As ASCs take on more surgical volume, the questions facing their leaders are getting harder and more consequential. Staffing, reimbursement, case complexity and technology decisions are no longer day-to-day concerns. They are long-term bets on where surgical care is headed.

To understand how the leaders closest to the work are navigating that shift, the ASC Insights podcast sat down with administrators, clinical leads, surgeons and consultants across the ambulatory surgery landscape. We asked them: What is happening inside an ASC today and what does it take to lead through it?

Their answers, captured in a series of conversations recorded at ASCA + SAMBA Conference & Expo in May, map the forces shaping the outpatient setting, from operational pressure and the migration of higher-acuity care to the role technology will play in what comes next. Together, they offer a clear view of where surgery centers are going, in the words of the leaders building that future.

What are the operational pressures reshaping surgery centers today?

Staffing shortages, anesthesia coverage, rising operating costs, regulatory complexity and reimbursement pressures are creating new operational challenges for ASCs. Ask almost any ASC leader what has changed over the past year and those same themes consistently emerge.

Allison Stock, RN, CASC, CAIP, chief operations officer at Surgical Management Professionals, named it plainly when we talked about how the landscape has shifted in just the last year.

“I think we’re seeing more and more pressures. And that comes in a lot of different ways. That’s from staffing pressures, the anesthesia pressures, just the cost of everything rising. But reimbursement is either staying the same or going down.”

That gap between rising cost and flat reimbursement is the daily math of running a center. And the policy environment reflects how high the stakes have become. In its 2026 final rule, the Centers for Medicare & Medicaid Services finalized a net 2.6 percent payment update for ASCs while moving to phase out the inpatient-only list over three years and adding 289 procedures to the ASC covered procedures list.¹ Additionally, CMS added 271 codes to the ASC CPL that were removed from the IPO list for CY 2026. With more volume and acuity now on the horizon, the margin for operational error is shrinking at the same time.

Shane Stanford, a healthcare consultant who helps standup interventional radiology and cardiac ASCs across the country, sees where that pressure lands first.

“It’s anesthesia staffing. Hiring staff. And then it’s the development of regulatory compliance.”

Brooke Day, administrator at Hastings Surgical Center, described a quieter version of the same strain that does not show up on a balance sheet.

“It’s a challenge to show up with that same motivation every single day. But also just from an industry standpoint, I think anesthesia continues to be an issue, and I don’t have an answer on how long I think that’s going to take to resolve itself.”

There is something clarifying about hearing leaders name the hard parts out loud. None of them framed these pressures as reasons to slow down. They framed them as the conditions you build around.

Why is the momentum shifting to ASCs?

Care is rapidly shifting from hospitals to ASCs, driven by lower costs, expanding procedure eligibility, and continued investment across the healthcare industry. The capital is following that migration. This past year, Ascension closed its $3.9 billion acquisition of Amsurg, a move that placed roughly 300 surgery centers under one health system and signaled, in dollars, where leadership across the industry believes care is headed.²

For the people inside these centers, that shift changes how quickly a center can adopt something new. Tiffany Williams, OR and robotic lead at Central Ohio Urology Group, has spent 26 years in surgical care, almost all of it in large hospitals before moving to the ASC setting. The difference surprised her.

“Being at an ASC is very different. You don’t have the ancillary staff; you are doing so many more trials and procedures because you have the availability to do that at an ASC. Bringing in new products is easier than going through all the filters of a hospital.”

That agility is part of why momentum keeps building. The leaders we spoke with are using that speed deliberately, not just to keep up, but to define what good care looks like in the outpatient setting.

What does it take to lead a high-performing ASC?

The throughline across every conversation was not a product or a policy. It was posture. The leaders setting the pace are the ones treating change as the baseline rather than the exception and holding a high standard for the patient at the center of it.

Dr. Jeffrey Roh, an orthopedic spine surgeon and chief medical officer at Excel Health, put the bar where it belongs.

“Success for me looks like we have surgery centers that deliver the highest level of the most cutting-edge technologies and techniques that we can provide to our patients, and that there would be no comparison to that delivery of care.”

That is the standard worth holding. Not adequacy. Not a smaller version of the hospital. The best care available anywhere, delivered in the setting patients increasingly prefer.

The conversation about the future of surgery centers is just beginning

Across every conversation, the same picture came into focus. The pressures on ASCs are compounding. The migration of care into the outpatient setting is structural. And the leaders setting the pace share a common posture: They treat constant change as the baseline, move faster than the hospital can, and hold an uncompromising standard for the patient at the center of it.

That posture is the throughline connecting a startup consultant, a rural administrator, a robotics lead and a spine surgeon. As Jeffrey Roh put it, the goal is care so good that there would be no comparison. It is a refusal to treat the ASC as a smaller version of the hospital, and a determination to make it something better.

For ASC leaders, the takeaway is less about any single decision than about the stance behind all of them. The centers thriving are building deliberately for what is next, not just keeping pace with what is already here.

Hear these conversations in full and explore the entire ASC Insights series at outcomesrocket.com/ascinsights.