As healthcare consolidation accelerates and operational pressures mount, independent rural ASCs are under threat. These facilities are not only fighting for their survival but also for the health and economic stability of the communities they serve.
Across the country, rural ASCs are navigating an increasingly complex landscape. Declining reimbursements, evolving payer mixes, rising operating costs and persistent workforce shortages have left many of these centers operating on razor-thin margins.
While many ASCs have been pillars of their communities for decades, the last few years have stretched them, especially independent centers, to the brink. That’s where ASCend steps in. Founded by CEO Linda Bedwell and COO and CFO Norberto Orellana, the new Wyoming-based management services organization aims to support independent and rural ASCs without requiring equity or ownership stakes.
Wyoming, for example, has seen a 30% increase in Medicare utilization over the past decade, Ms. Bedwell told Becker’s. Although volume is rising, shifting from commercial to government payers is creating financial pressure.
“We’re trying to figure out how to manage the case mix that was mostly commercial 20 years ago, and now you’ve got government payers making a significant impact on your ratios,” Ms. Bedwell said.
This payer shift, paired with a loss of purchasing power due to geographic isolation and low procedure volume, leaves rural centers with few options. ASCend is looking to access economies of scale, reaching the contracts that “you would typically find in a more urban market, where there is more buying power, where there is more leverage,” Mr. Orellana said.
But reimbursement challenges aren’t the only threat. The most existential pressure may be consolidation, Mr. Orellana said. National health systems and corporate entities are acquiring independent ASCs and physicians at a rapid pace, often diluting local ownership and community-specific care.
“[Consolidation] reduces autonomy, local ownership, local buy-in,” Mr. Orellana said. “There is a place for those companies, of course, but in the rural setting and for rural communities, it’s very important to have that connection to your providers and to have that local economic support that they generate.”
Interest in launching new ASCs is growing, especially in underserved regions like South Dakota and Wisconsin. ASCend sees an opportunity to reverse healthcare flight from rural America.
“Some people don’t want to admit they need help. Even if their nearest competitor is 200 miles away, there’s a hesitation to share,” Ms. Bedwell said. “We’re breaking down those walls slowly. Trust takes time.”
ASCend isn’t alone. Other groups are testing regionally adapted models to keep independent ASCs afloat.
Sapient Health, based in New York City and founded by Joseph Romano and Bill Ingram, offers the infrastructure of a large MSO while maintaining a personalized, startup-like feel. It focuses on regional support in New York, New Jersey and Florida. Their model prioritizes physician leadership, entering partnerships as minority investors to preserve clinical autonomy.
Surgical Solutions IPA, launched by Gregg Gordon in 2024, is one of the country’s first independent practice associations built exclusively for ASCs. Based in New York, the IPA unites independent centers to negotiate better contracts, streamline operations and strengthen their position in a consolidating market.
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