Key Considerations When Opening an Ambulatory Surgery Center

Ambulatory Surgery Centers (ASC), both freestanding and hospital outpatient department based, have transformed the outpatient surgery experience by providing a convenient, patient-focused alternative to hospital-based procedures. For this reason they have become a popular and lucrative business opportunity for hospitals and physicians alike.

According to the Advisory Board, “In 2017, ASC volumes increased by 22.9% nationally. In 20 of the top 50 largest U.S. markets, ASCs more than doubled their market share between 2015 and 2016. And looking ahead, the U.S. ASC market is expected to surpass $40 billion by 2020.”

Key Considerations When Starting Your Own ASC

When thinking of building an ASC, one of the key first steps is to conduct a feasibility assessment to determine what type of facility and services should be provided. This is an area where outside expert input can be most useful. For example, Sullivan Healthcare Consultants (SHC) can conduct geographic market research and identify local competitors to determine the likelihood for success.

Important next steps in the process include:

  • Working with architects to ensure a well-designed facility that supports efficient operations.

  • Establishing operational structure.

  • Obtaining regulatory approval.

  • Developing policies and procedures.

  • Recruiting, training, and educating staff.

  • Procuring equipment and supplies.

  • Setting up equipment and supplies.

  • Implementation of scheduling technology.

  • Billing implementation.

Most Common Pitfalls When Opening an ASC

Overbuilding or under building your ASC can be the most costly mistake, but there are additional common mistakes that can just as easily sink your business.

  1. Prolonged licensure & accreditation.

  2. Administrator learning curve.

  3. Overstaffing too early.

  4. Delayed implementation of governance structure.

  5. Surgeons’ buy in - early & often.

Bottom line, timing is everything. To give your ASC the best chance at long-term sustainable success, you’ve got to have a solid phased plan in place that covers everything from revenue generation, throughput to SPD and supply chain support.

Importance of Physician Involvement


Physician involvement is cited as one of the top three critical success factors for an ASC. Two ways this is accomplished: 


1. The first is determining physician interest and commitment levels to be a part of the ASC, either as an investor or just a provider. And if a joint investor model is not being considered, then exploring other alternatives for economic alignment (co-management). 

2. And second is involving them in the plans for the facility at the start.


Turnkey Approach to ASC Consulting

SHC ASC consultants provide a strategic approach to uncover root causes of start-up inefficiencies and possess the necessary experience to successfully implement ASC best practices. SHC implementation support is hands-on and includes a full-time on site educator for four months (two months prior to opening, two months after). We are subject matter experts with over 40 years of experience. We provide assessments, recommendations and implementation support critical to the success of the ASC.

SHC’s Wide Range of Assistance for ASC Start-ups:

  • Facility design.

  • Human resources.

  • Business operations.

  • Policies/procedures.

  • Equipment selection.

While the first year of opening can be overwhelming, it doesn’t have to be. SHC ASC consultants can also assist with first year milestones like:

  • Hiring an Interim Director and Educator.

  • Ensuring a smooth start-up and ramp-up phase.

  • Recruiting a permanent administrator.

  • Immediately placing an experienced Interim Administrator on site, full-time through the end of year one.

No Equity Interest Required

In addition, we do not demand equity interest, positioning SHC as one of the few ASC consulting agencies to provide a truly turnkey approach with a fully transparent, one-time fee. Fees are based on actual time on site working and aren’t due until milestones are met, governance is in place and the final phase of implementation is complete.

To learn more about our customized services and how our ASC consultants can help improve your organization’s performance, contact us today.

Randy Heiser is the President of Sullivan Healthcare Consulting. Randy has been a hospital consultant since 1983 and has specialized in perioperative consulting since 1992. He has directed more than 500 surgery department operational improvement studies (and participated in an additional 350) in programs ranging from small community hospitals and freestanding surgery centers to some of the largest university hospitals in the U.S. He was instrumental in the design, development and implementation of the Surgery Benchmark Program that has been used by more than 280 hospitals. He has also participated in the design of several proprietary surgery scheduling information systems currently available in North America.

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​​Tel: 866-303-8968

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