While ASCs remain largely independent, consolidation is on the rise as the industry's largest chains continue to expand, leaving the state of practice independence in flux.
Several leaders joined Becker's on a Nov. 2 panel at the 30th annual Business and Operations of ASCs Meeting in Chicago to discuss how ASCs can maintain their autonomy in large, dynamic markets.
Flexibility
Where larger health systems and practices may benefit from a larger pool of resources and finances, many ASCs look to be more responsive to the fast-changing dynamics of the market.
John Brady, CEO of Fox Valley (Ill.) Orthopedics, noted that operating with a small team allows for quicker decision-making than in larger organizations.
"I don't need 14 vice presidents to discuss it and take it to one person to approve. We can meet in the hallway," he said. Mr. Brady added that "tenacity" is essential to leading independent ASCs through challenges such as staffing shortages and supply chain issues, including the recent IV fluid shortage.
"We leverage everything we can. We leverage all of our relationships. We can't be afraid to pick up the phone and call a competitor. Also, we do a lot of planning. We look four or five weeks out, [at] what we expect," Mr. Brady said. "We started pulling certain surgeries forward, pushing other surgeries back — less fluid-intensive surgeries like joints, the open stuff. Under the current allocation, we ensured that we could cover our patient volume and our scheduled patient load through the end of the year. When this first started a couple of weeks ago, we didn't think we could get to today. So we were very creative and open, and put everything on the table."
Emphasis on staff training
Building a competent, well-trained and communicative team is essential for ASC growth, especially as more high-acuity procedures move to the ASC setting and practices face pressure to scale up quickly.
Alyson Engle, MD, an anesthesiologist and interventional pain specialist with Northwestern Medical Group in Chicago, said onboarding new physicians unfamiliar with the pacing required in an ASC can be challenging.
"One thing we've found helpful with these new grads coming out or people who haven't had the experience they say they do: we give them a mentor. It's usually our most efficient proceduralist who can do the quickest [work]," Dr. Engle said. "And [they're] also good at communicating and making [the new staff] feel like, 'Hey, you can reach out to me.'"
These mentor pairings continue until new physicians are better able to manage ASC procedure flow and meet quality metrics, Dr. Engle said. Establishing this strong foundation with new staff helps build a team capable of safely and efficiently handling new challenges.
Negotiate payer contracts when possible
ASCs have long struggled with lower reimbursement rates for the same services as HOPDs, and CMS recently finalized a 2.83% physician pay cut in its 2025 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System.
"We've aggressively been renegotiating all of our contracts — both facility and professional clinic — all year. And we've had some really great success in doing so," said Mr. Brady.
Maintaining thorough documentation of ASCs' relatively low cost and high accessibility may help practices in payer negotiations.
"Basically, we are forcing them to go back and look [at our records] and demonstrate to them that … we are high quality, we are accessible and we are the cost advantage," Mr. Brady said. "You look at what hospital outpatient charges compared to what an ASC charges for a knee — it's a no-brainer."