ASC leaders across the U.S. are facing an escalating series of headwinds, from anesthesia shortages to skyrocketing supply costs and stubborn staffing woes. And they’re getting creative to stay ahead.
During a panel at the 22nd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference in Chicago, administrators from a variety of ASC and hospital settings shared their strategies for surviving — and even thriving — amid their most pressing challenges.
Here are five major headwinds facing ASCs:
1. Anesthesia shortages:
Anesthesia coverage remains one of the most fragile elements of ASC operations, and panelists shared a range of solutions for staying staffed and open.
“In Austin, we’re pretty lucky. I work with an independent group that’s hungry and I feel like that’s the key thing because they need to be hungry,” said Tammy Smittle, RN, group CEO of Austin, Texas-based Northwest Hills Surgical Hospital and Stonegate Surgery Center.
During the panel discussion, Ms. Smittle explained that her ASC’s model incorporates both anesthesiologists and CRNAs, and they’re now trialing anesthesiologist assistants, a new approach for Texas.
“It’s been working fine and it keeps all my rooms open,” she said.
Others weren’t so fortunate, particularly as ASCs are increasingly bearing the burden of anesthesia stipends.
“There are many centers in my state that are basically breaking even profitwise because they’re giving all of their profits to the anesthesia group for a stipend,” said Elisa Auguste, CASC, administrator of East Setauket, N.Y.-based Precision Care Surgery Center.
With CRNAs unable to operate independently in New York state, staffing gaps are more acute. Ms. Auguste said she often has to condense operating rooms or delay cases when anesthesiologists are pulled to nearby hospitals.
2. Staffing woes
Staffing challenges remain relentless across the board, from front-desk staff to nurses to techs.
“Front desk people will jump ship for 25 cents more an hour,” said Paul Bruning, division administrator of sports medicine at Duke University School of Medicine’s Hand and Sports Sciences Institute in Durham, N.C. “We’re hiring people, getting them through onboarding, background checks, spending the cost on them, and then Day 1, they don’t show up.”
Ms. Auguste described similar frustrations:
“People don’t show up for interviews,” she said. I’ve been down two full-time nurses for almost a year.”
To combat attrition, she’s leaned into improving benefits, including covering up to 90% of staff insurance premiums, but acknowledged that rising costs aren’t always visible to employees:
Ms. Smittle emphasized building a strong culture over top-dollar pay:
“I don’t want people coming just for money. I want people to come and take care of patients. We’re a family,” she said.
3. Supply costs
Whether it’s implants or tape, cost containment has become a leadership priority, often requiring creative tactics. ASCs spend 26.3% of operating revenue on drugs and other medical supplies in 2024, according to data from EDM Medical Solutions. When broken down by individual cases, drugs and other supplies cost an average of $634 per procedure.
“One of my biggest vendors just increased their cost 8% on me in one year,” Ms. Auguste said. “The rising cost of expenses, but the rising cost of revenue never align.”
To adapt, she’s educated physicians about implant pricing and leaned into peer pressure among physician-owners to drive cost-saving behavior.
At Duke, Mr. Brunning implemented patient-reported outcomes to help guide implant standardization:
“We take a look at our outcomes and find out. Physicians tend to be very scientific,” he said. “They get it and they will be more cooperative.”
4. Physician recruitment
Surgeon retention and fast-track credentialing are mission critical in a competitive market.
“None of my doctors are employed. They can all choose where they go,” Ms. Smittle said. “A happy surgeon is the best marketer you’ll ever meet.”
“If they’re standing in the hall, they’re not making me money,” she said. “So I flip the doctor. We flip rooms. I become a mad scientist about moving patients around.”
Mr. Brunning reported strong pipeline recruitment through internal fellowships, while Ms. Auguste’s ASC leverages practice integration and offers a clear path to ownership to attract new surgeons.
5. Payer pressure
Payer dynamics, especially around Medicare Advantage and Medicaid, are starting to pinch, even in hospital-anchored ventures.
“How is that sustainable to provide care when your costs go up but your reimbursements go down?” Mr. Brunning said.
In New York, Ms. Auguste is dealing with commercial payers that won’t reimburse for implants, pushing her to cost-analyze every case.
“We don’t turn the cases away, but we do try to figure out ways how to do them economically,” she said.
The post ‘They have to be hungry’: How ASCs navigate stiff headwinds appeared first on Becker’s ASC.
