Independent ASCs are under growing pressure as reimbursement fails to keep pace with rising operational costs, staffing shortages and mounting administrative burdens.
In response to these challenges, Gregg Gordon launched Surgical Solutions IPA in 2024, one of the country’s first independent practice associations built solely for ASCs. Based in New York City, SSIPA works to bring together independent ASCs to strengthen payer negotiations, streamline operations and preserve autonomy.
Mr. Gordon joined Becker’s to discuss the future of ASCs and why, without collective action, many may not survive the next wave of consolidation.
Question: In an increasingly consolidated healthcare landscape, how realistic is it for ASCs to stay independent without something like SSIPA?
Gregg Gordon: The way I see it, market forces are threatening ASC independence. They’re struggling to absorb rising costs and take on new ones.
In New York alone, 19 new ASCs opened in 2024. Each of those needs anesthesiologists or CRNAs in multiple ORs — but the supply hasn’t grown. So now, anesthesia is becoming one of the biggest sticking points, even for payers who are willing to engage. Anesthesia groups are staying out of network or telling ASCs they won’t do cases unless the ASC makes up the difference between what they’re paid and what they want to be paid. What they want is astronomical. What they’re paid may be fair market value, but the ASC has no choice.
If they don’t pay stipends, or hire differently, or give up some equity, the cases don’t get done. So now they’re dealing with unexpected, unbudgeted costs on top of everything else. And they’re not getting help from payers or Medicare to adapt to these changes.
Eventually, there may not be many independents left. The big systems — Northwell, Mount Sinai, Presbyterian, NYU — they want to control the geography. They’re building, doing joint ventures or acquiring. And then you have PE-backed groups — USPI, SCA Health — who are watching for distressed or soon-to-be-distressed independents and offering to take them over. For legacy ASCs, that can be attractive. For newer or de novo ones, they’re more committed to autonomy and to doing right by the community.
SSIPA isn’t Robin Hood, though sometimes I like to think of it that way. But if the model is successful and we get the right partners, it can help independents stay independent. And maybe it can slow down the consolidation we’re seeing across every part of the healthcare continuum.
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