5 costly mistakes to avoid when building an ASC

Editor's Note

Poor planning and rushed decisions derail too many ambulatory surgery centers (ASCs) before they open their doors. In a recent blog post, ASC consultant Emily Spooner outlined the top five errors commonly made during ASC development, offering targeted guidance on how to avoid them.

According to the post, one of the most critical missteps is underestimating the complexity of regulatory and licensing requirements. Many assume Centers for Medicare & Medicaid Services certification and state licensure can be tackled late in the project, Spooner noted, but this leads to delays, construction changes, or even disqualification. She recommends involving a regulatory consultant early and embedding federal and state compliance standards into the architectural and operational planning from day one.

Another pitfall is selecting a location based on cost or convenience rather than clinical demand. Sites that lack accessibility, parking, or referral alignment often suffer from poor case volume and profitability, per the post. Spooner advised conducting a thorough market analysis that evaluates procedure demand, payer mix, and physician access to ensure long-term viability.

Workflow blind spots during facility design also carry steep consequences. Decisions made without clinical input can create choke points in patient flow, particularly in the preoperative, recovery, and sterile processing areas. According to the post, ASCs should engage perioperative nurses and infection control experts early and run mock case simulations to validate layout efficiency before construction finalizes.

Financial modeling that doesn’t reflect real-world conditions is another common failure point. Many ASC projects lean on overly optimistic volume and reimbursement assumptions. ASCs should use conservative, physician-specific projections and build in time for credentialing, staff ramp-up, and delayed reimbursements. Stress-testing models against multiple scenarios is essential, Spooner added.

Finally, the post warns against overlooking revenue cycle infrastructure. Many teams delay billing setup or assume generic practice management systems will suffice. This often results in lost revenue, denials, or compliance risk. Spooner stressed choosing ASC-specific billing systems and staffing with experts who understand the nuances of coding, reimbursement, and payer policies before go-live.