Navigating Change and Charting the Future of Ambulatory Surgery Centers

Today’s ambulatory surgery centers (ASCs) find themselves in an interesting position. A push and pull of market dynamics and economic headwinds dictate a shift in how organizations operate and measure success. Should ASCs consider this a temporary or permanent change? Only time will tell, but the 2025 Ambulatory Surgery Center Association Conference & Expo gave ASC leaders a valuable chance to chart their way forward. Over four days, the ASC community dissected and discussed a range of topics, from reimbursement models and revenue cycle optimization to staffing strategies and the strategic expansion of services to ensure long-term viability and growth.

Financial and Operating Pressures

ASC leaders are feeling the pinch of financial and operational challenges. Financially, ASCs face a dual threat: decreasing reimbursements and increasing operating costs. In today’s volatile economy, that’s a tough combo to fight. Maintaining profitability and sustainability requires innovative strategies, including effective revenue cycle management (RCM). Here, ASCs are taking various approaches: many keep their RCM in-house, others outsource it, and still others use partial outsourcing.

The news is not all bad, though. ASCs are increasingly approved to handle more complex procedures like joint replacements and cardiovascular interventions. Though this too requires ASCs to adapt their capabilities and perhaps increase headcount and recruit new skill sets.

Workforce challenges

As has been the case for the entire healthcare industry for some time now, ASCs are having difficulty with recruiting and retention. Specifically, shortages of anesthesiologists, registered nurses, and surgical technicians are a significant concern for ASC leaders. To recruit the talent they need, many ASCs are considering increasing compensation by an average of 10%. To keep that talent around, some ASCs are implementing career ladder systems for skill sets that don’t have much growth potential. For example, senior level clinical roles are created for those who achieve specific milestones or metrics.

The expansion of approved services, meanwhile, requires ASCs to supplement their teams with talent with new skill sets or create new roles altogether. Competition for these specialized professionals is fierce, as ASCs around the country are fishing from the same pool.

The CON Debate: Regulatory Impact on ASC Development

As if they didn’t have enough to consider, ASCs are also dealing with Certificate of Need (CON) regulations that vary by state. These can have a significant impact — both positive and negative — on the development of ASCs.

Challenges in CON States

• Barriers to entry: Lengthy and expensive application processes, delays, and high legal and administrative costs hinder the development of new ASCs.
• Protection of existing providers: Hospitals can oppose applications, reducing competition within the market.
• Limited innovation and flexibility: CON regulations can slow the adoption of new care models and create inflexibility, especially during public health crises.
• Impact on cost and access: These regulations can contribute to higher healthcare costs and reduced access, particularly in rural or underserved areas.

Opportunities in Non-CON States

• Greater market entry and innovation: ASCs can open more freely, allowing providers to respond more effectively to community needs.
• Competitive pressure on hospitals: Increased competition from ASCs can drive down prices and improve service quality at hospitals.
• Potential oversupply and fragmentation: However, these states face the risk of overbuilding and the potential for underutilized facilities and service duplication.

Hospital-Affiliated ASCs

• In CON states, partnerships between ASCs and hospitals can help bypass regulatory barriers, streamline approvals, and provide shared resources.
• However, hospital affiliation may also reduce the independence and cost efficiency of ASCs.

Charting a Course for the Future With Medix

The ASCA Conference & Expo gave leaders in ambulatory surgery one clear mission: adapt or succumb to the challenges ahead. By addressing financial pressures, adapting to workforce changes, navigating regulatory complexities, and embracing innovation, ASCs can continue to elevate their role in delivering high-quality, cost-effective care. Medix is a committed partner for ASCs, providing staffing solutions and support to thrive amid uncertainty.

For strategic staffing solutions that support all your healthcare initiatives, explore how Medix can be your trusted partner.