Ambulatory surgery center (ASC) operators are no strangers to change.
But as procedure migration accelerates and specialties like cardiovascular care become more common in the outpatient setting, ASC leaders are being forced to rethink everything from payer strategy to staffing models.
“We all have costs. We all see the increase in costs,” Todd Currier of Bend Surgery Center in Oregon said at the Arizona Ambulatory Surgery Center Association’s 2025 Annual Conference in Scottsdale. “Having payers not giving any increase, or very limited increases, is just not how we can stay in business long term.”
Bend Surgery Center is a large multispecialty ASC in Oregon.
These trends – more procedures being shifted into ASCs, margin pressures and limited payer movement – can create challenges.
“As we start to do more [procedures], and as these ASCs produce good quality data and good outcomes, we’re seeing more and more of those CPT codes continue to grow,” Sammy Ramirez, CEO of Banner Cardiovascular ASC Arcadia, added.
Banner is a cardiovascular-focused outpatient facility in Phoenix operated through a joint venture between Atlas Healthcare Partners and Banner Health, specializing in diagnostic and interventional heart procedures.
Arizona’s regulatory environment has helped ASCs produce this data, Ramirez said, adding that 15 to 20 CV-specific ASCs opened in the Phoenix area between 2019 and 2021.
The race to add high-acuity cases
As the U.S. Centers for Medicare & Medicaid Services (CMS) expands its ASC Covered Procedures List (CPL), surgery centers are seizing the opportunity to add high-acuity cases like total joints and cardiac ablations. But that expansion comes with new financial and operational demands.
Operators should analyze the return on investment before adding procedures like total shoulders or spinal implant, Currier said.
“Doing one or two a month is probably not going to pan out,” he said. “We’ve had to go back to vendors and say, ‘We have to get these costs down, or we’re just not going to do these anymore.’”
In the cardiovascular world, technology and case selection are rapidly evolving, Ramirez said. He pointed to pulse field ablation (PFA) as a breakthrough that could dramatically reshape the outpatient landscape, but only if centers can negotiate down the per case cost.
“We’re telling [vendors], ‘You want widespread adoption? You want your name out there? Let us crank out data and safety metrics for you,’” he said. “We’re almost to the point where we’ve got it at the same price as a standard radiofrequency ablation.”
Patient experience as a contracting tool
As payers become more outcomes-driven, patient satisfaction will be a key differentiator, Ramirez said.
“They don’t care about your accreditation. They care about patient satisfaction and quality outcomes,” he said. “We actually have a valet at our center. Sounds funny, but patients don’t have to navigate the parking lot, and they come in happy.”
His team also shoots custom videos featuring providers explaining procedures, and sends them to patients in advance via text.
“So when the patient gets there, they’re pretty familiar with the staff. They’ve already seen the facility,” Ramirez said. “We do the whole tracking board where … the family gets a text, you know, the patient’s going back to the OR, etc. And so it’s those little things that to us sound cumbersome, but from a patient experience perspective, they love it, and my scores reflect that.”
Currier echoed that sentiment. His team created a monthly “patient experience committee” to analyze feedback and coach staff on language and goals.
“This turned into a hot topic for us in 2025,” he said. “We created benchmarks, and when we hit those marks, we celebrate.”
Staffing pressures and creative solutions
Even the most refined case-mix strategy means little without staff to carry it out. Both panelists acknowledged the growing difficulty in attracting and retaining clinical workers, especially nurses.
“We’re competing with $25,000 to $50,000 sign-on bonuses at hospitals,” Ramirez said. “We’re tapping into paramedics and medical assistants to free up our RNs. We have to think unorthodox.”
Culture and transparency are key, Currier said.
“I’ve told my staff, if you need to chase the money, I understand. But we’re going to give you the best work-life balance and environment possible,” he said. “When we grow, we can do these additional things. But this is what we can pay you today.”
He added that cross-training and team-building are priorities at Bend Surgery Center, where new hires are paired with seasoned staff and encouraged to develop flexibility across roles.
“You want to get your staff as fully multitasking as possible,” he said.
And leadership visibility is critical in high-volume settings, Ramirez said.
“Tomorrow morning, I’m in the cath lab all day long because we had a call-off,” he said. “I’m not going to leave my team hanging.”
Both panelists said ASCs looking to expand their case mix should ease into it.
“Start with low-risk, high-volume cases, build your team, get your providers comfortable, then scale up safely,” Ramirez said.
Currier agreed, encouraging administrators to reach out and learn from peers.
“Don’t reinvent the wheel,” he said. “We learn from each other every single day.”
