How One ASC Catches Thin-Margin Cases Before They’re Posted

Ep. 151 Angela Ary – How One ASC Catches Thin-Margin Cases Before They’re Posted

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

Angela Ary is ASC Business Office Manager at CSMO Surgery Center, where she oversees the business office, pre-certification and patient estimates. Angela joins us this week to break down case costing and the payor grid. She walks through the case costing meetings her team holds twice a month, the payor grid that flags thin-margin cases before they’re posted, how the team presents case data to the physician owners, and the move from paper charts to an EMR. She also shares one thing any center can do to build staff buy-in.

In our news segment, we’re talking about HealthSpan Partners’ agreement to acquire Surgery Partners, third quarter results from HCA, Tenet and UHS, and ASCA’s survey on anesthesia access. We’ll look at what each one means for ASC leaders.

Correction: ASCA’s third quarter 2026 survey found that 76% of centers reported adequate access to anesthesia providers. The news segment says about 67%.

Resources Mentioned:
Surgery Partners and HealthSpan Partners joint release, Oct. 26, 2026 – https://ir.surgerypartners.com/news-releases/news-release-details/healthspan-partners-acquire-surgery-partners-establishing
Becker’s Hospital Review, Oct. 26, 2026 – https://www.beckershospitalreview.com/asc-transactions-and-valuation-issues/bon-secours-mercy-health-affiliate-to-acquire-surgery-partners-for-5-7b/
Healthcare Dive, Oct. 27, 2026 – https://www.healthcaredive.com/news/bon-secours-affiliate-5-7-billion-bid-surgery-partners/872887/
HCA Healthcare Q3 2026 release, Oct. 27, 2026 – https://s23.q4cdn.com/949900249/files/content_files/FINAL-PR_HCA-Reports-3Q-2026-Results.pdf
Tenet Q3 2026 release, Oct. 29, 2026 – https://www.financialcontent.com/article/bizwire-2026-10-29-tenet-reports-strong-third-quarter-2026-results-raises-2026-financial-outlook
Becker’s ASC on the UHS earnings call, Oct. 28, 2026 – https://www.beckersasc.com/finance/uhs-surgical-volumes-dip-as-procedures-migrate-to-ascs-physician-offices/
UHS Q3 2026 release, Oct. 27, 2026 – https://www.sec.gov/Archives/edgar/data/0000352915/000119312526434414/uhs-ex99_1.htm
ASC Focus on ASCA’s third quarter 2026 anesthesia survey, Oct. 16, 2026 – https://www.ascfocus.org/202610-asca-anesthesia-survey
Becker’s ASC on the anesthesia survey, Oct. 19, 2026 – https://www.beckersasc.com/anesthesia/anesthesiologist-only-ascs-report-88-access/

Brought to you by HST Pathways.

Episode Transcript

Ryan Cohn: [00:00:00] Welcome to This Week in Surgery Centers. If you’re in the ASC industry, then you’re in the right place. Every week we’ll start the episode off by sharing an interesting conversation we had with our featured guest.

And then we’ll close the episode by recapping the latest news impacting surgery centers. We’re excited to share with you what we have. So let’s get started and see what the industry’s been up to.

Hey everyone, here’s what you can expect on today’s episode. Our guest this week is Angela Ary, Business Office Manager at the Center for Sports Medicine and Orthopedic Surgery Center. Angela oversees the business office along with pre-certification and patient estimates.

She walks us through the case costing meetings her team holds twice a month, the payor grid that flags thin margin cases before they’re posted, and how her team presents case data to the physician owners. She also looks back on moving from paper charts to an EMR and shares one thing any center can do to build staff buy-in.

[00:01:00] After the interview, we’ll get into the news. We’ll cover a health system affiliate that has agreed to buy Surgery Partners for $5.7 billion. We’ll also go through the latest quarterly results from HCA, Tenet, and UHS, and new survey numbers on anesthesia access in surgery centers.

I hope everyone enjoys the episode. And here’s what’s going on this week in surgery centers.

Awesome, Angela. Well, thank you so much for being here. It’s so nice to meet you in person. So if you could share us a little bit about yourself and the work that you’re doing with the Center for Sports Medicine and Orthopedic Surgery Center and the areas that you oversee.

Angela Ary: Yeah, so I’m the business office manager. I have been with Center for Sports Medicine for a little just hit my seven year anniversary. I’ve been at the surgery center for three years, three of those years.

And I currently oversee the business office. The [00:02:00] staff that that includes is front desk staff, medical records, and then I also oversee two departments that work alongside with us at the surgery center because the majority of our surgeries, you know, are at our ASC.

So I’m over the pre-cert department getting all the authorizations for MRIs and surgeries and procedures in office and at the surgery center, and then also over the patient financial representatives that do all of the estimates and contact the patients and get that collected beforehand.

Ryan Cohn: Wow. Yeah, so you’re doing doing a lot of different things.

And so you’ve been there for about three years. Have you always been in healthcare or

Angela Ary: I have. I I went later in life to nursing school. So I was originally, you know, a nurse, did patient care for the first several years of my career, and then COVID hit and decided I didn’t want to be in patient care anymore.

Having my three kids, you know, at home. So switched over to more [00:03:00] of the you know, admin side. Started with CSMO doing MRI pre-service, like that’s where I started.

And then CSMO is very big about promoting within, and so just kind of grew from there and went to a team lead and then manager. And then was, we like to joke, I was kind of voluntold to do the implementation for HST at the surgery center. And probably the best thing I’ve ever been asked, or oh wow, recommended to do, because you know I’m, you know, business office manager, so it’s just been great in growth and yeah, stuff like that with the center.

Ryan Cohn: Oh, that’s so cool. So you’ve you’ve really been able to progress your career and and take on more and more and more.

Angela Ary: Yes, yes.

Ryan Cohn: Which is what happens. But it just means that you you obviously deserve it and and work hard for it. So you know it sounds like yeah in our previous conversation you mentioned that your center went from paper charting, you know, to you know bringing on an EMR and and digital [00:04:00] you know systems. So could you walk us through that process?

Angela Ary: Yeah. So originally we were, you know, we would get a a fax paper copy of a surgery order and we would get that added. We would make a you know paper chart if the patient didn’t already have one, we would you know make a paper chart, put the surgery order in it, wait for the authorization, add that to it and then you know keep it there until the date of service.

We would have that taken up room for the paper chart. You know, we would keep it and then the date of service would come and of course you know that that paper chart would follow the patient all the way through and then come back to the business office where it would then sit again to wait on you know an op note and from there, once the op note, then you would let a coder review it, and then get it billed.

And so you know it just took up a lot of space and time and you know all of that. And so definitely moving you know to an EMR has been so much more efficient for all of staff. The [00:05:00] physicians love it.

The staff all love it now you know that they know it. Of course change is always scar you know scary and you get some pushback but it’s it’s overall it’s been you know it has been great and a very easy process.

Ryan Cohn: Well, that’s great to hear that, you know, and that’s on some other conversations I’ve had. You know, everyone has talked about how you get pushback when there’s change or some people are really stuck in their ways and you know, they’ve been in healthcare for a long time and and so that’s that’s common.

But you guys are kind of like a living testament to once you get to that other side, people actually do like it and and love it. Would you say they’re pretty much everyone is fully on board now at that point at this point?

Angela Ary: Absolutely. The you know, the surgeons are yeah, they’re it’s we’re physician-owned. So in order to make it work, it was mainly, you know, get them to approve and buy in and be supportive and everybody else will follow suit.

So they [00:06:00] are all very active with it. I have but there’s not I literally got a text message before we sat down and asking if I can go in and update an op note because the physician saw you know something you want to change.

And so we have some of our surgeons that go in and change stuff themselves and build their own templates and then I build templates for some. And so they’re all very interactive and what can we do? How can we make this easier so we can, you know, spend less time and more time with the patient and more time in surgery. Yeah.

Ryan Cohn: Yeah, and I think that’s so important with with having a system is you do need to have that continuous feedback loop of making sure everyone does have their voices heard and and you know, they can only get better when when those when that feedback is given.

So I know your team completed, you know, that transition on a compressed timeline with while also dealing with some, you know, some facility disruptions. So what did that experience teach you about implementing new [00:07:00] technology in the ASC?

Angela Ary: Yeah, so all of that said, we were we were supposed to go we were going live at the end of December 2022. And earlier in the month of that December, we had some pipes, water pipes that froze and busted and we walked into about two feet of water throughout our entire ASC.

And that was before so we we in that whole process we were also building a new facility. So we were currently in a 5 OR facility very small older building. And we were building our new 10 OR, you know, huge.

Yeah. We love it new facility. So you know we were just trying to make it through till that July like you know get through and then we had the you know the pipes bust.

It closed us down fourth quarter in December, which was huge for us. And so got everything, you know, we had a good company that were they were currently working on the new center and they stopped everything there and came over and replastered the [00:08:00] walls and got everything fixed, reopened back up then to have one of the ORs have to shut down because there was a an AC that caught fire.

So shut us down for a couple more days and on top of all that got going back up again right there the last week of December and then went full force into you know HST and implementing everything that we could at the new center because we wanted to be fully engaged in all the HST products we were going with by the time we moved in July.

Nice. And so it was it and it worked out very well it taught me for sure patience you know because you never know what you’re gonna walk into each day. And so it it taught us just to be you know at the time it wasn’t a laughable matter, but now we look back and we’re like, wow, we survived all that for implementing from paper to EMR stuff.

Ryan Cohn: Now you can do anything.

Angela Ary: Yep, that and then just communication. Yeah. I had a great implementation team.

[00:09:00] My super users, they knew their stuff in and out. So, you know, having them and communicating with them throughout was fantastic. And that was kind of, you know, so I definitely say patience and communication.

Ryan Cohn: Yeah. Yeah. That makes so much sense.

And you know, pat it pat yourself on the back for getting through that because that seems like a lot.

Angela Ary: I have to give credit to our CEO and our administrator though, because they were you walked in and the CEO had on her knee high rain boots, scooping and mopping out water, you know, so very hands-on the administrator as well, just you know, there and very active in everything and so helpful.

And that leadership just led to everything else falling into place. Yeah, yeah.

Ryan Cohn: Well, that good leadership is yeah, what it what it takes and you know, creates other good leaders. So and so I know a major part of your role today is turning operational data into useful reports. What kind of questions do people bring to you? [00:10:00] And how do you determine what information they need?

Angela Ary: So just an example of last week the sterile processing team lead came to me and was like, I need to know how many of this one you know supply we have used over the past six months just to kind of get an idea of average how many we’re using a day to see if that’s something that we need to increase our supply with, or if we should be good on what we keep, you know, in stock.

So of course, you know, I just said, okay, do you do you want that by you know, just a six month period? Do you want that average by the week? Or, you know, what do you want?

You know, how do you want that to look? And you know, he just let me know. I’d like to see it, you know, how many we use a week and a month, you know, and so was able to pull that information, you know, out of practice management, put it in a pivot table and give it to him and then we, you know, we were able to see we didn’t necessarily need more on this, you know, on the shelf.

Yeah. [00:11:00] We we were having enough to cover and make sure we always had enough because just based off the average of what we had been using it for, it was, you know, we were keeping enough in stock and they’re at the center. So we didn’t need to increase our supply on that.

Ryan Cohn: Yeah.

Angela Ary: You know, so things like that, or you know, my administrator she asked for reports constantly from staff utilization to you know surgery time, you know, to look to see if we can adjust what times we’re posting for a surgeon.

So we’ll pull that surgery time log and I’ll look at that and you know average you know the OR time that they’re in there total for the OR versus you know the surgeon’s actual time in the room and see, you know, because we’re gonna, you know, our surgeons are always in two rooms so they’ll bounce back and forth.

So we’ll see how long we need to schedule it to kind of make that block utilization make more sense. So we don’t have as much you know that you know white space.

Ryan Cohn: Yeah.

Angela Ary: Not using the OR.

Ryan Cohn: So and that’s called the flipping method or flop. Is it flop or flip?

Angela Ary: Flip yeah they it’s [00:12:00] a flip room.

Ryan Cohn: Yeah a flip room.

Angela Ary: Okay.

Ryan Cohn: Interesting. And so you’re you’re kind of the go-to person for pretty much all things data and analytics.

Angela Ary: Yeah yeah for the ASC, we do have some analysts that pull reports from ASC and our practice side. And you know, they help out with some of that. But as far as just day to day data, you know, or quick reports here and there, they they come to me and I I’ll ask them a few questions about how they want it to look or the layout or who they want included or not included. And then I’ll just take it from there and pull the data and put it on.

Ryan Cohn: Do you use any like AI tools to help like read the data or create some tables for you or

Angela Ary: no? I am everything I pull, I pull from practice management. I will pull it straight into an Excel spreadsheet and then just piece together what I need, remove, you know, move some columns around and put it in a pivot. I love a pivot table.

Ryan Cohn: I do [00:13:00] too, yeah.

Angela Ary: Yeah. So that just, you know, for the most part, I can get everything I need, you know, from the data that’s provided. Yeah. Yeah, out of practice management.

Ryan Cohn: Well, that’s great. And for other surgery centers that don’t have you know large dedicated analytics teams, or maybe it’s just one person, you know, what reports are most useful for understanding how the center is performing.

Angela Ary: Yeah. So I tell everybody the DE 5500 is my favorite report. It gives you so much data.

You can, you know, you can see anything from the patient’s name, date of birth, you know, what insurance, the contract fee, what we were paid from the contract, what CPT codes were billed, the description of the CPT codes, the procedure code, the procedure code description.

I mean, there’s everything, what implant costs were used, to you know, total staff cost, the time in the room, everything. So it really gives you a good overall. I run that [00:14:00] report frequently when we have people, like if we have a case that’s questionable about you know, the profitability or whatever, I I’ll just do a quick report, run it, do some numbers, you know, over last six months, or you know, whatever it needs to be.

But yeah, the DE 5500 is kind of an overall glimpse of you know a case. So you can see a lot of detail in that case.

Ryan Cohn: Yeah, that’s awesome. And I know one thing that’s really interesting about you guys is you hold case costing meetings twice a month. Could you talk to us a little bit more?

Like what’s what are you looking at? What’s being discussed, and I think that’s really indicative of a center that’s running well, yeah, you know.

Angela Ary: Yeah, so we take you know, we will take our analyst, she will pull that DE 5500, and we are able to sort that out by CPT code and by looking at the CPT code that we’ll we’ll look at the primary CPT code, [00:15:00] and then of course we get into a case that we see was very close to being profitable or you know, for some reason was not profitable, then we can you know review that data, we can we get together, it’s our CEO is on these meetings, our administrator, myself, the nurse manager, we have her on there so that she can say, Yeah, that’s typical for that kind of case.

You know, when we’re looking at the supplies because I can’t, you know, I can’t look at the what they are charted and be like, yes, that’s normal to be on, you know, a total knee. Yeah. Whereas between her and the sterile processing team lead, they can they’re on there kind of for that knowledge, and they can tell me, you know, that’s normal for that case, or yep, we remember that case specifically because the physician requested that more expensive implant or you know, things like that.

So they’re in there for that kind of knowledge, and then we have a coder that is on the meeting. Coder [00:16:00] is able to be there. And if I pull up in practice management, we got authorized one CPT code, but I see that they build a different CPT code.

Why did that happen? You know, did we get a retro auth to cover the CPT code that they say you know needed to be coded and built? So we’re able to do that in that meeting.

That’s kind of, you know, we look at you know all of that stuff from the implant cost to the physical paper implant log that has been scanned in, you know, to the supplies to the staff cost to the time the physician was in there, and then we take all of that and compare it to what that insurance contract fee is.

And if we see that, you know, you know, sometimes we’ll catch that an implant was duplicated. And then we say, okay, this this was a profitable case. We just need to adjust, you know, the implant log.

Ryan Cohn: Interesting.

Angela Ary: So we’re able to catch things like that, catch supplies that have been on there that didn’t need to be on there, or you know, like I said, there’s supplies that can be duplicated. [00:17:00] And by doing all this, we have been able to go in and you know, when we started with HST, we kind of just made this big and mass supply list so that they would generate in, you know, all cases, or you know, in pre-op or PACU.

And then we figured we were like, okay, we’re not using this supply on every single case. So we need to go back and refigure, rebuild these supply lists. And by doing that, we got them to just the basics.

And so now our staff go in and add the additional supplies that they’re actually using that aren’t on that. So we weren’t, you know, charting or billing for all the, you know, had all these supplies listed that weren’t actually used.

We’ve been able to catch a lot, watch a lot of cases. So if we think that they’re, you know, kind of close to you know hitting that, you know, comfort level, we can just follow that, you know, that CPT code for a little bit.

It’s been very beneficial. We were meeting weekly. Now we [00:18:00] meet biweekly and we’ve just now switched it because it’s been so good and we’re so on top of things now that we are able to by doing this, if we see that it’s a case that we don’t need to bring to the facility, we’re able to catch it beforehand, you know, so that we’re not bringing those you know negative margin cases by putting this group together, but now we’re at the point where our CEO and administrator like they’re only going to come to one you know meeting a month because it’s just it’s so fine-tuned at this point. But yeah.

Ryan Cohn: Yeah, that makes sense. And yeah it seems like a really good process that that has obviously had good returns and you know now upper leadership doesn’t you know they feel like they can trust the process and and

Angela Ary: And this is, it’s also data that we present to our physicians. Yeah. And so, like I said, being physician-owned, being able to show them like the actual numbers and data, you know, and they’re [00:19:00] able to look at it and compare and see where they stand compared to other physicians. And we, we always say, you know, all surgeons are competitive, but I feel like orthopedic surgeons even more so, you know. They, they’re able to see, you know, everybody else’s

Ryan Cohn: okay so you’re comparing them to each other.

Angela Ary: Yes.

Ryan Cohn: Everyone that is working there.

Angela Ary: Yeah, so they, they present this data that we review. So after we go through and review it, and are able to, you know, put notes as to why a case was negative, or why case was so close, or why this case just cost more on average, you know, more than the average that that case cost, we have that noted. So that when it is presented to the physicians, we can explain, this is why, or, you know, you use a different implant on this one to trial it, and, you know, it made it cost more. And then they’re fully on board. They’re like, okay, you know, it’s very transparent, it’s very, it’s very detailed, and you know it’s [00:20:00] been reviewed by multiple eyes before it hits their, their eyes. So there’s really no, you know, by the time it gets to them, there’s not room for really, you know, a lot of questions. Yeah, other than they’ll come back and say, okay, well, what can we do to make it better? Yeah, you know, or how can we fix it and make it, you know, more profitable?

Ryan Cohn: yeah yeah and I I would be interested to learn more about that but I have another burning question. So are you typically going like in these meetings are you going case by case by case or is it just ones that like you have a workflow built that sort of flag certain cases that are close.

Angela Ary: So our analysts will go through and review it before we meet as a team to review, and of course she will, you know, it’s, it’ll be marked, you know, it’ll turn it red if it’s, you know, in the negative, or if it’s just a very low margin profit. Those will be marked until we just review. Those are the only ones that makes sense. Yeah, or, you know, [00:21:00] if she does see something that, like, where the average supply cost is this, and then she sees one surgery that the supply cost was double that.

Yeah, you know, she’ll flag that and be like, let’s just take a look at it. Like that doesn’t something looks

Ryan Cohn: off.

Angela Ary: And by that, you know, we can catch, like I said, you know, if possibly a supply was in it that wasn’t used or duplicated. Okay by doing it that way. So, you know, and then we can, you know, then it just goes back to, you know, staff education, you know, like make sure you’re double checking your supplies and you know, your charting and everything, you know, before you confirm and yeah.

Ryan Cohn: So this is before a case would be accepted. You’re making sure that it gets flagged, it gets discussed, or sometimes it’s after the fact and then the other.

Angela Ary: So a lot of times it’ll be, you know, after the fact, but we’ve got the process down so much that the cases that we want to be questioned on, we have a workflow [00:22:00] on on our payor grid, and that’s kind of what we look at. Kind of the average case cost versus what insurance pays.

And so the ones that are close to the contract fee for insurance or you know, or under, or I guess I would say over, you know, what they’re gonna pay us, and you know, if it would put us in a negative or even close to a negative, those are the ones that come to myself or you know, our administrator, and we’ll review those and see has the case costing for that changed in the last three months.

Have we gone with a new vendor? How has our vendor have you know, did we look at it and say, okay, we can go cheaper this route? And we went to our vendor and the vendor changed the price.

So, you know, we look at that, or I’ll get with our facilities manager and and our inventory manager and say, you know, has it you know, has doing this here the cost lowered, and can we, you know, can we change this on our payor grid? Is this now more profitable [00:23:00] case?

Ryan Cohn: Interesting.

Angela Ary: Yeah. So we look at some, you know, by doing the case costing, we’ve been able to make a good reference list to catch the cases prior to posting. And then, but like I said, we still meet, you know, twice a month to catch any that have pricing is changed or you know, just something’s different, or a case that we haven’t done before.

So, you know, we couldn’t have caught it, you know, beforehand. You know, we had one come across this past week and it was the first time we had done the case. So it was good to see it because then we know we can keep it here or we can’t.

So that’s you know, so yeah, we catch them beforehand, and then we catch them afterhand, you know, afterwards, you know, for the cases that we haven’t already able to establish as.

Ryan Cohn: And then that helps, yeah, create some ground rules for future cases. Got it. And so you mentioned the payor grid.

For look for listeners who may not use one or not familiar with it, what exactly is a payor grid and and [00:24:00] how does your team use it? How does it work?

Angela Ary: Yeah, so the payor grid was created, it it it shows all payor contracts and their contract fee or that specific CPT code. So there’s several tabs in this Excel spreadsheet, but then we have a quick reference tab. And so that’s kind of what we look at.

Our surgery schedulers are on the practice side. So when they get an order from the surgeon, they will look at it and whatever CPT codes are on there, they’ll reference that you know that payor grid. And if that payor grid is in yellow, then that means you know, of course, caution.

Let’s you know, look at it, see who the payor is. So on that one spreadsheet, it’ll list you know, our most common payors, and it will list if it’s gonna if it’s a profitable contract fee, right? Or and not, you know, or a negative, and so they’ll look at that.

And of course, you know, if it’s highlighted in yellow, it’ll have a note out to decide, you know, contact management before posting. So, you know, they’ll [00:25:00] contact us and we’ll say, Yep, it’s good, let’s post it, or no, let’s you know, take that to the hospital, just because that’s not something that insurance wants to pay, you know, at an ASC, you know, at a reasonable rate.

So we look at that. So our surgery scheduling staff and then our our scheduler that will actually post the cases. She’s kind of that second set of eyes to look at that and review.

But yeah, it does it’ll it list the CPT code, it lists the you know the payor contract fee for that specific insurance. Well, and then they’ve figured in the average case costing for that specific that single CPT code. So you know, we have some CPT codes that’ll be like an order that’s just a single CPT code, and they’re not as profitable.

But if you mix it with a couple of the other that show profit, then you know, if there’s three or four codes, then we’re like, okay, well, if it’s multiple codes, you know, bring it. So yeah, yeah.

Ryan Cohn: Oh, interesting. And [00:26:00] are you I guess for building that out, is that a tool that you’re using? Is it Excel?

Angela Ary: Yeah, it’s Excel. And it’s just the the different data from the insurance companies that have been pulled into it. Just like I said, it it’s just the contract, yeah.

Yeah, you know, our contracts with the different insurance companies that we have in there and the spreadsheets that they you know tell us this is what we pay for the CPT code. Well, or you know, the allowable

Ryan Cohn: seems like a good system that you’ve built out there.

Angela Ary: Yeah, they’ve been they’ve used it. The payor grid’s been around, you know, for for us for years. So even before we went electronic, we s you know, we had a payor grid.

Ryan Cohn: Oh wow.

Angela Ary: And so use it based off of that. But now being on an EMR system, of course it’s easier because we can run numbers so much faster and yeah, get it within five minutes, you know, see the CPT code case costing. So yeah.

Ryan Cohn: That makes sense. So and and so reliable reporting, it depends obviously on accurate documentation. How [00:27:00] do we standardize templates and workflows improve the quality of the data of the surgery center and the data that surgery center can use?

Angela Ary: Yeah, so we we try to have our staff and the way that we run reports and view the reports, we try to be just very consistent across the board. Because being consistent in our documentation from like I always say from registration to discharge, you know, being consistent and you know, making sure that you know our nurses are charting, you know, exactly like like I said, you know, at first we had, you know, just a general list of pre-op supplies that could be needed.

And then come to find out by doing the work and looking at it, you know, deeper that not not every patient needs a band-aid or not every patient, you know, needs this or that, but having more of a base set of supplies, you know, for [00:28:00] every phase, pre op, the OR and then again, you know, in recovery, just being uniform.

Yeah. And, and consistent with our training of our, our staff, you know, when we get new nurses or new physicians. We’ve had a couple of new physicians since we went with the, the EMR system, and so just making sure that they are trained, you know, and, and taught the system in the same way. And so we do. We have a lot of our implementation team that were super users for those departments, are the people that train when they come in, you know, when a new hire comes in.

So it just makes it easier because they’re who trained the original and so they’re training the new and everybody is you know just consistent and uniform across with all workflows.

Ryan Cohn: Yeah. And yeah, it makes sense. I mean, yeah, standardizing that process seems like the only way to really get consistent data across the board. Otherwise, if everyone has their own little way of [00:29:00] doing it, or it was never really taught, this is a step by step, what you need to do, it could, it could start to go a little awry.

Which it sounds like maybe that’s that’s something you guys have maybe trial or trial by fire to some degree I could see by your smile.

Angela Ary: Yes, we definitely, you know, just learned in the process, because that’s really the only way to do it. I will say our implementation team with HST was fantastic. Our trainers were wonderful. Still in contact with several of them today, and that’s been three and a half years ago, and, you know, I know at any point I could reach out and ask my question and they would, you know, get back with me. But until you’re, you know, every, I feel like every specialty is different.

So until you’re in it doing your specialty, like HST can teach you the basics and how to do this and that, you know, kind of for all specialties, this is how it’s done. But then when you really get into it being orthopedic specialty, you know, it was kind of, you know, just trial and error, [00:30:00] you know, learning what was most efficient.

You know, because we don’t want to do anything that you know takes longer. We want to do it, you know, the most accurate that you know in efficient way. So that, you know, our biggest thing is so that we can have more time to spend with our patients.

So even if that’s at check-in, my front desk staff, you know, I’m like, if we can get registration down to a minimal, like you can have you have time to have conversations with these patients. I’m nervous when they come in.

Or you know, you have time if your family member has a question while they’re back in surgery. Like you have that that extra time to spend and not feel rushed. So even you know in pre-op our surgeons feel like they have more time.

And it’s it’s been really good. You know, so we yeah trial and error and you know we’ve learned from a lot of things and been able to help you know other centers with the you know orthopedic based centers based off of you know what we’ve been able to learn from. Oh that’s awesome [00:31:00] in the growing process.

Ryan Cohn: That’s really awesome. Yeah, and that seems like a recurring theme that I’ve been hearing today, is how do we get more, you know, how do we free up our staff’s time so they can spend more time with, with patients and, and making their process smoother and more enjoyable. And I mean, that’s, that’s the beauty of technology, you know, and that’s why it’s so important to be able to have an open mind to adopt and, and learn and, and just try these new systems.

So last question for you. Thank you so much for for being here. And of course, really appreciate you making time.

What’s one thing our listeners can do this week to improve their surgery centers.

Angela Ary: Yeah. So and you kind of touched on it earlier and I was like, oh, that’s that’s my end point. Oh, it’s a good idea.

Yeah. So always, you know, get feedback from your staff. That includes front desk staff to the surgeon.

So, you know, we like to reach out to different departments, you know, and say, you know, if you were able to change something or [00:32:00] or if you see something you think would make the workflow more efficient, let us know. Because, you know, I might know, you know, practice management as well as I, you know, can right now, or eChart or you know, the workflow, but I’m not in it day to day.

I’m not in the OR every day. And you know, I’m not in recovery and you know, just kind of seeing from start to finish, you know, I see an overview of it and how you know it should work, but we’re not doing it every day.

So we like to, you know, get that feedback from the staff. I think that is made, you know, for buy-in from you know, the start by doing that, even to current, because in an ASC facility, it’s changing daily. If it’s not, you know, if it’s, you know, insurances that are changing things or you know, state regulations that [00:33:00] are changing things, or just a change in staff or a change in, you know, workload.

Yeah, you know, going into the fourth quarter, we we’re we’re reaching out to staff and saying, what do you see that we could do better? What do you see? And so I think just having that open communication with the staff that they know they can come to us with ideas.

I I tell my staff all the time, if you think of something that can make this better that I don’t see, please tell me because we’re gonna look at it and we’re gonna you know take it into consideration and you know look at it from all angles because I’m I’m very big believer that yes, it might work for your department, but it might make it difficult on a different department. So we need to see how it’s gonna benefit all departments involved.

Ryan Cohn: Yeah.

Angela Ary: And so by doing that and taking their you know, their input and ideas and opinions on things. Yeah. I just feel like it it just makes our surgery center, you know, we’re a whole team.

We have our different, you know, departments and different, you know, [00:34:00] job titles and different tasks, but it makes it it just makes it for a better work week, better work day, and overall, you know, a better year. Yeah.

Especially, you know, when you see your numbers, it’s you know, it’s good and you get those patient, you know, surveys back where you know, you took care of my mom, or you know, if I wear, you know, our color is like a royal blue, so it’s a CSMO blue, and yeah, we I have children that are and I you know they play sports and so I can come straight from work and have on a CSMO, you know, shirt or scrubs or something, and they’re like, oh, you know, such and such didn’t, you know, my grandmother’s surgery or you know, stuff like that. Y’all took great care of us.

Ryan Cohn: Are you talking about the other other parents?

Angela Ary: Yeah, just you know, yeah, just out in the community and stuff.

Ryan Cohn: Wow.

Angela Ary: It it’s great to to hear that. And so just by, you know, and just being a close, a close team of working together. It really pays off, [00:35:00] you know, in the community and just everywhere by you know, really being supportive and having that that staff communication and feedback and just all of that is it all works together and you see how it benefited the patient.

Ryan Cohn: Yeah, that’s such great advice. Yeah, being able to take care of your, your employees so they can take care of, you know, your staff is, is so important, and it makes them feel heard and, oh yeah, you know, yeah, ultimately just leaves, leads to better happiness. So thank you so much for that advice, Angela. I appreciate you coming on.

Angela Ary: All right, thank you.

Ryan Cohn: Welcome back. Let’s get into this week’s news. First, a major deal in the surgery center industry. On Monday, October 26th, HealthSpan Partners, an affiliate of Bon Secours Mercy Health, announced a definitive agreement to acquire Surgery Partners. It’s an all-cash deal at $23.50 [00:36:00] a share with an enterprise value of about $5.7 billion.

Surgery Partners would become a privately held company and according to the announcement its name, brand and Brentwood Tennessee headquarters are all expected to stay in place. The company operates in 30 states with more than 200 locations that include surgery centers, surgical hospitals, physician practices, and urgent care facilities.

Bon Secours Mercy Health CEO John Starcher said it’s important to grow in ways that allow the system to serve more people in more communities. The deal still needs approval from Surgery Partners shareholders and from regulators but the companies expect it to close in the first quarter of 2027.

For the industry, this is another sign that health systems are choosing to buy into outpatient surgery rather than only compete with it. Ascension completed its $3.9 billion acquisition of AmSurg earlier this year, [00:37:00] and if this deal closes, that’ll be two large multi-state operators that will be held by health systems or their affiliates.

Both deals are priced in the billions, which shows just how much capital health systems are putting behind care moving outside of the hospital. Next, third quarter results from three large operators, HCA, Tenet, and Universal Health Services.

HCA reported on October 27th, same facility admissions rose about 2.7%, and same facility inpatient surgeries declined 1.4%, and outpatient surgeries declined 3.7% compared with the third quarter of last year. In the second quarter, the outpatient decline was 3.4%.

HCA also estimated that a shift in payer mix reduced its pre-tax income by about $400 million in the quarter, and it tied that shift to patients who lost coverage on the health insurance [00:38:00] exchanges. Tenet reported on October 29th in its ambulatory segment that net operating revenue rose about 7.5% and adjusted EBITDA rose 9.1%.

Same facility surgical cases fell 1.5% compared with a decline of about 1.2% in the second quarter. Net revenue per case rose 6.1%, which Tenet attributed to higher acuity and more favorable service mix. And as of September 30th, they had interests in 535 surgery centers and about 25 surgical hospitals.

UHS also reported on its October 28th earnings call, according to Becker’s ASC, that same facility surgeries decreased 0.7%. And CFO Steve Filton described a continued shift to procedures out of hospitals and into other settings, including ASCs and physician offices.

That [00:39:00] figure comes from the call and isn’t in UHS’s written release. Each company defines the same facility differently, so the figures aren’t directly comparable here. Surgical volumes were down at all three companies, including in Tenet’s ambulatory segment, and even so, Tenet’s ambulatory revenue and earnings grew, helped by higher revenue per case.

HCA’s income, meanwhile, was weighed down by payer mix. For surgery centers, the point is that case mix and payer mix can move financial results even when case counts actually don’t. And lastly, new survey data on anesthesia access.

ASCA released results from its third quarter 2026 60-Second Survey on October 16th. It drew in 307 responses from surgery centers in 44 states. And of those respondents, about 67% said that they actually have adequate access to anesthesia providers. [Correction: ASCA’s survey found 76%, not 67%.]

[00:40:00] And ASCA says that that’s the highest share across its four anesthesia surveys that it’s ran. Access differed by staffing model among centers staffed only by anesthesiologists, 88% reported adequate access. And among centers where anesthesiologists supervise CRNAs or anesthesiologist assistants, it was about 72%.

That supervised model is the most common one among respondents. By size, about 85% of small centers with one or two rooms reported adequate access compared with about 70% of centers with five or more rooms. Respondents named limited provider availability at 81% and high provider cost at 66% as barriers to maintaining anesthesia services.

82% use contracted anesthesia rather than employing providers in-house. And of course, the numbers are self-reported [00:41:00] by centers, and ASCA doesn’t define adequate access in the published results, but the results are interesting nonetheless.

And that’s all for this week’s episode. Thanks so much for listening to This Week in Surgery Centers. If you found it at all helpful, please do share it with a colleague. It’s the best way to support the show and help us grow. We’ll see you again next week.