Editor's Note
Terry A. Bohlke, MSHA, CPA, CMA, CASC, emphasized that Rocky Mountain High Surgery center is a pseudonym “to protect the innocent,” but the numbers he presented at the 2025 Ambulatory Surgery Center Association (ASCA) Conference & Expo in Denver last week were real enough. Based on actual scenarios and experiences, they added up to significant revenue-generation opportunities for any ambulatory surgery center (ASC) willing to look a little deeper at the most fundamental accounting documents: the income statement and balance sheet.
Bohlke, who is vice president, ASCs, at Community Health Systems, opened the presentation with the imagined surgery center’s 2023 financials: 4,500 cases, nearly $7 million in net patient revenue, and a $680,000 EBITDA loss. Despite increasing to 5,500 cases in 2024, the center posted a deeper loss of $1.2 million.
The team began at the top line of the income statement: revenue. Benchmarking net revenue per case, they found their center averaged just $1,622 against a regional average of $2,874. A deeper payer analysis revealed two contracts reimbursing well below Medicare. In response, the center renegotiated the payer A and C contracts to include carve-outs for their most common procedures, which were mostly those added from the hospital.
As detailed by the sample case of Rocky Mountain High Surgery Center, other opportunities to be found in the income statement might include:
Bohlke went on to highlight opportunities to be found in an ASC’s balance sheet. Examples include:
Bohlke’s list of opportunities to be found in basic financial statements did not end there. Among other items, he discussed facility rent, real estate expenses, and various other examples of using basic accounting as a proactive tool for problem solving. The cumulative impact was dramatic, with projections showing an expected $2.6 million EBITDA in 2025.
Read More >>