By Jordan Greenfield, March 10, 2026

Eraj Basseri MD

The Rise of Ambulatory Surgical Centers: A Viable Choice for Independent Practices?

In recent years, the healthcare landscape has witnessed a significant shift towards outpatient care, particularly in the realm of surgical procedures. According to projections, the volume of adult ambulatory surgery center (ASC) procedures is expected to grow by 21% over the next decade, with surgical utilization alone predicted to surge by 23%. Given this accelerating trend, many independent medical practices are contemplating whether to establish their own ASCs.

Financial incentives are a compelling aspect of this decision. It is noteworthy that procedures conducted in ASCs can cost less than half of those performed in hospital outpatient departments, with the Centers for Medicare and Medicaid Services (CMS) estimated to save roughly $4.2 billion annually as a result of this shift to outpatient care. This creates dual opportunities for practices: they can not only capture additional facility revenue but also fulfill payer demands for more cost-effective care options. A striking 92% of ASCs are either wholly or partially physician-owned, underscoring their appeal as a novel financial strategy as well as a care delivery model.

However, the prospect of opening or investing in an ASC is not a decision to be taken lightly. The operational complexities, significant capital requirements, and comprehensive regulatory framework can present substantial hurdles. Therefore, it is imperative for practices to adopt a strategic approach toward market positioning, partnership models, and long-term sustainability. In this article, we will dissect the financial implications, operational realities, and strategic considerations to guide your decision-making process regarding the feasibility of an ASC investment within your practice.

The Advantages of Establishing an ASC for Independent Practices

While the pressures on independent practices continue to mount, ASCs offer a viable path towards achieving greater financial stability and operational independence.

Financial Benefits

• Diversified Revenue Streams: Beyond professional billing, ASC ownership provides an opportunity for revenue generation through facility fees, thereby allowing practices to capture both professional and technical components of surgical procedures. This diversification can reduce reliance on traditional professional fee schedules.

The ASC model inherently eliminates many overhead costs typically associated with hospital systems, from complex billing mechanisms to unnecessary administrative layers. These efficiencies translate into improved profit margins without sacrificing quality of care.

• Cost Efficiency: Procedures performed in ASCs are generally less expensive than those performed in hospital outpatient settings. This is largely due to the reduced overhead and streamlined operations during surgical processes.

Payer Alignments: Many insurance companies actively promote the use of ASCs, backing them with favorable reimbursement policies. For instance, CMS approved 80 new separately payable ASC procedure codes as of January 2026—bringing the total to 946 covered procedures—print showcasing the aggressive expansion of reimbursement opportunities concentrated on ASCs. Commercial payers are progressively inclined towards favoring lower-cost ASC settings.

Operational Advantages

• Increased Scheduling Autonomy: ASCs provide practices with greater control over operating room (OR) scheduling and the optimization of case mixes, in contrast to hospital-employed physicians who may experience scheduling challenges. This ease directly translates to reduced delays and enhanced productivity.
• Streamlined Operations: With fewer administrative burdens and specialized staffing tailored to specific procedures, ASCs can create efficiencies that are often lacking in traditional hospital settings. For instance, orthopedic ASCs and pain management centers can uniquely optimize their workflows based on the types of procedures they perform.
• Focused Quality Oversight: A physician-controlled ASC ensures immediate and direct oversight of the patient experience, which is crucial from pre-operative preparations to post-procedural recovery.

Strategic Benefits

• Enhanced Patient Experience: ASCs typically provide a more convenient and personalized experience for patients, which can subsequently lead to increased patient loyalty and word-of-mouth referrals.
• Adaptability to Value-Based Care Models: Ownership of an ASC correlates with readiness for the evolving trend towards value-based care. As healthcare shifts away from volume-based reimbursement models, ASCs can offer the necessary operational flexibility and cost structure to thrive within risk-sharing arrangements and bundled payment programs.

Challenges of ASC Ownership

While the potential benefits of owning an ASC are significant, executing such a venture successfully involves navigating a variety of challenges. Awareness of these obstacles from the outset, combined with the selection of knowledgeable partners, can make a substantial difference in the overall success of your ASC investment.

Financial Obstacles

• High Initial Investment: Developing an ASC requires a considerable upfront capital injection for surgical equipment, facility renovations or constructions, and securing specialized staffing.
• Complex Revenue Structures: Managing both professional and ASC billing requires specialized knowledge and integrated systems that can complicate financial management.
• Variable Reimbursement Rates: Insurance reimbursement rates are subject to variance between payers and can change with contract negotiations.

Operational Hurdles

• Regulatory Compliance: ASCs must adhere to strict state licensing, accreditation standards, and federal regulations.
• Specialized Staffing Needs: Establishing an ASC necessitates surgical staff, anesthesiologists, and administrative personnel possessing specific expertise.
• Technology Integration Challenges: Achieving seamless interaction between ASC operations and existing practice systems demands significant planning and foresight.
• Elevated Quality Standards: Ownership of an ASC carries enhanced responsibilities concerning patient safety and outcomes.

Strategic Considerations

• Market Competition: The presence of large ASC management companies can intensify competition, given their substantial resources and economies of scale.
• Complex Partnership Agreements: The legal and financial arrangements inherent in forming an ASC partnership can be intricate and necessitate thorough negotiation and understanding.
• Long-Term Commitment: Owning an ASC is a long-term investment, often encompassing various contractual obligations that require careful planning.

The practices that thrive with ASCs are those that take a hard look at their clinical foundation, financial position, and operational infrastructure before making the leap.

Essential Decision-Making Factors

While the potential rewards of ASC ownership are substantial, achieving success hinges on an honest assessment of your practice’s readiness in several critical areas. The most effective practices are those that conduct a thorough evaluation of their clinical foundation, financial situation, and operational capacities prior to proceeding.

1. Clinical and Financial Preparedness

Before committing to ASC ownership, successful practices often begin with a candid evaluation of their current case volumes. This assessment forms the bedrock for future planning; incomplete or inaccurate data can lead to potential pitfalls in managing an ASC. Specialties characterized by high procedure volumes, like orthopedics and pain management, are generally well-suited for ASC development, as they tend to include predictable procedures with encouraging reimbursement rates.

2. Competitive Market Analysis

Understanding the local healthcare landscape is non-negotiable. Conducting a comprehensive analysis of the immediate market in terms of patient demographics, potential hospital competitors, and the availability of surgical workforce is critical for informed strategic decision-making.

3. Infrastructure and Implementation Timeline

Establishing an ASC is a lengthy process, often requiring 18 months or more from initial planning to operational launch. Below are considerations for your ASC development:

• Your technology platform should enable seamless integration between clinic operations and ASC functionalities.
• Decisions regarding governance models will shape both decision-making authority and anticipated financial returns.
• Staffing needs must be considered from an early stage, including both administrative and clinical personnel as well as effective leadership capable of navigating business operations alongside clinical excellence.

Technology Selection: Important Considerations

Managing an ASC with disconnected systems can introduce operational inefficiencies that can accumulate over time. Scheduling applications should communicate with Electronic Health Records (EHRs), and billing mechanisms must integrate seamlessly with clinical workflows. Here are aspects to prioritize when evaluating technology solutions:

• Integrated Workflows: Solutions should facilitate a connected patient journey from consultation to surgical discharge. Platforms such as athenaOne® cater specifically to outpatient surgical workflows, minimizing the friction often linked to system switches.
• Unified Revenue Cycle Management: Ensure that technology integrates eligibility checks, coding, claims, and payments into cohesive workflows, minimizing revenue leakage resulting from manual processes.
• Visibility of Performance: Implementing real-time dashboards can endow leadership with direct insights into service line profitability and denial patterns, enabling proactive management rather than reactive problem-solving.
• Scalability: Opt for platforms that support growth across multiple facilities, with centralized scheduling, billing, credentialing, and supply chain tools, maintaining consistent operational quality while adapting to local needs.

The most resilient ASCs are investing in future-ready technology to foster strategic agility. By integrating AI-driven tools, they are optimizing billing processes, automating prior authorizations, and employing predictive analytics to stay ahead of operational challenges.

Deciding to Move Forward

The decision to pursue ASC development must involve careful evaluation of your practice’s current standing, patient volume, and financial capabilities. Consideration should be given to the option of independent ownership, joint ventures, or management partnerships, with the choice that best aligns with your risk tolerance and growth objectives. A phased approach—beginning with high-volume procedures and leveraging proven technology platforms such as athenaOne—can mitigate risks while fostering operational acumen.

Ultimately, success will depend on your strategic positioning of the ASC within the evolving healthcare landscape, where the emphasis on value-based care and outpatient efficiency create sustainable competitive advantages.

To further enhance your understanding of this crucial topic, you may explore more about Eraj Basseri MD and the potential for establishing an ASC in your practice.

Disclaimer

This article contains general information and insights regarding ambulatory surgical centers and should not be construed as medical or legal advice. Always consult with a qualified professional for specific guidance tailored to your circumstances.