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.

Subscribe for weekly ASC news and ops insights.

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

Patient payments don’t have to be complicated. In this week's episode, we kick off our Patient Payments series with a practical guest conversation on what “good” looks like in 2026: integrated processing, fewer manual steps, faster reconciliation, and an easier way for patients to pay.

We cover where workflows commonly break down, why manual reconciliation and disconnected tools create errors and wasted time, and what to look for in modern payments and reporting.

We also close with quick headlines: CMS’s rural health transformation push, new research linking pre-surgery stress to worse recovery in older adults, a CEO transition at Compass Surgical Partners, and why the South is becoming a hotspot for ASC growth.

Subscribe for weekly ASC news and ops insights.

Resources mentioned:

CMS Establishes Office of Rural Health Transformation, Unveils $50B in State Awards: What ASCs Need to Know [https://ascnews.com/2025/12/cms-establishes-office-of-rural-health-transformation-unveils-50b-in-state-awards-what-ascs-need-to-know/] (Ambulatory Surgery Center News)

Stress among older adults linked to worse surgery recovery [https://medschool.duke.edu/news/stress-among-older-adults-linked-worse-surgery-recovery] (Duke University School of Medicine)

Compass Surgical Partners Names Mark Langston Chief Executive Officer [https://www.compass-sp.com/news/press-releases/compass-surgical-partners-names-mark-langston-chief-executive-officer] (Compass Surgical Partners)

Why ASCs are surging in the South [https://www.beckersasc.com/asc-transactions-and-valuation-issues/why-ascs-are-surging-in-the-south/] (Becker’s ASC Review)

Brought to you by HST Pathways.

Patient Payments: Moving from Manual to Modern

If you’ve been looking for a clear, ASC-focused breakdown of the 2026 CMS final payment rule, this episode is for you. This week, ASCA’s Chief Advocacy Officer, Kara Newbury, joins us to break down the most important things ASC leaders should note coming out of the 1600+ page document (all in under half an hour). Kara takes us through the reimbursement rate, the weight scalar update and ASCA’s advocacy for its elimination, a major rate oversight on the most common ASC procedure, massive covered procedure list expansion, and more.

In our data segment, we look at patient payment behavior at ASCs and discuss some of the reasons why partial payments are rising and paid-in-full cases are declining, and how financial stress and insurance complexity are showing up in case cancellation rates.

Resources mentioned:

Ambulatory Surgery Center Association [https://www.ascassociation.org/home]

Calendar Year 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Final Rule [https://www.cms.gov/newsroom/fact-sheets/calendar-year-2026-hospital-outpatient-prospective-payment-system-opps-ambulatory-surgical-center]

HST Pathways 2024 State of the Industry Report [https://www.hstpathways.com/resources/surgery-center-industry-report/]

Brought to you by HST Pathways.

What to Know About CMS’s 2026 Final Rule for ASCs

If you only had time to do one thing this week to improve your surgery center, what should it be? 

To kick off the countdown to year-end, This Week in Surgery Centers pulls together a year’s worth of conversations into one rapid-fire episode, featuring input from 30 past guests on the closing question of every interview: what is one thing ASC leaders can do this week to improve their surgery centers? You’ll hear practical, do-it-this-week ideas from ASC administrators, nursing leaders, business office experts, consultants, and physicians on:

 * Supporting and recognizing your staff in meaningful ways
 * Cleaning up payer profiles, item masters, and days to bill to strengthen margins
 * Tightening credentialing, monitoring, disaster plans, and IT/infosec policies
 * Improving communication with patients, caregivers, schedulers, and surgeons
 * Getting your financials and partnerships ready for the next phase of growth

This episode gives you simple, concrete starting points to make 2026 a stronger year for your center — one small improvement, week by week.

Brought to you by HST Pathways.

2025 Highlights: 30 Guests on One Thing You Can Do This Week

In the third installment of our case costing series, HST Pathways’ Chief Innovation Officer, Gavin Fabian, breaks down what “mature” case costing actually looks like in a real ASC (and why, done right, it’s pretty boring). The conversation covers why so many initiatives fall apart at the cost-data level, how to clean up your item master and documentation workflows, and practical steps to move from retrospective spreadsheets to automated case profitability forecasting. Gavin also shares where AI can help plug data gaps, where forecasting should live in your scheduling workflow, and how to use these insights to drive surgeon alignment without sacrificing culture.

In the data segment, we discuss a custom metric from HST’s demographic benchmarking report: OR Minute–Case Gap (by Sex). You’ll hear how this metric is calculated from a 5.3 million–case dataset, what national patterns look like in specialties such as Cardiovascular and Spine, and how ASC leaders can use these insights to challenge assumptions about block times, staffing, and scheduling — so days run closer to plan..

Resources mentioned:

Who’s on Your Schedule? Demographic Trends and Benchmarks for ASCs [https://www.hstpathways.com/specialty-data/asc-demographic-data]

Who’s on Your Schedule? Exploring Demographic Data for ASCs (Podcast) [https://youtu.be/NFoBXHO0V_g?si=ZPxoSxLpxnqzS6Yw]

HST Pathways 2025 Client Award Nominations [https://www.hstpathways.com/client-awards/]

Brought to you by HST Pathways.

From Case Costing to Profit Forecasting

In this week’s episode, the second installment in our case costing series, Grant Duncan sits down with VMG Health’s Vanessa Sindell and Nancy Stephens to unpack the unsung hero of accurate case costing: a clean inventory master. They cover practical, do-it-today tactics like using naming conventions that work at the point of care, leveraging GPO data to understand all of your pricing options, and keeping preference cards current, so cost-per-case is surgeon ready. They also make the case for dedicating an FTE to the process to maximize cost savings.

In the news: the still-pending OPPS/ASC final rule, the implications of CMS site-neutrality efforts, a new analysis drawing scrutiny to UnitedHealthcare’s payments to Optum-employed physicians compared with market peers, and encouraging results for a multi-cancer blood test showing high detection accuracy alongside standard screening.

Resources Mentioned:

VMG Health [https://vmghealth.com/]

CMS’ delayed ASC rule release, explained [https://www.beckersasc.com/asc-news/cms-delayed-rule-release-explained/] (Becker’s ASC Review)

CMS’ site-neutral reform poised to upend hospital-ASC dynamics [https://www.beckersasc.com/asc-coding-billing-and-collections/cms-site-neutral-reform-poised-to-upend-hospital-asc-dynamics/] (Becker’s ASC Review)

Study suggests UnitedHealthcare pays Optum docs more than other providers [https://www.fiercehealthcare.com/payers/study-suggests-unitedhealthcare-pays-optum-docs-more-other-providers] (Fierce Healthcare)

A simple blood test can detect 50 types of cancer: We explain [https://www.usatoday.com/story/graphics/2025/11/09/cancer-blood-test-dna-galleri/87126236007/] (USA Today)

Brought to you by HST Pathways.

Case Costing: Creating a Clean Inventory Master

This week’s guest, Melissa Rice, is the administrator at Loyola Ambulatory Surgery Center at Oakbrook Terrace (part of Trinity Health), and the newly elected Illinois Ambulatory Surgery Center Association President. In the first episode of our Case Costing series, Melissa lays out a practical playbook that changes behavior — how to pull the levers that drive profitability (implants, supplies, staffing), why clean data must come first, how subspecialty data can surface margin-wrecking outliers, and the right way to align your staff, surgeons, vendors, and your board using clear numbers and transparent governance.

In our data segment, we spotlight the Days to Bill benchmark — which rose to 4.4 days on average in 2024 from 3.6 in 2023 — and a few specialty-specific improvements. We talk about why this metric matters, what it can indicate, and a few simple ways to accelerate cash while mitigating denial risk.

Resources mentioned:

HST Pathways State of the Industry Report [https://www.hstpathways.com/resources/surgery-center-industry-report/]

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

HST Pathways Cardiovascular Specialty Data Report [https://www.hstpathways.com/specialty-data/cardiovascular]

HST Pathways Gastroenterology Specialty Data Report [https://www.hstpathways.com/specialty-data/gastroenterology]

Brought to you by HST Pathways.

The 3 Case Costing Levers: Implants, Supplies & Staffing

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!