Is opening an ASC right for your medical practice?

Should your medical practice open an ambulatory surgical center? Considerations for independent physician groups

Recent data projects that total adult ambulatory surgery center (ASC) volume will grow 21% over the next decade, with surgical utilization specifically expected to surge 23%.¹ As this transformation continues, you may be wondering if this is a good time for your independent practice to open an ASC.

The financial incentives are compelling. Procedures performed in ASCs cost less than half of those conducted in hospital outpatient departments, with Medicare saving an estimated $4.2 billion annually.² For practices, this creates dual opportunities: capturing additional facility revenue while meeting payer demands for cost-effective care. The fact that 92% of ASCs are wholly or partially physician-owned underscores their appeal as both a care delivery model and financial strategy.³

But opening or investing in an ASC isn't a decision to take lightly. The operational complexity, capital requirements, and regulatory obligations are substantial. Success requires strategic thinking about market positioning, partnership structures, and long-term sustainability.

Independent practices need an honest framework to evaluate ASC opportunities, weighing genuine advantages against significant challenges. Here, we'll examine the financial implications, operational realities, and strategic considerations to help you determine whether an ASC investment aligns with your practice's goals and capabilities.

The pros: Why ASCs appeal to independent practices

As independent practices face mounting pressures, ASCs offer compelling paths to financial stability and operational independence.

Financial advantages

• Revenue diversification: Facility fees beyond professional billing

ASC ownership can create an additional revenue stream through facility fees, allowing practices to capture both the professional and technical components of surgical procedures. This dual income source provides financial diversification, reducing dependence on professional fee schedules alone.

• Cost efficiency: Procedures cost less than half of hospital outpatient department rates⁴

The streamlined ASC model eliminates many hospital overhead costs, from administrative layers to complex billing systems. These efficiencies translate to improved margins while maintaining quality care standards.

• Payer alignment: Strong reimbursement support for cost-effective care

Insurance companies actively encourage ASC utilization through favorable reimbursement policies. Medicare's January 2026 approval of 80 new separately payable ASC procedure codes — bringing the total to 946 covered procedures — further expands coverage opportunities, while commercial payers increasingly prefer lower-cost ASC settings.⁵

Operational control

• Scheduling autonomy: ASCs give practices control over OR scheduling and case mix optimization, which hospital-employed physicians might sacrifice. This allows you to reduce delays and maximize productivity.
• Streamlined operations: With leaner overhead and specialized staffing models tailored to specific procedures, practices can reduce administrative inefficiencies common in hospital settings. Orthopedic ASCs and pain management centers particularly benefit from this specialization, as they can optimize workflows around specific procedure types and equipment needs.
• Quality oversight: Physician control over the patient experience makes quality oversight direct and immediate from pre-operative preparation through recovery.

Strategic benefits

• Enhanced patient experience: ASCs offer convenience, reduced wait times, and personalized attention. This improved experience can encourage stronger patient loyalty and increased word-of-mouth referrals.
• Value-based care readiness: ASC ownership positions practices for the ongoing shift toward value-based care. As healthcare moves away from volume-based reimbursement toward outcome-focused models, ASCs help provide the operational flexibility and cost structure necessary to succeed in risk-sharing arrangements and bundled payment programs.

The cons: Challenges for successful ASC ownership

While ASC ownership offers compelling advantages, successful implementation requires navigating several challenges. Understanding these obstacles upfront and choosing experienced partners can help ensure your ASC investment delivers the expected returns.

Financial challenges

• Significant upfront investment: ASC development requires substantial initial capital for surgical equipment, facility construction or renovation, and specialized staffing.
• Revenue complexity: Managing both professional and facility billing requires specialized expertise and integrated systems.
• Variable reimbursement rates: Insurance reimbursement rates can vary between payers and change with contract renegotiations.

Operational challenges

• Regulatory requirements: ASCs must maintain compliance with state licensing, accreditation organizations, and federal agencies.
• Specialized staffing: ASCs require surgical staff, anesthesia providers, and administrative personnel with specific expertise.
• Technology integration: Connecting ASC operations with existing practice systems requires careful planning.
• Enhanced quality standards: ASC ownership involves elevated patient safety and outcome responsibilities. 

Strategic considerations

• Market competition: Large ASC management companies bring significant resources and economies of scale.
• Partnership complexity: ASC partnerships may involve detailed legal and financial arrangements with various stakeholders.
• Long-term commitment: ASC ownership represents a significant long-term investment with various contractual obligations.

Key decision factors

While the potential rewards of ASC ownership are substantial, success hinges on honestly assessing your practice's readiness across several key areas. 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.

1. Clinical and financial readiness

Before diving into ASC ownership, successful practices start with an honest assessment of their current position. Case volume assessment forms the foundation of everything that follows — and incomplete or inaccurate data can result in ASC failure. High-volume specialties like orthopedics and pain management are particularly well-suited for ASC development, as they typically involve predictable procedures with strong reimbursement rates.

2. Market analysis and competitive positioning

Understanding your local healthcare landscape is non-negotiable. You’ll want a solid understanding of your immediate environment in terms of patient demographics, potential hospital and ASC competitors, and surgeon workforce.⁶

3. Infrastructure and timeline readiness

ASC development spans 18+ months from initial planning to operational launch.⁷ Your technology platform must seamlessly integrate clinic and ASC operations, while your governance model decision will shape both decision-making authority and financial returns.

Staffing considerations deserve early attention. You'll need both administrative and clinical personnel, plus strong leadership capable of handling both business operations and clinical excellence.⁸

Technology considerations: What to look for

Managing ASCs with disconnected systems can create operational inefficiencies that compound over time. Scheduling applications that don't communicate with EHRs, billing platforms isolated from clinical workflows, and patient portals that can't access surgical records all contribute to administrative burden. Instead, here’s what to look for in a connected solution:

• Integrated workflows must seamlessly connect the entire patient journey from clinic consultation through surgical discharge. Cloud-native platforms like athenaOne®, can be built specifically for outpatient surgical workflows, helping to eliminate the friction of switching between systems and reduce cognitive load on clinicians working across both settings.
• Unified revenue cycle management becomes critical as you manage both facility and professional billing streams. Modern platforms integrate eligibility checks, coding, claims, and payments into smooth workflows that prevent revenue leakage from manual processes and disconnected systems. athenaOne's integrated approach helps staff apply codes accurately, track claims faster, and prevent duplication or denial issues that come from split systems.
• Performance visibility through real-time dashboards gives leadership immediate access to service line profitability and denial patterns. This financial data becomes a strategic asset for resource allocation and payer negotiations, moving beyond reactive problem-solving to proactive management.
• Scalability helps your platform support multi-entity growth with centralized scheduling, billing, credentialing, and supply chain tools. Successful expansion requires maintaining consistent quality and operational excellence across all locations while preserving the flexibility to adapt to local market needs and specialty requirements.

The most resilient ASCs are moving beyond convenience to strategic agility — using AI-driven tools for billing optimization, automated prior authorizations, and predictive analytics that help teams stay ahead of operational challenges rather than constantly reacting to them.

Making the strategic decision

The decision to enter the ASC market requires honest evaluation of your practice's readiness, patient volume, and financial resources. Consider whether independent ownership, joint ventures, or management partnerships best align with your risk tolerance and growth objectives. A phased approach — starting with high-volume procedures and proven technology platforms like athenaOne — can reduce risk while building operational expertise. Success ultimately depends on positioning your ASC within the evolving healthcare landscape, where value-based care and outpatient efficiency create sustainable competitive advantages.

Learn more about how athenaOne can support ASCs.