Here's what to expect on this week's episode. 🎙️

Dr. Brian Cohen, practicing anesthesiologist and founding member and administrative chief of Miami Anesthesia Services, and Lee Kortmansky, Site Administrator at Physician Outpatient Surgery Center, join Grant Duncan to discuss one of the biggest issues facing ASCs right now: anesthesia subsidies and coverage. They break down how anesthesia costs often reveal deeper operational issues around scheduling, OR utilization, staffing models, room flipping, surgeon relationships, patient collections, and case profitability. Lee also shares how his center worked with Dr. Cohen’s team to reduce anesthesia subsidy exposure by nearly $300,000.

In our data segment, we connect the conversation to our 2026 SOTI report and highlight what ASC leaders can learn from block utilization, cancellation rates, patient collections, and case profitability benchmarks.

Resources Mentioned:
2026 State of the ASC Industry Report: https://www.hstpathways.com/resources/surgery-center-industry-report/

Brought to you by HST Pathways.

How ASCs Can Reduce Anesthesia Subsidy Pressure

Eric Gonzales and Alexandra DeHart are healthcare banking leaders at Columbia Bank, where they work with healthcare organizations on financing, growth, and capital planning. Eric and Alexandra join us this week to break down how ASC leaders should think about funding growth. They walk through the key differences between debt and equity, what ownership and control trade-offs come with each path, and which financial metrics lenders care about most — including EBITDA, revenue growth, leverage, fixed charge coverage, payor mix, stabilization, and quality of financial reporting.

In our data segment, we’re connecting the conversation back to HST’s 2026 State of the ASC Industry Report. We’ll look at how operational and financial metrics like net collection rate, OR utilization, cancellation rates, specialty mix, and case profitability can help ASC leaders build a stronger, more bankable growth story before pursuing expansion, adding physicians, or taking on new capital.

Resources Mentioned: HST’s 2026 State of the ASC Industry Report [https://www.hstpathways.com/resources/surgery-center-industry-report/]

Brought to you by HST Pathways.

What Lenders Want to See Before You Expand 

Quality data can be one of the most powerful tools an ASC has to improve both safety and operations. In this episode, Nina Goins, Executive Director of the ASC Quality Collaboration, explains how centers can use benchmarking data to uncover deeper operational issues, strengthen payer and board conversations, and build a stronger culture of quality. She also shares why measures like wrong-site events and unplanned hospital transfers matter so much, how ASCQC’s Safety and Quality Assessment can help centers benchmark best practices, and why a simple daily safety huddle can make a meaningful difference.

In our news recap, we’ll cover the latest wave of ASC development, Leapfrog’s expansion of public ASC quality reporting, new research showing how outpatient surgery growth is creating uneven access across communities, and why anesthesia remains one of the biggest operational risks to ASC growth.

Brought to you by HST Pathways

Using Quality Data to Improve ASC Operations

Sean Hartzell is a Managing Director at VMG Health, where he advises healthcare organizations on strategy and capital planning. Sean joins us this week to break down how ASC leaders should think about funding growth. He walks through the key differences between debt and equity, how to calculate the “true” cost of major investments beyond the upfront price, and what factors can make or break a new initiative.

In our data segment, we’re talking all about spine. Spine is being called one of the fastest-growing ASC service lines, driven by a combination of CMS policy changes, payer pressure, and continued advancements in minimally invasive techniques. We’re going to spend the episode focusing specifically on spine ASCs and the potential opportunity for growth based on data-driven insights.

Resources Mentioned:

HST’s Specialty Data Report: Spine [https://www.hstpathways.com/specialty-data/spine]

Brought to you by HST Pathways.

Should You Make That Investment?

Jon Vick is the Founder and Principal of ASC Realty Advisors, where he has spent decades advising physicians and ASC operators on healthcare real estate strategy. Jon joins us this week to explain how ASC sale-leasebacks work and why they are becoming an increasingly relevant strategy for physician owners. He walks through how centers can use sale-leasebacks to fund de novo projects, expansions, and renovations without taking on additional debt, while also addressing common concerns around control and long-term value.

In our data segment, we’re discussing OR block utilization and showing how increased usage can generate millions in revenue. We’ll use real podiatry stats as an example, but the same concept and tips apply to any specialty.

Resources Mentioned: https://www.hstpathways.com/specialty-data/podiatry

Contact Jon + his team: https://www.ascrealtyadvisors.com/about/leadership/

Brought to you by HST Pathways.

How ASC Sale-Leasebacks Work 

Stephanie Tarry brings more than three decades of experience in the ASC industry. Now with Physician Transaction Advisors, she works closely with physician groups to evaluate partnership opportunities and guide them through the transaction process from start to finish. In this episode, she breaks down how ASC transactions actually unfold, from early readiness and confidential information memorandums to letters of intent, quality of earnings, and closing.

In our data segment, we’re breaking down Case Share by Age Group from HST’s demographic benchmarking report. If you’re not tracking your age mix, you may be missing a key component of what is truly driving demand and financial performance at your ASC. There is a direct correlation between age and specialty, which means there is a secondary correlation between your patient’s age and potential revenue.

Resources Mentioned: https://www.hstpathways.com/specialty-data/asc-demographic-data

Brought to you by HST Pathways.

Inside the ASC Deal Process: From LOI to Close 

Dr. Leo Spector, MD, MBA, is the CEO of OrthoCarolina, where he leads strategy across a growing network of ASCs while continuing to practice as a spine surgeon. With decades of experience navigating joint ventures and certificate-of-need restrictions, Dr. Spector brings a physician-leader perspective on what it takes to successfully own and operate ASCs today. In this episode, he shares OrthoCarolina’s journey from hospital joint ventures to wholly owned surgery centers, how CON reform is reshaping growth opportunities, and what independent groups should consider as they evaluate their ownership options.

In our news recap, we’ll cover five ways CMS is continuing to impact the ASC industry, two HCA medical centers that sold, cybersecurity concerns around generative AI, and how Amazon's same-day delivery can help your ASC with patient outcomes.

One other note: our other host, Alex Larralde, unfortunately, needed to step away from HST so she could help with personal family needs full-time. That means this will be the last episode she’s included in. I’m sure she’d appreciate a kind message from you if you’re up to it.

Resources Mentioned:

 * 5 CMS moves shaping the ASC industry [https://www.beckersasc.com/asc-coding-billing-and-collections/5-cms-moves-shaping-the-asc-industry-2/]
 * Montecito Buys Two HCA Medical Centers [https://realtynewsreport.com/montecito-buys-two-hca-medical-centers/]
 * How the generative AI boom changes healthcare cybersecurity [https://www.healthcaredive.com/news/generative-ai-cybersecurity-healthcare-taylor-lehmann-google-cloud/811890/]
 * Amazon Pharmacy to expand same-day delivery to 4,500 cities [https://www.healthcarefinancenews.com/news/amazon-pharmacy-expand-same-day-delivery-4500-cities]

Brought to you by HST Pathways.

The Power Shift After CON Reform

Jim Freund is the Managing Partner at Physician Transaction Advisors, where he and his team have spent more than 20 years advising physician-owned surgery centers through transactions, partnerships, and long-term strategic planning. Having worked on hundreds of ASC deals across the country, Jim brings a unique perspective on what drives centers to explore a transaction and how leaders can prepare before beginning the process. In this episode, he walks through when to start the conversation and what to consider as you evaluate your next move.

In our data segment, we will discuss a custom metric from HST’s demographic benchmarking report: Payment Share by Specialty. The data consistently proves that your case mix and your revenue mix are not the same. And if you’re only looking at case volume, you’re probably missing what’s really driving your financial performance. I'll share what we uncovered after analyzing 5.3 million cases.

Resources Mentioned: https://www.hstpathways.com/specialty-data/asc-demographic-data

Brought to you by HST Pathways.

Preparing for a Transaction and Valuating Your ASC 

Anesthesia costs and staffing pressures are reshaping ASC operations. In this episode, Garrison Gordon and Cory Hollmann break down shifting reimbursement, rising subsidies, and evolving partnership models between surgery centers and anesthesia groups. Learn practical strategies to align incentives, improve collections, manage risk, and build sustainable anesthesia relationships that support long-term growth.

In our news recap, we’ll cover Oath Surgical’s new partnership with NVIDIA, how Optum’s acquisition of physician practices and ASCs is playing out, Medtronic and Mindray’s investment in the ASC space, and how the University of Michigan Health is using AI-driven diagnostic tools to scan brain MRIs in seconds with 97.5% accuracy.

Resources Mentioned:

Oath Surgical Strikes NVIDIA Partnership to Push AI Deeper Into Outpatient Surgery [https://ascnews.com/2026/01/oath-surgical-strikes-nvidia-partnership-to-push-ai-deeper-into-outpatient-surgery/]

Optum ASC Acquisitions Raised Prices Without Shifting Referrals [https://ascnews.com/2026/02/optum-asc-acquisitions-raised-prices-without-shifting-referrals/]

Medtronic and Mindray North America broaden strategic partnership beyond hospitals [https://news.medtronic.com/Medtronic-and-Mindray-North-America-broaden-strategic-partnership-beyond-hospitals-to-ambulatory-surgery-centers-across-the-U-S?utm_source=chatgpt.com]

Michigan Health AI model scans brain MRIs in seconds [https://www.beckershospitalreview.com/healthcare-information-technology/ai/michigan-health-ai-model-scans-brain-mris-in-seconds/]

Brought to you by HST Pathways.

How Anesthesia Costs Reshape ASC Growth

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.

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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: Workflow Best Practices for Maximizing Collections

If you’re in the ASC industry, then you’re in the right place. Every episode, our hosts will recap the important news and data impacting ASCs, and share an interesting conversation we had with an expert from the industry. Check back often for new episodes!

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