From cardiology to total joint replacements: The key opportunities for ASC growth, per 36 experts

The COVID-19 pandemic demonstrated to the healthcare industry that ASCs are ripe for taking on more complex procedures, including cardiac surgeries and total joint replacements. As more patients want to spend less time in a healthcare setting, ASCs have continued to expand. 

From cardiology to total joint replacements to anesthesia, there are several key opportunities for growth in the next several years. 

As part of an ongoing series, Becker's is talking to healthcare leaders who will speak at the conference on October 26-28, 2023. The following are answers from our speakers.

To learn more about this event, click here.

If you would like to join as a speaker, contact Claire Wallace at

Question: What are the biggest opportunities for growth you see in the ASC industry currently? 

Ali Ghalayini. Administrator at Munster (Ind.) Surgery Center: ASCs, within the healthcare industry, are witnessing substantial growth driven by several factors, and the following are key opportunities for expansion and development. 

1. Increasing demand for outpatient procedures. ASCs have gained popularity as a cost-effective and convenient alternative to traditional hospital-based surgeries. The shift toward outpatient procedures is driven by advancements in medical technology, improvements in anesthesia and pain management techniques and the desire to reduce healthcare costs. This trend is expected to continue, providing opportunities for ASCs to expand their service offerings.

2. Expansion of specialized services. ASCs have traditionally focused on performing low-risk procedures, such as cataract surgeries, endoscopies and orthopedic surgeries. However, there is an increasing trend toward ASCs offering more complex and specialized procedures, such as total joint replacements, spine surgeries and cardiac procedures. Expanding into these areas can open new avenues for growth.

3. Growing aging population. The aging population drives the demand for healthcare services, including surgical procedures. As the baby boomer generation continues to age, there is an increased need for procedures like joint replacements, cataract surgeries and gastrointestinal procedures. ASCs can capitalize on this trend by expanding their services to cater to the specific needs of the elderly population.

4. Healthcare policy and reimbursement. Changes in healthcare policies and reimbursement structures can significantly impact the ASC industry. Staying updated with regulatory changes and actively participating in advocacy efforts can help ASCs navigate the evolving landscape and identify growth opportunities.

5. In addition to technological advances that can enhance the capabilities of ASCs, moreover, strategic partnership and collaboration with hospitals and physician groups can provide access to a broader patient base and additional resources.

Alyson Engle, MD. Pain Medicine Physician at Northwestern Medical Group (Chicago): The biggest opportunities for growth in the ASC space are investing in high quality physicians to create superior care compared to hospital settings. Employee satisfaction is likely to remain higher in the ASC setting. Higher staff engagement and satisfaction is likely to produce higher quality care and patient satisfaction. 

Alyson Hughes, MSN, RN. Director of Nursing at Andrews Institute Surgery Center (Gulf Breeze, Fla.): The biggest opportunity for growth within the ASC industry currently is higher acuity patients. Servicing a lower volume improves revenue and lowers staffing needs. Total joint arthroplasty, cervical spine fusions and other orthopedic cases moving to an ASC setting is the biggest opportunity for growth in 2023.

Andre Blom. CEO at Illinois Bone & Joint Institute (Des Plaines): The biggest restraint on ASCs will be the availability of consistent staff levels at all required roles within the ASC. 

Andrew Lovewell. CEO of Columbia (Mo.) Orthopedic Group: There are several opportunities for growth in the ASC industry in the future. Two of the biggest growth trends that I am following are the opportunities for value-based care and bundles as well as appropriate case migration to the ASC setting. Overall, the low cost/high value outpatient ASC setting provides a great opportunity for value-based care and bundles. On top of that, the safe and appropriate transition of higher acuity surgical cases to an ASC will continue to be a growth trend in certain surgical areas. 

Beverly Bryant, MSN, RN. Director of Nursing at Palmetto Endoscopy Suite (Columbia, S.C.):: If there is anything positive that resulted from COVID-19, it is the realization that ASCs are a vital and necessary component in U.S. healthcare systems. The temporary cessation of elective surgeries and diagnostic procedures may impact morbidity and mortality risks concomitant with treatable and preventable health conditions. ASCs have a tremendous opportunity to abate the demand of surgical services in the most impactful way. Increased surgical services in the outpatient setting accelerates patients' access to treatment and may contribute to the delay of disease progression. 

Bill Willis, RN. ASC Clinical Director at Vance Thompson Vision (Sioux Falls, S.D.): This may not be the "biggest" opportunity, but the patient experience is sometimes overlooked and drives patients to centers with a good reputation for great patient care. Patients may only have two eyes, two knees, etc., to have surgery on; however, what they say about their experience with the surgery center and the team afterwards will drive patients to specify your center over others if given the freedom to choose. Your reputation for great patient care will benefit you. Hire for attitude and train for skill. Train to a five-star patient experience and a good value-based culture and growth is likely to follow. 

Brian Cole, MD. Managing Partner of Midwest Orthopaedics at Rush, Associate Chair of the Department of Orthopedics at Rush Oak Park Hospital and Professor in the Department of Orthopedics at Rush Medical College (Chicago): Areas of potential growth in the ASC space include a focus on matching supply-demand loads to best optimize our centers. Looking for ways to control and reduce supply costs through group purchase, and sharing best practices amongst surgeons and specialties can highlight areas for expense reduction. Incentivizing staff to optimize efficiencies and unnecessary use of disposables will create buy-in and a collaborative environment in the ASC. Finally, a focus on outcomes and comparisons to the inpatient setting will provide data as risk-based contracting becomes more available. 

Bruce Feldman. Associate Administrator of SUNY Downstate Medical Center (New York City): The biggest area for growth is in the cardiovascular services area. Peripheral vascular stenting, ICD implants, pacemaker insertions and battery changes and even cardiac catheterization will migrate out of the hospital setting into the ASC environment as insurance companies and third party payers realize it's more cost effective to do so.

Charles Roberts, MD. Pain Management Specialist at OrthoCincy (Crestview Hills, Ky.): The biggest opportunities for growth in the ASC industry are largely orthopedic and to a lesser degree the other surgical specialties. Many of those cases that were kept in the hospital are now being reduced in terms of third party payers and being promoted, incentivized, to move to the ASC sector. On a personal level I am seeing more and more of the orthopedic surgeons frustrated by the slowness and bureaucracy of hospital-run operative suites. Many of my surgeons are excited at the prospect of greater say over operative schedules and with regards to having a greater say on the staff in the operative room. In a hospital setting, this is most exclusively determined by administration, but in the ASC sector a greater move toward a free market exists. Other surgical specialties will also see growth, however at this time I see the biggest growth in orthopedics and then spine surgeries. 

Davis Hurley, MD. CEO of Orthopedic Centers of Colorado (Aurora): The best opportunities for growth are tracking and demonstrating quality results on all cases. Patient-reported outcomes and quality outcomes can be matched with the cost of care to validate a commitment to serving the community's needs. Showing patients, payers and employers a dedication towards a new affordable pathway that emphasizes meeting the patient's needs at a lower cost will drive volume and success. 

Devi Nampiaparampil, MD. Associate Professor at NYU Grossman School of Medicine (New York City): Many people, including healthcare providers, feel the healthcare system shouldn't profit off others' poor health and desperation. This sentiment has increased since the pandemic. Therefore, we may be better off expanding into areas where we can offer a menu of luxury services rather than those services patients feel they depend on. We can be more straightforward about pricing and payment and patients can feel more "free'” about what they choose to have done. 

Elisa Auguste. Administrator of Precision Care Surgery Center (East Setauket, N.Y.) and Board Member of the New York Association of ASCs (Albany): The biggest opportunities for growth are new additional procedures and specialties. ASCs have done an amazing job with the services they currently provide, and during the pandemic they were able to do so much more, from providing birthing and cardiac services. The future is growth. The future is technology. Transitioning cardiac cases and safe births to ASCs will provide greater access to all patients.

Emma Gimmel, BSN, RN. Director of Nursing at Manhattan Endoscopy (New York City): We can count over 10,000 surgery centers in the U.S. These represent creative and complex entities and operators and developers that include several specialties and as time goes, adding others. There is no end to this development, since there are billions in profit in this industry. Ambulatory care remains under rigorous federal, state and local regulating agencies and supported resources from professional organizations standards and guidelines. A brief picture of the growth from its beginnings is that patients have options to follow with recommended procedures and some surgeries. The future ASC may look different by adding the opportunities of innovation and continue with its record of safety. Ambulatory went through a pause during the global COVID-19 pandemic where it was forced to rethink, re-evaluate and recreate its services with the limitations to align with the times. During this pause, ambulatory services were subject to the same challenges all industries found themselves against, some … for a determinate time halting services to the community; confronting generalized, and at times critical, supply chain restrictions; and not less concerning, experiencing the nursing and other personnel turmoil across the board and having to limit or adjust services according to existing supplies and equipment. To prevail while maintaining best practices, attempting to do it all, centers had to rethink possibilities and consider alternatives. With these changes, the capacity of ASCs to do more, differently and better with the resulting engagement of all stakeholders, the sky becomes the limit. We are talking about doing what has been done and more, while keeping what should remain in hospitals, but expanding what is done now with the aid of technology advancements and AI plus lessons learned from … the pandemic. 

Ambulatory may prove to remain resilient, embracing the challenges of the times to remodel, adjust, innovate and continue adapting while achieving more of an indispensable delivery model in our healthcare system. Patients' concern shall remain the center and their safety kept as the common denominator in the services and care provided. I can picture a respected, recognized and promoted giant venue that provides ambulatory care services, independent from the unique model that represents hospitals because both may complement each other but do not serve well to be treated the same since they are not the same. Neither are better or worse; they are different. This includes all aspects of the organization as a provider and as a business. Such as, one approach that best serves the unique ambulatory environment is recognizing that successful and productive personnel in the ambulatory services may not have the same success in a hospital environment and vice versa. Diversity helps to develop, create and resource, especially when not all goes as planned. One aspect of science needed in ambulatory is more research. It would supplement talent and help advance science. Basically, research could be better represented, engaged and sponsored to support this industry in professional specialties. 

Genevieve Kragness, PhD, RN. Nurse Manager of Surgical Services at Marshfield (Wis.) Medical Center: With the 2021 American Cancer Society guideline change to decrease the recommended age for colorectal cancer screening age from 50 to 45 years of age, along with pandemic elective procedural shut-downs and delays, endoscopy backlog continues to challenge ASCs nationwide. Developing strategies to increase endoscopy volume will remain critical in preventative care retention and subsequent revenue capture. Recent changes to inpatient-only code lists from CMS also created new opportunities this year to perform same day orthopedic and general surgery in stand-alone ASCs. Shifting volumes from overwhelmed hospital operating rooms to ASCs still working to improve volume post-pandemic will be crucial in preserving OR throughput and revenue streams.

Indran Indrakrishnan, MD. President and CEO of GDC Endoscopy Center (Lawrenceville, Ga.): Commercial healthcare insurance deductibles and coinsurances have gone up considerably high, and patients frequently end up paying the entire expense, or at least a portion, for the elective outpatient surgeries and procedures. Insurance companies' contractual negotiated facility rates for the ASC are much less than that of the hospital settings. As such, patients can make huge savings by going to the private ASCs rather than the hospitals for elective surgeries and procedures. With the current bleak economy and potential recession, the likelihood of insurance companies raising the deductibles and coinsurance even more over the next three to four years is high. The ASCs can market and explain the advantages to the public about how patients coming to them over hospital settings will save them lots of money. 

Jayesh Dayal, MD. Anesthesiologist at White Flint Surgery (Rockville, Md.): While most ASCs are organized around single specialty MDs, and this has its advantages, a very underutilized model for phenomenal growth in the volumes of your ASC is the multispecialty MD group model, where MDs of various specialties and primary care MD groups coalesce under the same tax ID and neutralize the "referral" hurdle — there are still anti-kickback and Stark Law restrictions on "per tick" compensation formulas, but most lawyers can draft language in corporate compliance rules to avoid these. This way, everyone has skin in the game and high volumes of all kinds of procedures, small ticket or large ticket ones, make the center super efficient economically, as the small ticket surgeries pay for the overheads and break even, and the large ticket surgeries go directly to the profit center. Obviously it is easier said than done, as getting primary care MDs to participate in anything is harder than herding cats, but when, and if, they do come around and acknowledge the paradigm shift in the conservative treatment versus early surgery risk-benefit balance tilting in favor of outpatient surgery advances, it can work wonders.

There should truly be re-education seminars and CME lectures for primary care MDs to bring them up to speed on the massive advances in surgical and anesthesia techniques where traditionally massive surgeries with huge incisions and significant blood loss and ICU stays, like laminectomies, hysterectomies, joint replacements, etc., have been largely tamed and transformed into routine ASC cases. The primary care MDs are still not up to speed with these advances, and still assign the surgery option to the ultimate last resort — such that a patient that could easily get a partial knee and be fully active hiking, biking, etc., is still trudging along with conservative medications and injections for years.

It has been my goal to single-handedly educate primary care MDs on moving their surgical option needle much higher on their algorithms as in most cases, the surgical risk profile has dropped dramatically, and persisting with conservative treatments is actually more harmful for quality of life and general well-being. Our organization has been able to move in this direction and we are beginning to see the results.

Jitander Dudee, MD. Surgeon at Medical Vision Institute (Lexington, Ky.): The ASC industry is experiencing significant growth due to several factors, such as increasing demand for outpatient surgical services, advances in medical technology and cost containment efforts by healthcare payers. Here are some of the biggest opportunities for growth in the ASC industry:

1. Expansion of service lines. ASCs have traditionally focused on procedures such as endoscopy, cataract surgery and pain management. However, as technology continues to advance, ASCs are increasingly able to offer more complex procedures such as total joint replacement, spine surgery and neurosurgery. Expanding service lines can help ASCs attract more patients and increase revenue.

2. Partnerships and joint ventures. ASCs can partner with hospitals, health systems and physician groups to expand their services and reach more patients. Joint ventures can provide ASCs with access to capital and expertise while enabling them to retain their independence.

3. Focus on patient experience. ASCs that prioritize patient experience can improve patient satisfaction, which can lead to increased referrals and revenue. Providing amenities such as comfortable waiting areas, private recovery rooms and high-quality food can improve the patient experience.

4. Embracing technology. ASCs can leverage technology to improve efficiency and patient outcomes. For example, using electronic health records can reduce paperwork and improve communication between healthcare providers. Robotics and other advanced surgical technologies can improve the precision and accuracy of surgical procedures.

5. Addressing healthcare disparities. ASCs can help address healthcare disparities by providing care to underserved populations. ASCs can partner with community organizations, offer transportation services and provide language translation services to increase access to care.

Overall, the ASC industry is poised for continued growth, and ASCs that focus on expanding service lines, partnering with other organizations, prioritizing patient experience, embracing technology and addressing healthcare disparities are likely to see the greatest success.

Johnny Russell. Director of Area Operations at Sutter Health (Sacramento, Calif.): When the world changes, we must change with it. One area the ASC industry has opportunity for growth is exploring the demand for services. This may be increasing operational hours, looking at ways to provide safe, high quality and affordable care without any compromising. Patients are benefitting from having procedures at the ASC versus a hospital. Partnering with hospitals is another way for growth. It allows the patient to be treated at the appropriate facility. Hospitals and ASCs must collaborate going forward for the better of the patient community at large. 

Kayla Schneeweiss-Keene, BSN, RN. ASC Administrator of Mann Cataract Surgery Center (Houston): The biggest opportunities for growth in the ASC industry now and for years to come is the impact AI will have not only on the day-to-day administrative work in ASCs but also in surgical performance. AI will be used to help with surgical outcomes, in-surgery performance and improve training. It will also challenge how we care for patients from a personal perspective. Patients still look for that one-on-one personal touch. Humans were born with the innate need for touch. I think that will be important to remember as AI grows in our industry and the impact on patient satisfaction.

Mark Chaplick, DO. Pain Management Specialist at Midwest Pain Management Center (Lee's Summit, Mo.): I see a big opportunity for pain management procedures being done in an ASC verus outpatient hospital setting. More and more carriers are requiring prior authorization and more scrutiny for any hospital-based procedure, whereas there are fewer obstacles in getting procedures approved or not requiring a prior authorization if performed in an ASC. As time goes on, the list of commonly performed cases will only increase because of cost savings. 

Manoj Mehta, MD. Medical Director at Endoscopy Center of the North Shore (Wilmette, Ill.): COVID-19 has been a turning point for the perception of quality medicine outside the hospital setting. While people might have been ambivalent about the cost benefits of ASC procedures, and even wary of the quality, they are now very much behind avoiding hospital settings if at all possible. More importantly, we have been doing quality work the whole time, and the people who have visited ASCs or in-office specialty centers have come away with a new understanding of the high quality of care. That feedback feeds into new referrals and patients happy to return. The opportunity for us is to capitalize on the quality and efficiency we can provide, and over which the hospital fell flat where people needed them the most.

Marietha Silvers, RN. Administrator at the Surgery Center of Cleveland (Tenn.): ASCs have the biggest opportunity to increase volume as payers seek lower cost of services providers. As payers move forward as to where healthcare will be in the next five to 10 years, they will be seeking ways to save budgeted revenue by moving more cases to the ASC. As the lower cost provider, it potentially has a win-win opportunity for both the ASC and payers. 

Marina Williams. CEO at Texas Health Surgery Center Irving/SCA Health: There are several opportunities for growth in the ASC industry, including:

1. Technological advancements. With advancements in medical technology and AI, more complex procedures can now be performed in an outpatient setting, thereby expanding the types of surgeries that can be safely performed in ASCs. 

2. Increased demand for outpatient services. Due to rising healthcare costs, patients are increasingly seeking cost-effective alternatives to hospital-based procedures. ASCs offer a convenient and cost-effective alternative to hospitals.

3. Aging population. As the population ages, there will be a higher demand for surgeries and outpatient procedures, which can be performed in ASCs.

4. Mergers and acquisitions. Consolidation within the healthcare industry has created an opportunity for ASCs to partner with hospitals, health systems and other healthcare organizations to expand their service offerings and increase their patient population.

5. Focus on quality and safety. ASCs are focusing on improving their quality and safety standards, which can attract more patients and increase their overall reputation in the healthcare industry.

6. Cost savings. Efficient operations at ASCs, combined with reduced overhead costs, make ASCs an attractive option for both payers and patients, resulting in increased demand for access to ASCs. 

Mithra Gonzalez, MD. Associate Chair of Clinical Affairs at the University of Rochester (N.Y.): As part of the healthcare ecosystem, the ASC operates in a dynamic landscape. That said, there are stable trends such as de-escalation, a focus on high quality care experience and the need for ever improving efficiency. The biggest opportunities for growth occur when we are slightly ahead of the field on those trends. Thus, the answer to what is the biggest growth opportunity is largely a local or regional question and may be discovered by answering the following: What can we de-escalate from the hospital setting to the ASC, how can we generate the highest quality patient care experience, and lastly, what resources/systems can we supply that will be a force multiplier for our surgical teams? 

Nathan Sheridan. Director of Radiology at Advanced Cardiac and Vascular Amputation Prevention Centers (Grand Rapids, Mich.): I think we will start seeing more procedures come to the ASC space that have historically only been performed in a hospital setting. Procedures such as percutaneous coronary intervention have evolved within the hospital setting itself over the past few decades; first only being permitted in a hospital with open-heart capabilities, then to hospitals within a certain proximity to those capabilities and now to the ASC setting. I believe with enough safety data and provider support that many other procedures will find a home in the ASC. 

Olga Medowska. Director of Operations at ANR Clinic (Tampa, Fla.): We all know that the entire healthcare industry is facing strong headwinds. The reimbursements for hospitals and ASCs continue to decrease despite expenses increasing exponentially. At the same time,

ASCs are unique environments allowing them to capitalize on several opportunities. One strategy ASCs can use to their advantage is strategic partnerships. Whether with hospitals or physicians, alliances and joint ventures can help drive volume and increase revenues. Investing in technology and automation is another opportunity to increase productivity and cost-effectiveness. We are on the brink of AI being a part of everyday life. The key is to use this emerging technology to optimize operations, reduce staff workload and improve employee satisfaction and patient experience.

Patty Shoults, BSN, RN. Executive Director of Ambulatory Surgical Services at AdventHealth (Altamonte Springs, Fla.): The ability to demonstrate and share outcome and satisfaction data. This will overcome the perception that ASCs cannot provide the same or better level of care as a hospital. Payers already have pricing information. ASCs will need EMRs to be able to respond quickly.

Philip Louie, MD. Medical Director of Research and Academics at Virginia Mason Franciscan Health (Seattle): Expanding the surgeries that can be safely performed. There will be two main drivers. 

1. Enabling technologies must continue to serve as areas of innovation that will improve the visualization, access and safety of our surgeries. Building and fostering ongoing collaborations with our anesthesia colleagues will remain critical in the preoperative care at these ASCs and determining which patients can be effectively cared for. Can we safely expand our indications and provide greater access to care? Will require a coordinated team effort.

2. Also, an improved understanding of how ASCs fit into the value-based care equation that is dominating our healthcare landscape. Patient care and outcomes will always be the most important factor. But, in a world where we are seeing a shift to value-based healthcare and reimbursement, we will also need to re-evaluate how spine surgical care is delivered and billed. Further evidence to understand the safety, efficacy and the economic factors are underway. 

Randal Reynolds. Senior Vice President of Field Operations at HealthCrest Surgical Partners (Edmond, Okla.): The biggest opportunity for growth in the ASC industry involves partnerships with hospital systems. The leverage with commercial payers and the built-in referral network provides a winning combination for a new surgery center. The healthcare environment is ripe for these arrangements with qualified managers who provide a flexible platform to make it happen. 

Ranjan Sachdev, MD. Surgeon at Sachdev Orthopaedics (Easton, Pa.): The biggest opportunities for growth in ASCs is participation in value-based care that will result in shifting of higher-cost hospital-based procedures to lower-cost high quality ASCs, resulting in exponential growth of these entities. To be successful, ASCs will need to focus on patient engagement, optimization, care coordination and post discharge monitoring supported by strong data analytics and carefully chosen key performance indicators. 

Rick Ngo, MD. Founder and Surgeon at Texas Surgical Specialists (Fort Worth): I feel the biggest opportunities for growth in the ASC industry lie in these three areas:

1. Advocacy for ASC-friendly policies at the local, state and national levels. 

2. Collaboration among ASCs at the local and regional levels in regards to contracting, supply chain purchasing, and most importantly

3. Optimizing the efficiency within your own ASC.

Ronald Shealy, MD. Independent Consultant and Retired Medical Director of Piedmont Outpatient Surgery Center (Winston-Salem, N.C.): One of the great opportunities is the growing business of direct contracting between providers and employers using a bundled payment platform. This method of doing business is not only good for ASCs (payments set by providers/payment w/in 10 days), but also for employers (cheaper pricing per case) and employees (no up front charges). 

Sandra Roush, BSN, RN. Director of Nursing at Pacific Cardiovascular Surgery Center (Salem, Ore.): The biggest opportunities for ASC growth currently are for cardiac clinics. I'm sure the hospitals don't like hearing that as they have been the traditional destination for cardiac care. At Pacific Cardiovascular Surgery Center, we provide surgical procedures such as cardiac catheterization, stent placements and pacemaker implants in a safe environment that is preferred by the patients to the large local hospital. Benefits of ASCs include more personalized nursing care, faster admission and discharge, timely procedures, significant cost savings and great parking. 

Scott Sigman, MD. Surgeon at OSA Orthopaedics (Chelmsford, Mass.): The biggest growth for the ASC industry is the continued migration of more and more complex surgeries to outpatient procedures. With the advent of regional anesthetic blocks and innovative surgical techniques, surgeries will move from the hospital to ASCs. In addition, as private-equity-backed platforms continue to expand, they will capitalize on the growing outpatient surgery market by purchasing or developing new centers to meet the demands of their expanding market share. 

Vishal Mehta, MD. President and Managing Partner at Fox Valley Orthopedics (Geneva, Ill.): I think the biggest opportunities for growth in ASCs is the continued movement of total joint replacements and spine surgery to the ASC setting. A second major driver of growth will be the realization by all stakeholders that the ASC provides the most cost efficient setting to provide surgical care. Hopefully the focus on price transparency will act as a catalyst to this growth.

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