Session: Setting Sail—Top 5 Business Trends for Ambulatory Surgery Centers in 2025

Editor's Note

In this panel at the 2025 OR Business Management Conference, led by Bob Winandy, MSN, MBA, RN, CEO of Brightside Surgical; Janet Carlson, MSN, BSN, RN, NE-BC, FACHE, executive director of ASCs at Commonwealth Pain & Spine; and Geri Eaves, BSN, RN, CASC, CNOR, CEO and administrator, The Bone and Joint Institute of Tennessee Surgery Center, the engaging discussion focused on key strategies to optimize efficiency, increase revenue, manage staffing shortages, and navigate regulatory requirements at ambulatory surgery centers (ASCs). The panelists shared insights on how to grow and sustain successful ASCs, adapt to evolving industry trends, and foster collaboration across healthcare systems.

One trend discussed was how total joint replacements, spine procedures, and pain management are driving revenue growth. A unique trend discussed is the integration of urology into orthopedic ASCs, which has enhanced postoperative efficiency for joint replacement patients experiencing urinary retention. Developing specialized protocols for postoperative care, such as implementing urinary retention protocols and indwelling catheterization, can significantly improve patient throughput and minimize unnecessary emergency department visits.

Another significant factor in ASC success is strategic expansion and infrastructure planning. Centers that anticipate growth design ORs with flexible space and large sterile processing departments, allowing for seamless expansion into new service lines. States with no certificate of need requirements offer greater flexibility in developing multispecialty ASCs.

The panelists emphasized the importance of identifying high-revenue cases and aligning services accordingly. Total joint replacements and bariatric surgeries were identified as high-margin procedures, with one noting that a single bariatric surgical procedures generates more revenue than an entire day’s worth of gastrointestinal (GI) cases. In the same vein, financial planning is key and should factor securing favorable payer contracts and ensuring physician buy-in. Physician ownership increases engagement, which in turn drives utilization and financial performance.

One of the biggest challenges facing ASCs—like most other healthcare facilities—is staff recruitment and retention. Traditional incentives like higher wages are difficult for ASCs to match compared to large hospital systems, so leaders focus on alternative motivators, such as:

• Flexible scheduling (eg, 4-day work weeks, customizable shift structures)
• Guaranteed holiday closures (eg, closing on the Friday after Thanksgiving)
• Work-life balance and reduced burnout (eg, no nights, weekends, or on-call shifts)
• Productivity and quality-based bonus structures, with biannual payments to maximize tax benefits.

Proposed solutions for making the most of overnight cases include:

• Dedicated overnight staff with higher pay differentials (eg, $10/hour incentives)
• Limiting overnight cases to specific days of the week (eg, Monday to Thursday)
• Pre-scheduling overnight shifts with PRN nurse practitioners and CRNAs.

Creative staffing solutions the panelists discussed include:

• Partnering with local colleges to train and recruit scrub techs
• Encouraging physicians to bring their own PAs to offset staffing shortages
• Creating internal staffing agencies to offer better benefits and stability to employees.

They also emphasized that ASC culture and work environment play a major role in attracting and retaining talent. Staff members value stability, predictable hours, and employer recognition over short-term financial incentives like sign-on bonuses. Succession planning is another consideration to guarantee a steady influx of new surgeons to replace those nearing retirement. Long-term success depends on proactively recruiting fellows and residents and gradually integrating them into ASC workflows.