News / Periop Café

Challenges and Opportunities at ASCs: Tips from Industry Experts 

September 27, 2023


Challenges and Opportunities at ASCs: Tips from Industry Experts 

By Carisa Brewster

An increasing number of surgical procedures are getting greenlit for ASCs (ambulatory surgery centers). There are many advantages to ASCs, chief among them being they are less expensive for parties; insurance companies are likely to prefer claims on procedures done in an outpatient setting (if safe to do so for the patient). Other benefits include more convenience, earlier discharge to recover at home, and less likely to have a delay or reschedule.  

However, ASCs struggle with staffing, employee retention/engagement, and capturing revenue like most healthcare facilities. ASC leaders Robin Menefee and Christina Holloway discuss what’s happening in the world of ASCs.  

On Staffing 

Christina Holloway, BS, RN, Corporate Compliance Specialist, ASC Bala Cynwyd, Pennsylvania 

In the current market, Anesthesia is a big player in staffing appropriately for surgical cases. Clinicians are few and far between, and what they can charge because of the shortage is significant. Staff shortages obviously impede maintaining surgical volume, which subsequently prevents organizations from expanding and growing the business.  

At some of our centers, we have started offering a more flexible work shift and changing case scheduling to accommodate staff availability better. We schedule cases later than you would expect at an outpatient surgical facility. Expanding business hours allows practitioners and nurses to work in multiple settings that meet their life obligations, improving employee engagement and satisfaction, which leads to maximizing efficiency.   

Robin Menefee, MBA, BSN, RN Regional Director of Operations, Sutter Health – Palo Alto Medical Foundation 

Staffing since COVID has been an issue. When we don’t have enough staff to maintain proper ratios, this puts stress on the entire system. Staffing shortages have created longer workdays and extenuated the burnout that began with COVID. Leadership has focused on decreasing burnout in staff and physicians and increasing the joy of work. We did this by being transparent with the entire team and celebrating our wins when we had them. We also made a point of sharing the patients’ appreciation of their excellent work. 

Many people are retiring from healthcare, and the next generation is more interested in tech-based jobs or social media options. Recruiting the best team members can be difficult.   

Creative solutions 


We’re doing some creative things, like experimenting with adding Saturdays. Some team members do not want to work on Saturdays, so it’s a work in progress. Currently, we do one Saturday a quarter at two of our centers. They are GI cases only, so our nurses sedate the patients. We can get 30-40 cases done on a weekend, which is pretty amazing. Patients love it because it’s not breaking up their work week. You’re not out for the rest of the day with a colonoscopy, so once it’s done, you can go home and relax for the rest of the weekend. Doctors like it because their patients love the weekend accessibility and ease for their lives. These days are high-energy and usually fun for all involved. Staff enjoy Saturdays because it’s a special assignment, and they get OT for their time.  

Saturday blocks have been a big win for us because our volume is off the charts. It’s definitely showing in the numbers. 

We’re also looking at extending weekday hours. Some people are open to coming in earlier or coming in later and working until later in the day. It gives the patient more flexibility, and those hours may be better for the physician. They have kids and school pick-ups. It might work better for some to start their day later.  


One thing that they’re starting to do now is the anesthesia home monitoring evaluation. Before, we would hold patients for 23 hours to ensure basic recovery from anesthesia wasn’t a problem. But it’s minimal oversight, so the trend is for anesthesia to oversee patients virtually. This is definitely something to watch.  

Expanding procedure types at ASCs 


Currently, we do not do spine cases in our ASCs. But we are looking into starting them at our sites. We want to ensure that we have trained employees and the capability to keep patients overnight. Currently, about half of my sites can do overnight stays.  

We will also require special equipment depending on the case type and literal space to accommodate some of the equipment needed to do some of these cases.   


Allowing more procedures at ASCs is a wonderful benefit to both the centers and the community. Patients get their procedure done at a lower price point, and they get to go home the same day. We have a more streamlined workflow. An issue that can arise is having a million ASCs in places where the volume isn’t there. That’s a high financial risk.  

Regarding spine cases, our ambulatory centers specialize in orthopedics and spine surgery, so that has been a niche market since the option was available with CMS. Most of our patients are injury cases, so the volume stays consistent. However, I have noticed more surgeons applying for privileges within this specialty in the outpatient setting. 

Novel ideas for staffing ASCs in the Future 


I think we need to consider more flexible hours. Some people may prefer to be off earlier and work until later. Many people working at ASCs have not had to work later in the day, but they might find doing so is advantageous for their lives. Flexible hours would allow time during their week to get tasks done that can only happen during certain hours of the day (usually when they’re working).  

Another thing we can look at is staffing part-timers. Traditionally, we haven’t done this because it’s logistically challenging. But I think it would help bring more people into the workforce. We lost some people because we were unable to get part-time shifts. We can’t staff a physician part-time, but we could add later hours for them. I think it’s one of those situations where if you build it, they’ll come.  

What unique ways is your ASC operating during this nationwide staffing crisis? Remember Whitman Partners is a phone call or email away for your leadership staffing needs. For interim leadership, contact Zach Parker or Ines Radic; for permanent leadership, contact John Elffers