hip and knee replacements.
Kyle Anderson. Vice president of finance and ASC at Ortho Rhode Island: Ortho RI Surgery Center’s growth in 2024 and beyond is focused on expanding service lines that are most impactful to our communities including spine, pain and joint arthroplasty. To remain mission focused on cost-effective and patient-centric care, we continue to recruit like-minded, skillfully trained physicians and surgical teams. Ortho RI’s leadership in technology and innovation is a catalyst for perpetual growth, and thoughtful alignment between the patient, surgical team, anesthesia and surgeon will truly support effective medicine.
Reuben Gobezie, MD. Founder and director at Gobezie Shoulder Institute and Regen Orthopedics: Growth for our ASC in 2024-2025 is likely to come from three different areas:
- Increased volume from Medicare cases that have moved from the in-hospital list to the ASC payable procedures. This growth in cases is likely to result in increased volume of cases with a modest increase in net revenue given the lower reimbursement rate from Medicare as compared to commercial payers.
- Increased alternative payment models that enable MSK providers to aggressively compete against expensive hospital systems for self-insured employer contracts that drive value-based care
- Continued recruitment of private practice physicians into ASCs. The bulk of these successful recruitments are being driven by the remnant private practice orthopedic and pain management specialists who have continued doing their procedures in hospitals and are now transitioning into established ASCs. The reasons for this transition by these physicians are often related to decreases in efficiency and availability of OR block times secondary to staff shortages at large hospital systems as well as the potential to drive more revenue through ASC ownership.