Rural surgery centers are poised to play a pivotal role in the evolution of American healthcare — offering high-quality, lower-cost care in regions often overlooked by large health systems.
ASCend, a new management services organization based in Gillette, Wyo., is on a mission to keep rural ASCs independent and locally owned. Founded by CEO Linda Bedwell and COO/CFO Norberto Orellana, ASCend aims to empower physician-led surgery centers in underserved regions.
The co-founders recently joined Becker’s to discuss the future of rural ASCs and how ASCend plans to help them thrive, not just survive.
Editor’s note: This response was edited lightly for clarity and length.
Question: How do you see rural ASCs evolving over the next five years or so? And as a follow-up, what role do you want Ascend to play in that future?
Norberto Orellana: I think it’s critical to the success of healthcare in general. In Wyoming, if someone needs a total hip or another major surgery, they’re not even going to Google providers in Wyoming — they’re going to look in Colorado, Billings or Rapid City. But we have an incredible opportunity here because we have amazing surgeons and a strong workforce that we want to retain.
We also have a physician development program called the WWAMI program. Local aspiring physicians can go through this program and return to one of the participating states. We want to have a place for them to come back to, which is really exciting. Ultimately, everyone here just wants to provide a great service, build a strong reputation, and become a destination for healthcare. We want to keep healthcare local, provide it at an equitable price, and ensure our businesses and communities can thrive.
Linda Bedwell: I would add that rural America is essential to the broader fabric of our country — whether it’s the supply chain, food production, manufacturing or energy. Gillette, in particular, is the energy capital of the nation. Communities like ours keep the country running, and they need high-quality healthcare.
Unfortunately, many hospital systems are cutting services, leading to healthcare deserts. ASCs are uniquely positioned to be a solution—providing affordable, sustainable healthcare. On a national level, healthcare costs continue to rise, and ASCs can and should play a key role in controlling those costs. That includes everything from Medicare solvency to the financial burden patients feel. ASCs are essential to achieving a value-based care future.
Ascend’s role is to help local ASCs reach that future—without giving up who they are or sacrificing local ownership. We were recently in talks to connect with an ASC in Wisconsin, which shows how this is expanding from a Wyoming-focused project to potentially a national one. Whether it’s existing ASCs or de novo centers in underserved areas, Ascend wants to fill those gaps and show what outpatient surgery can achieve in rural America.
NO: ASCend isn’t here to criticize or judge. We say: “Look at what you’ve achieved with limited resources. Now let us help you go further.” We want to help centers that are operating in “average” move into “massive action” and get results they couldn’t achieve alone — not from lack of effort, but because they lacked resources and expertise.
That’s who we are. That’s what we do. Any ASC out there thinking, “We’re surviving, but we want to do more,”—that’s where Ascend comes in. We can help them go beyond average.
LB: And that’s a big reason there are so few surgery centers in the Mountain West. It’s hard for physician-owners to succeed — they hesitate to take the risk. It’s challenging to get the right operations team in place. But if we can show we can take them from average to successful, we’ll encourage more value-based care centers where they’re needed.
Also, and maybe I’ve lost my mind for saying this, but I believe if we work together, hospitals, surgery centers, physicians, all of us, we can grow together. Rural hospitals are struggling even more than ASCs. But surgery centers know how to run lean. That’s been our model from the start. We’ve had to survive on bundled payments and tight margins. Hospitals haven’t had to think that way.
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