This Week in Surgery Centers

Patient payments are getting messier — not always because patients won't pay, but because the workflow is full of friction, surprises, and missed follow-through. In this episode, HST experts talk about what really works for top-performing ASCs: clearer upfront estimates, fewer handoffs, easier ways to pay, and the operational fixes that keep small balances from quietly aging into "never gets paid." You'll also hear why many centers are seeing more partial payments even as total patient collections decline, and what that means for staffing, patient experience, and revenue cycle priorities heading into the year. In our data segment, we highlight insights from HST's demographic benchmarking report: case volume and payment share don't always line up by specialty — and that matters for more precise planning and forecasting. Subscribe for weekly ASC news and ops insights. Resources mentioned: HST Pathways Demographic Trends & Benchmarks for ASCs [https://www.hstpathways.com/specialty-data/asc-demographic-data] Brought to you by HST Pathways.

Patient payments don't have to be complicated. In this week's episode, we kick off our Patient Payments series with a practical guest conversation on what "good" looks like in 2026: integrated processing, fewer manual steps, faster reconciliation, and an easier way for patients to pay. We cover where workflows commonly break down, why manual reconciliation and disconnected tools create errors and wasted time, and what to look for in modern payments and reporting. We also close with quick headlines: CMS's rural health transformation push, new research linking pre-surgery stress to worse recovery in older adults, a CEO transition at Compass Surgical Partners, and why the South is becoming a hotspot for ASC growth. Subscribe for weekly ASC news and ops insights. Resources mentioned: CMS Establishes Office of Rural Health Transformation, Unveils $50B in State Awards: What ASCs Need to Know [https://ascnews.com/2025/12/cms-establishes-office-of-rural-health-transformation-unveils-50b-in-state-awards-what-ascs-need-to-know/] (Ambulatory Surgery Center News) Stress among older adults linked to worse surgery recovery [https://medschool.duke.edu/news/stress-among-older-adults-linked-worse-surgery-recovery] (Duke University School of Medicine) Compass Surgical Partners Names Mark Langston Chief Executive Officer [https://www.compass-sp.com/news/press-releases/compass-surgical-partners-names-mark-langston-chief-executive-officer] (Compass Surgical Partners) Why ASCs are surging in the South [https://www.beckersasc.com/asc-transactions-and-valuation-issues/why-ascs-are-surging-in-the-south/] (Becker's ASC Review) Brought to you by HST Pathways.

If you've been looking for a clear, ASC-focused breakdown of the 2026 CMS final payment rule, this episode is for you. This week, ASCA's Chief Advocacy Officer, Kara Newbury, joins us to break down the most important things ASC leaders should note coming out of the 1600+ page document (all in under half an hour). Kara takes us through the reimbursement rate, the weight scalar update and ASCA's advocacy for its elimination, a major rate oversight on the most common ASC procedure, massive covered procedure list expansion, and more. In our data segment, we look at patient payment behavior at ASCs and discuss some of the reasons why partial payments are rising and paid-in-full cases are declining, and how financial stress and insurance complexity are showing up in case cancellation rates. Resources mentioned: Ambulatory Surgery Center Association [https://www.ascassociation.org/home] Calendar Year 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Final Rule [https://www.cms.gov/newsroom/fact-sheets/calendar-year-2026-hospital-outpatient-prospective-payment-system-opps-ambulatory-surgical-center] HST Pathways 2024 State of the Industry Report [https://www.hstpathways.com/resources/surgery-center-industry-report/] Brought to you by HST Pathways.

If you only had time to do one thing this week to improve your surgery center, what should it be?  To kick off the countdown to year-end, This Week in Surgery Centers pulls together a year's worth of conversations into one rapid-fire episode, featuring input from 30 past guests on the closing question of every interview: what is one thing ASC leaders can do this week to improve their surgery centers? You'll hear practical, do-it-this-week ideas from ASC administrators, nursing leaders, business office experts, consultants, and physicians on: * Supporting and recognizing your staff in meaningful ways * Cleaning up payer profiles, item masters, and days to bill to strengthen margins * Tightening credentialing, monitoring, disaster plans, and IT/infosec policies * Improving communication with patients, caregivers, schedulers, and surgeons * Getting your financials and partnerships ready for the next phase of growth This episode gives you simple, concrete starting points to make 2026 a stronger year for your center — one small improvement, week by week. Brought to you by HST Pathways.

In the third installment of our case costing series, HST Pathways' Chief Innovation Officer, Gavin Fabian, breaks down what "mature" case costing actually looks like in a real ASC (and why, done right, it's pretty boring). The conversation covers why so many initiatives fall apart at the cost-data level, how to clean up your item master and documentation workflows, and practical steps to move from retrospective spreadsheets to automated case profitability forecasting. Gavin also shares where AI can help plug data gaps, where forecasting should live in your scheduling workflow, and how to use these insights to drive surgeon alignment without sacrificing culture. In the data segment, we discuss a custom metric from HST's demographic benchmarking report: OR Minute–Case Gap (by Sex). You'll hear how this metric is calculated from a 5.3 million–case dataset, what national patterns look like in specialties such as Cardiovascular and Spine, and how ASC leaders can use these insights to challenge assumptions about block times, staffing, and scheduling — so days run closer to plan.. Resources mentioned: Who's on Your Schedule? Demographic Trends and Benchmarks for ASCs [https://www.hstpathways.com/specialty-data/asc-demographic-data] Who's on Your Schedule? Exploring Demographic Data for ASCs (Podcast) [https://youtu.be/NFoBXHO0V_g?si=ZPxoSxLpxnqzS6Yw] HST Pathways 2025 Client Award Nominations [https://www.hstpathways.com/client-awards/] Brought to you by HST Pathways.

In this week's episode, the second installment in our case costing series, Grant Duncan sits down with VMG Health's Vanessa Sindell and Nancy Stephens to unpack the unsung hero of accurate case costing: a clean inventory master. They cover practical, do-it-today tactics like using naming conventions that work at the point of care, leveraging GPO data to understand all of your pricing options, and keeping preference cards current, so cost-per-case is surgeon ready. They also make the case for dedicating an FTE to the process to maximize cost savings. In the news: the still-pending OPPS/ASC final rule, the implications of CMS site-neutrality efforts, a new analysis drawing scrutiny to UnitedHealthcare's payments to Optum-employed physicians compared with market peers, and encouraging results for a multi-cancer blood test showing high detection accuracy alongside standard screening. Resources Mentioned: VMG Health [https://vmghealth.com/] CMS' delayed ASC rule release, explained [https://www.beckersasc.com/asc-news/cms-delayed-rule-release-explained/] (Becker's ASC Review) CMS' site-neutral reform poised to upend hospital-ASC dynamics [https://www.beckersasc.com/asc-coding-billing-and-collections/cms-site-neutral-reform-poised-to-upend-hospital-asc-dynamics/] (Becker's ASC Review) Study suggests UnitedHealthcare pays Optum docs more than other providers [https://www.fiercehealthcare.com/payers/study-suggests-unitedhealthcare-pays-optum-docs-more-other-providers] (Fierce Healthcare) A simple blood test can detect 50 types of cancer: We explain [https://www.usatoday.com/story/graphics/2025/11/09/cancer-blood-test-dna-galleri/87126236007/] (USA Today) Brought to you by HST Pathways.

This week's guest, Melissa Rice, is the administrator at Loyola Ambulatory Surgery Center at Oakbrook Terrace (part of Trinity Health), and the newly elected Illinois Ambulatory Surgery Center Association President. In the first episode of our Case Costing series, Melissa lays out a practical playbook that changes behavior — how to pull the levers that drive profitability (implants, supplies, staffing), why clean data must come first, how subspecialty data can surface margin-wrecking outliers, and the right way to align your staff, surgeons, vendors, and your board using clear numbers and transparent governance. In our data segment, we spotlight the Days to Bill benchmark — which rose to 4.4 days on average in 2024 from 3.6 in 2023 — and a few specialty-specific improvements. We talk about why this metric matters, what it can indicate, and a few simple ways to accelerate cash while mitigating denial risk. Resources mentioned: HST Pathways State of the Industry Report [https://www.hstpathways.com/resources/surgery-center-industry-report/] HST Pathways Spine Specialty Data Report [https://www.hstpathways.com/specialty-data/spine] HST Pathways Cardiovascular Specialty Data Report [https://www.hstpathways.com/specialty-data/cardiovascular] HST Pathways Gastroenterology Specialty Data Report [https://www.hstpathways.com/specialty-data/gastroenterology] Brought to you by HST Pathways.

Recorded live at the New York State Association of Ambulatory Surgery Centers conference in Albany, NY (Oct 6-8), this special edition episode brings three vantage points on where ambulatory surgery is headed next: Dr. Daniel Choi of Spine Medicine & Surgery of Long Island on scaling a multi-physician practice with 10,000+ annual visits and what it really takes to plan an ASC; JoAnn Vecchio of ASC of Western New York on sustaining growth and continuity through a partnership with Catholic Health; and Kara Newbury of ASCA on how a federal shutdown could affect timelines and current legislation — and what ASC leaders should prioritize now amid uncertainty. One theme connects them all: ASCs are built for this moment — safer care, smarter costs, and real runway for growth — if you can execute. Resources mentioned: Ambulatory Surgery Center Association (ASCA) [https://www.ascassociation.org/home] Brought to you by HST Pathways.

This week, Will Evans, Head of Data Science & Insights at HST Pathways, joins us to unpack our new five-and-a-half-year look at how case volume, OR minutes, and dollars are distributed across patient demographics. We discuss the biggest findings, a few surprises, and the simple metrics any ASC can track to anticipate scheduling and staffing nuance by population. In our news segment, we cover venture fundraising in the ASC industry, a recent survey report showing a growing number of health systems making ASCs a core part of their strategy, how cyberattacks have disrupted patient care at hundreds of healthcare organizations this year, and a new FDA-cleared blood test to aid in initial Alzheimer's assessments. Resources mentioned: Report: Who's on Your Schedule? Demographic Trends & Benchmarks for ASCs [https://www.hstpathways.com/specialty-data/asc-demographic-data] Oath Surgical Raises $24M to Expand Surgeon-Led Centers, Develop AI Platform [https://ascnews.com/2025/10/oath-surgical-raises-24m-to-expand-surgeon-led-centers-develop-ai-platform/] Health systems expand ambulatory strategies: Report [https://www.beckersasc.com/asc-news/health-systems-expand-ambulatory-strategies-report/] In 2025, patients are in the healthcare cybersecurity crosshairs [https://www.healthcareitnews.com/news/2025-patients-are-healthcare-cybersecurity-crosshairs] Roche, Lilly's blood test for Alzheimer's diagnosis gets US approval [https://www.reuters.com/business/healthcare-pharmaceuticals/roche-lillys-blood-test-alzheimers-diagnosis-gets-us-approval-2025-10-13/] Brought to you by HST Pathways.

In this episode, Benita Tapia, Administrator & Director of Nursing at Beverly Hills ASC, joins Alex — along with Conor McGinn, CEO of Akara — to unpack how she's using AI to improve everyday operations: tightening block utilization and surgeon accountability, speeding turnovers, answering scheduling questions in real time, and boosting registration accuracy to cut preventable denials. We also cover the guardrails — privacy, policy, and a human in the loop — that keep these tools safe and useful. In our data segment, we look at Otolaryngology benchmarks from nearly 112,000 cases across 202 centers. OR block utilization sits around 46%; net revenue per case is up 26% ($2,981 to $3,765); deposits slipped, and denials ticked up while days to bill improved. We highlight trends to watch, and simple steps leaders can take now to tighten collections, curb denials, and move closer to that 70% utilization goal. Resources mentioned: HST Pathways State of the Industry Report [https://www.hstpathways.com/resources/surgery-center-industry-report/] HST Pathways Otolaryngology Benchmark Report [https://www.hstpathways.com/specialty-data/otolaryngology] Brought to you by HST Pathways.

As Q3 wraps, this episode spotlights the signals that matter for ASC leaders heading into the busiest quarter of the year. We track policy direction, the continued shift of cases to outpatient settings, and how employer data transparency is accelerating site-of-care redirection. We scan market momentum and partnerships, revisit anesthesia coverage and how centers are adapting, and share pragmatic AI wins that tighten schedules and improve RCM. Skim the quarter's major ASC trends in under 20 minutes to guide Q4 execution and set up 2026 planning. Resources mentioned: CMS proposed CY-2026 OPPS/ASC rule [https://www.cms.gov/newsroom/fact-sheets/calendar-year-2026-hospital-outpatient-prospective-payment-system-opps-and-ambulatory-surgical] ICD-10-CM FY-2026 code update [https://www.cms.gov/medicare/coding-billing/icd-10-codes] National Alliance of Healthcare Purchaser Coalitions Pulse of the Purchaser 2025 Survey [https://www.nationalalliancehealth.org/resources/pulse-of-the-purchaser-2025-survey-results/] Tenet Reports Strong Second Quarter 2025 Results; Raises 2025 Financial Outlook [https://investor.tenethealth.com/press-releases/press-release-details/2025/Tenet-Reports-Strong-Second-Quarter-2025-Results-Raises-2025-Financial-Outlook/?utm_source=chatgpt.com] Ascension nears $3.9B AmSurg acquisition: Bloomberg [https://www.fiercehealthcare.com/providers/ascension-nears-39b-amsurg-acquisition-bloomberg?utm_source=chatgpt.com] Avanza Strategies 6th Hospital Leadership ASC Survey [https://avanzastrategies.com/wp-content/uploads/2025/05/6th-Avanza-Intelligence-Hospital-Leadership-ASC-Survey.pdf] JAMA Surgery, Effect of a Predictive Model on Planned Surgical Duration Accuracy, Patient Wait Time, and Use of Presurgical Resources [https://pmc.ncbi.nlm.nih.gov/articles/PMC7841577/] Becker's ASC Annual Meeting, October 16–18, Chicago [https://conferences.beckershospitalreview.com/31st_Annual_ASC_Meeting_2025] Brought to you by HST Pathways.

For the final episode of our Improving the Patient Experience series, show co-host Grant Duncan and Marta Shultz, a clinical workflow expert at HST Pathways, join Alex to unpack pre-assessments — why they're essential for patient safety and satisfaction, when to complete them, how many forms you actually need, and practical ways ASC leaders can reduce nurse phone time and cut cancellations and delays. In our data segment, we analyze gynecology benchmarks from 33,000+ cases across 99 centers. OR block utilization fell 10% year over year to 41%, while a number of financial metrics improved. We cover trends to watch, and steps leaders can take to curb operational challenges at their own centers. Resources mentioned: HST Pathways State of the Industry Report [https://www.hstpathways.com/resources/surgery-center-industry-report/] HST Pathways Gynecology Benchmark Report [https://www.hstpathways.com/specialty-data/gynecology] Brought to you by HST Pathways.

Jeffrey Flynn, Administrator and Chief Operating Officer at Gramercy Surgery Center and President of the New York State Association of Ambulatory Surgery Centers, joins the show to share how Gramercy keeps care personal at scale — training every team member as a patient advocate, keeping families informed, and even empowering nurses to call a case when something feels off. He also gives us insight into what the NYSAASC has been up to and previews what's ahead for New York ASCs as we approach next month's state conference in Albany. In our news recap, we'll cover why anesthesia providers are choosing ASCs, CMS's proposed 2.6% payment update and additions to the ASC-Covered Procedures List fueling industry growth, ASCA's July 60-Second Survey on EHR adoption, and a nationwide study in New Zealand using AI to speed stroke imaging. In or near New York? Join us at the NYSAASC Conference in Albany, NY, at the Desmond Hotel, October 6-8, 2025. [https://www.nysaasc.org/nysaasc-conferences] Resources mentioned: Why anesthesia providers are drawn to ASCs [https://www.beckersasc.com/anesthesia/why-anesthesia-providers-are-drawn-to-ascs/] The policy shifts driving the ASC boom [https://www.beckersasc.com/new-asc-development/the-policy-shifts-driving-the-asc-boom/] ASCA Survey Shows Continued Growth of EHR Usage by ASCs [https://www.ascfocus.org/ascfocus/content/articles-content/articles/2025/digital-debut/asca-survey-shows-continued-growth-of-ehr-usage-by-ascs] National rapid stroke imaging AI study underway in New Zealand [https://www.healthcareitnews.com/news/anz/national-rapid-stroke-imaging-ai-study-underway-new-zealand] Brought to you by HST Pathways.

In this episode, Grant Duncan sits down with Katie Sypher, a registered dietitian and healthcare operations leader, and Michael McClain, founder of LeftCoast Healthcare Advisors, to tackle one of the most overlooked challenges in the ASC space: communication. They share practical strategies for aligning messaging between clinics, surgery centers, and patients — covering everything from mapping touchpoints to creating a single source of truth to reduce duplication, avoid confusion, and build patient trust. After that, tune into our Data & Insights segment, where we explore why ASCs saw claim denial rates drop from 8% to 4% in 2024 — a 50% improvement — and what your center can do to replicate that success. Resources Mentioned: 2024 State of the Industry Report by HST Pathways [https://www.hstpathways.com/resources/surgery-center-industry-report/] Brought to you by HST Pathways.

Colleen Ramirez, Chief Administrative Officer at Bone & Joint Surgery Center of Novi, and Dr. Michael Bernard, Director of Anesthesia, join the show to share how they work together to drive case volume, choose which cases to accept, and stay profitable—all while maintaining a strong clinical partnership. In our news recap, we'll cover the first ever ASC in the Dominican Republic, a new ASC joint venture, the rising demand for dental surgeries, and, of course, end the news segment with a positive story about how engineers have discovered a way to turn dental floss into a vaccine. Lastly, an exciting update: starting next week, Erica Palmer will be handing over hosting duties to Alex Larralde! Resources Mentioned: * One World Surgery Opens First Ever ASC in DR [https://www.ascfocus.org/ascfocus/content/articles-content/articles/2025/digital-debut/one-world-surgery-opens-first-ever-asc-in-dr] * Solara Surgical Partners, Orlando Health Announce New ASC Joint Venture [https://ascnews.com/2025/07/solara-surgical-partners-orlando-health-announce-new-asc-joint-venture/] * Demand Rises for Dental Surgery in ASCs [https://www.ascfocus.org/ascfocus/content/articles-content/articles/2025/august/demand-rises-for-dental-surgery-in-ascs] * Engineers transform dental floss into needle-free vaccine [https://www.science.org/content/article/engineers-transform-dental-floss-needle-free-vaccine] Brought to you by HST Pathways.

This week, we're joined by Wes Battiste, an experienced anesthesiologist and ASC developer, to talk about a growing trend: surgery centers building their own in-house anesthesia teams. What once seemed like a wild idea is now becoming the best path forward for centers looking to stay profitable. Then, in our Data & Insights segment, we dive into 10 key metrics from spine centers—some promising, some concerning, but all worth paying attention to. Plus, a personal update: After nearly three years hosting This Week in Surgery Centers, Erica Palmer will be passing the mic. You'll meet your new host, Alex Larralde, in this episode (she interviews Wes!), and you'll also start hearing from Grant Duncan in the coming weeks. Resources Mentioned: https://www.hstpathways.com/specialty-data/spine Brought to you by HST Pathways.

Alex Taira from ASCA breaks down the key takeaways from CMS's 2026 Proposed Payment Rule for ASCs. From reimbursement rates to the ASC Covered Procedures List and quality reporting changes, Alex shares what ASC leaders need to know from the 913-page proposal. In our news recap, we highlight an AI-JAMA partnership, payer challenges facing anesthesiologists, tips to prevent cyberattacks, and a breakthrough device preserving donor organs. ASCA Resources: * Proposed Rule Highlights [https://www.ascassociation.org/asca/news-and-publications/ga-update/2025/07-17] * Propsed Rule Webinar on 7/22/25 [https://www.ascassociation.org/asca/education-and-events/virtual/2025-regulatory-series/understanding-medicares-proposed-rule-for-2026] * ASCA's 60-Second Survey [https://www.surveymonkey.com/r/ASCA60Survey_EHR] * National Advocacy Day [https://www.ascassociation.org/national-advocacy-day-2025/home] News Stories: * JAMA signs multi-year deal with OpenEvidence [https://www.fiercehealthcare.com/ai-and-machine-learning/jama-signs-multi-year-deal-openevidence-inform-ai-powered-medical-search] * The payer issues pressing anesthesiologists [https://www.beckersasc.com/anesthesia/the-payer-issues-pressing-anesthesiologists/] * Offensive Mindset: Preventing Cyberattacks [https://www.aorn.org/outpatient-surgery/the-magazine/article/offensive-mindset] * 'Life-saving' organ-preserving device wins major award [https://www.positive.news/society/good-news-stories-from-week-28-of-2025/] Brought to you by HST Pathways.

This week, ASC expert Carol Hiatt joins us to share practical tips for improving OR utilization in orthopedic surgery centers. With over 30 years in the industry, Carol dives into common causes of underutilization and how to fix them. Then in our Data & Insights segment, we spotlight dental ASCs. Drawing from 35 facilities and over 15,000 cases, we break down key metrics like block utilization, pre-auth rates, and patient deposit collection. Resources Mentioned: https://www.hstpathways.com/specialty-data/dental Brought to you by HST Pathways.

Kevin Turner is the Sr. VP of IT & Analytics at HealthCrest Surgical Management. He has been in IT for over 30 years and has been through the software evaluation process countless times. Kevin shares with us his repeatable, proven, 8-step process that anyone can use to guide their software decisions. Whether you're choosing your first system or replacing a legacy tool, this structured approach will help you navigate the process with confidence. With so many vendors and features to consider, it's easy to feel overwhelmed, but this step-by-step process will keep you focused on what matters most and make sure all stakeholders are happy with the decision. In our news recap, we'll cover the DOJ's Anticompetitive Regulations Task Force, Ascension's acquisition of AMSURG, the biggest opportunity for growth in ASCs, and, of course, end the news segment with a positive story about a nurse who uses her own personal tragedy to provide once-in-a-lifetime care. Recommend 8-Step Process: 1. Define Business Needs and Objectives 2. Assemble a Cross-Functional Selection Team 3. Gather Requirements and Prioritize Features 4. Research the Market and Identify Potential Vendors 5. Evaluate and Compare Options 6. Assess Integration, Security, and Compliance 7. Review Costs and Negotiate Contracts 8. Pilot, Test, and Finalize the Decision Resources Mentioned: * ASC Stakeholders Voice Market-Competition Concerns, Ask DOJ Task Force to Cut Red Tape [https://ascnews.com/2025/06/asc-stakeholders-voice-market-competition-concerns-ask-doj-task-force-to-cut-red-tape/] * Ascension agrees to acquire Amsurg to expand ambulatory surgery reach [https://www.healthcaredive.com/news/ascension-acquire-amsurg-asc/750938/] * The biggest opportunities for ASC growth  [https://www.beckersasc.com/leadership/the-biggest-opportunities-for-asc-growth/] * From Paralyzed Patient to Spinal Cord Nurse: Rachel Stewart, BSN, RN, Turns Trauma into Triumph [https://www.dailynurse.com/rachel-stewart-nurse-spinal-cord-injury-journey/] Brought to you by HST Pathways.

At the end of every discussion, we always ask our guests, "What is one thing our listeners can do this week to improve their surgery centers?" For today's episode, we took the last 15 answers we received from our guests and turned them into a 20-minute highlight reel. This roundup features, in order: Scott Allen, Becky Ziegler-Otis, Tina DiMarino, Kathy Wilson, Ryan Short, Colin Park, Mayte Rechani, Mark Henderson Leary, Maddie Traylor, Richard Parker, Melanie Howitt, Kristle Young, Josh Rudd, Nyleen Flores, Shannen Reyes-Aguayo, and Will Evans. A huge thank you to everyone who has shared their advice! Brought to you by HST Pathways.