Colleen Ramirez, Chief Administrative Officer at Bone & Joint Surgery Center of Novi, and Dr. Michael Bernard, Director of Anesthesia, join the show to share how they work together to drive case volume, choose which cases to accept, and stay profitable—all while maintaining a strong clinical partnership.

In our news recap, we’ll cover the first ever ASC in the Dominican Republic, a new ASC joint venture, the rising demand for dental surgeries, and, of course, end the news segment with a positive story about how engineers have discovered a way to turn dental floss into a vaccine.

Lastly, an exciting update: starting next week, Erica Palmer will be handing over hosting duties to Alex Larralde!

Resources Mentioned:

 * One World Surgery Opens First Ever ASC in DR [https://www.ascfocus.org/ascfocus/content/articles-content/articles/2025/digital-debut/one-world-surgery-opens-first-ever-asc-in-dr]
 * Solara Surgical Partners, Orlando Health Announce New ASC Joint Venture [https://ascnews.com/2025/07/solara-surgical-partners-orlando-health-announce-new-asc-joint-venture/]
 * Demand Rises for Dental Surgery in ASCs [https://www.ascfocus.org/ascfocus/content/articles-content/articles/2025/august/demand-rises-for-dental-surgery-in-ascs]
 * Engineers transform dental floss into needle-free vaccine [https://www.science.org/content/article/engineers-transform-dental-floss-needle-free-vaccine]



Brought to you by HST Pathways.

Anesthesia: Driving Surgical Volume

This week, we’re joined by Wes Battiste, an experienced anesthesiologist and ASC developer, to talk about a growing trend: surgery centers building their own in-house anesthesia teams. What once seemed like a wild idea is now becoming the best path forward for centers looking to stay profitable.

Then, in our Data & Insights segment, we dive into 10 key metrics from spine centers—some promising, some concerning, but all worth paying attention to.

Plus, a personal update: After nearly three years hosting This Week in Surgery Centers, Erica Palmer will be passing the mic. You’ll meet your new host, Alex Larralde, in this episode (she interviews Wes!), and you’ll also start hearing from Grant Duncan in the coming weeks.

Resources Mentioned:

https://www.hstpathways.com/specialty-data/spine

Brought to you by HST Pathways.

Anesthesia: Building an In-House Team 

Alex Taira from ASCA breaks down the key takeaways from CMS's 2026 Proposed Payment Rule for ASCs. From reimbursement rates to the ASC Covered Procedures List and quality reporting changes, Alex shares what ASC leaders need to know from the 913-page proposal.

In our news recap, we highlight an AI-JAMA partnership, payer challenges facing anesthesiologists, tips to prevent cyberattacks, and a breakthrough device preserving donor organs.

ASCA Resources:

 * Proposed Rule Highlights [https://www.ascassociation.org/asca/news-and-publications/ga-update/2025/07-17]
 * Propsed Rule Webinar on 7/22/25 [https://www.ascassociation.org/asca/education-and-events/virtual/2025-regulatory-series/understanding-medicares-proposed-rule-for-2026]
 * ASCA’s 60-Second Survey [https://www.surveymonkey.com/r/ASCA60Survey_EHR]
 * National Advocacy Day [https://www.ascassociation.org/national-advocacy-day-2025/home]

News Stories:

 * JAMA signs multi-year deal with OpenEvidence [https://www.fiercehealthcare.com/ai-and-machine-learning/jama-signs-multi-year-deal-openevidence-inform-ai-powered-medical-search]
 * The payer issues pressing anesthesiologists [https://www.beckersasc.com/anesthesia/the-payer-issues-pressing-anesthesiologists/]
 * Offensive Mindset: Preventing Cyberattacks [https://www.aorn.org/outpatient-surgery/the-magazine/article/offensive-mindset]
 * ‘Life-saving’ organ-preserving device wins major award [https://www.positive.news/society/good-news-stories-from-week-28-of-2025/]

Brought to you by HST Pathways.

The CMS 2026 Proposed Payment Rule for ASCs

This week, ASC expert Carol Hiatt joins us to share practical tips for improving OR utilization in orthopedic surgery centers. With over 30 years in the industry, Carol dives into common causes of underutilization and how to fix them.

Then in our Data & Insights segment, we spotlight dental ASCs. Drawing from 35 facilities and over 15,000 cases, we break down key metrics like block utilization, pre-auth rates, and patient deposit collection.

Resources Mentioned:

https://www.hstpathways.com/specialty-data/dental

Brought to you by HST Pathways.

Maximizing OR Utilization in Ortho ASCs

Kevin Turner is the Sr. VP of IT & Analytics at HealthCrest Surgical Management. He has been in IT for over 30 years and has been through the software evaluation process countless times. Kevin shares with us his repeatable, proven, 8-step process that anyone can use to guide their software decisions. Whether you’re choosing your first system or replacing a legacy tool, this structured approach will help you navigate the process with confidence. With so many vendors and features to consider, it’s easy to feel overwhelmed, but this step-by-step process will keep you focused on what matters most and make sure all stakeholders are happy with the decision.

In our news recap, we’ll cover the DOJ’s Anticompetitive Regulations Task Force, Ascension’s acquisition of AMSURG, the biggest opportunity for growth in ASCs, and, of course, end the news segment with a positive story about a nurse who uses her own personal tragedy to provide once-in-a-lifetime care.

Recommend 8-Step Process:

 1. Define Business Needs and Objectives
 2. Assemble a Cross-Functional Selection Team
 3. Gather Requirements and Prioritize Features
 4. Research the Market and Identify Potential Vendors
 5. Evaluate and Compare Options
 6. Assess Integration, Security, and Compliance
 7. Review Costs and Negotiate Contracts
 8. Pilot, Test, and Finalize the Decision

Resources Mentioned:

 * ASC Stakeholders Voice Market-Competition Concerns, Ask DOJ Task Force to Cut Red Tape [https://ascnews.com/2025/06/asc-stakeholders-voice-market-competition-concerns-ask-doj-task-force-to-cut-red-tape/]
 * Ascension agrees to acquire Amsurg to expand ambulatory surgery reach [https://www.healthcaredive.com/news/ascension-acquire-amsurg-asc/750938/]
 * The biggest opportunities for ASC growth  [https://www.beckersasc.com/leadership/the-biggest-opportunities-for-asc-growth/]
 * From Paralyzed Patient to Spinal Cord Nurse: Rachel Stewart, BSN, RN, Turns Trauma into Triumph [https://www.dailynurse.com/rachel-stewart-nurse-spinal-cord-injury-journey/]

Brought to you by HST Pathways.

The 8-Step Software Evaluation Checklist

At the end of every discussion, we always ask our guests, “What is one thing our listeners can do this week to improve their surgery centers?” For today’s episode, we took the last 15 answers we received from our guests and turned them into a 20-minute highlight reel.

This roundup features, in order: Scott Allen, Becky Ziegler-Otis, Tina DiMarino, Kathy Wilson, Ryan Short, Colin Park, Mayte Rechani, Mark Henderson Leary, Maddie Traylor, Richard Parker, Melanie Howitt, Kristle Young, Josh Rudd, Nyleen Flores, Shannen Reyes-Aguayo, and Will Evans.

A huge thank you to everyone who has shared their advice!

Brought to you by HST Pathways.

Highlight Reel – 15 Tips to Improve Your Surgery Center 

Will Evans, HST’s Senior Director of Data Science and Insights, is fresh off presenting Advanced Financial Strategies at last month’s ASCA conference. I wanted to spend a few minutes with Will recapping the second half of that presentation for those who may have missed it, including four key metrics for assessing financial health, how to identify the most important metrics for your unique ASC, and ways to incorporate benchmarking. If you’re looking to strengthen your ASC’s financial performance, this is a great place to start—and you’ll hear a success story or two along the way.

After my conversation with Will, we’ll shift to our Data & Insights segment. You’re likely familiar with our full State of the ASC Industry Report, but we recently released 12 new specialty benchmarking reports—shorter, data-focused reports that take a deeper dive into one specialty at a time. Today, I’ll spotlight average monthly revenue trends for two longstanding specialties—Gastroenterology and Ophthalmology—versus two emerging specialties—Cardiology and Total Joints. We’ll break down average monthly case volume, revenue per case, and what trends we’re seeing across these specialties.

Resources Mentioned:

 * https://www.hstpathways.com/specialty-data/gastroenterology/
 * https://www.hstpathways.com/specialty-data/ophthalmology/
 * https://www.hstpathways.com/specialty-data/cardiovascular/
 * https://www.hstpathways.com/specialty-data/totaljoint/

Brought to you by HST Pathways.

ASCA Session Recap: Advanced Financial Strategies 

Nyleen Flores, CEO of MedElevate, and Shannen Reyes, President of Advanced Quality Compliance, are joining us today. With decades of experience between them, Nyleen and Shannen have helped countless surgery centers streamline their credentialing processes, reducing risk and improving patient safety along the way. In this episode, we unpack common misconceptions, share tools and systems that actually work, and chat about their brand-new podcast, Credentialing Chronicles.

Later in the episode, I’ll walk through our latest Data & Insights spotlight. You’ve probably seen our full State of the ASC Industry Report, but we’ve just released 12 new benchmarking reports focused on specific specialties. Today, we're focusing in on Cardiovascular ASCs—with insights from 108 centers and roughly 9,000 cases.

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

Brought to you by HST Pathways.

Smarter Credentialing Strategies 

Josh Rudd recently opened Knoxville Spine Surgery Center, his first time leading the launch of a brand-new facility. I sat down with Josh to hear what the process was really like, from the initial idea all the way to their very first procedure. Whether you're planning a new build or just curious about what it takes to open an ASC from scratch, this conversation is packed with first-hand insights you'll find both valuable and engaging.

After my conversation with Josh, we’ll head into our Data & Insights segment. HST released its annual State of the Industry report in September, based on data from 590 surgery centers. Today, we’re diving into expected vs. actual OR start times and sharing practical tips to help keep your schedule running on time.

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

Brought to you by HST Pathways.

Behind the Scenes of Opening an ASC

We’re continuing our series on Improving Profitability. Last week, Melanie Howitt shared how AI and automation can improve your ability to collect outstanding balances. This week, Kristle Young from Collective RCM joins us to discuss strategies for reducing days in AR.

In our news recap, we cover key trends from the ASCA Conference, the rise of shoulder replacements, a new joint venture between Cleveland Clinic and Regent Surgical, and end on a high note with this year’s Nap Gary Award recipient.

Resources Mentioned:

ASCA 2025 Recap: Profitability, Tech, and Leadership [https://www.hstpathways.com/blog/asca-2025-recap-profitability-tech-and-leadership/]

Gaining Ground [https://www.aorn.org/outpatient-surgery/the-magazine/article/gaining-ground]

Cleveland Clinic, Regent Surgical Strike ASC Joint Venture Agreement [https://ascnews.com/2025/05/cleveland-clinic-regent-surgical-strike-asc-joint-venture-agreement/]

Wilson Receives Nap Gary Award for Lifetime Achievement [https://www.ascfocus.org/ascfocus/content/articles-content/articles/2025/names-in-the-news/wilson-receives-nap-gary-award-for-lifetime-achievement]

Brought to you by HST Pathways.

Improving Profitability: Reducing Days in AR

If you’re in the ASC industry, then you’re in the right place. Every week our hosts will recap the latest news impacting ASCs, and share an interesting conversation we had with our featured guest. New episodes released every Tuesday!