Ashley Hilliard, MBA, MSN, RN, CPAN, Administrator of Piedmont Outpatient Surgery Center

Summary

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Becker’s Healthcare Podcast — Episode Summary

Episode Title:
Ashley Hilliard, MBA, MSN, RN, CPAN, Administrator of Piedmont Outpatient Surgery Center

Air Date:
September 15, 2025

Host:
Francesca Matthews

Guest:
Ashley Hilliard, MBA, MSN, RN, CPAN

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Overview

In this episode of Becker’s Healthcare Podcast, host Francesca Matthews interviews Ashley Hilliard, Administrator of Piedmont Outpatient Surgery Center in Winston Salem, North Carolina. The conversation centers on current trends shaping ambulatory surgery centers (ASCs), key regulatory changes, strategic adaptations, and Ashley’s outlook on industry opportunities and challenges.

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Key Discussion Points & Insights

Introduction & Background (00:00–00:37)

• Ashley Hilliard introduces herself, highlighting her 23 years as an RN, 4 years as an ASC administrator, and her dual master's degrees in Nursing Leadership and Business Administration.

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Top Three Trends in Healthcare and ASCs (00:37–01:50)

Ashley’s Top Trends:

1. Increased Procedure Codes on the ASC List

   • "First, I'm anxious to see how the new procedure codes added to the ASC list is going to work out. We're seeing that more complex cases can be safely done in the ASC setting." (00:56)
   • This trend potentially increases ASC volume and complexity.

2. Impact on Reimbursement

   • "With more procedures able to be done in the ASC, I'm really watching to see if reimbursements are going to change when we add more complex cases. There's going to be an increased cost, and we need to make sure that our reimbursement reflects this." (01:10)
   • Concern about aligning reimbursements with increased operational costs.

3. Physician Alignment and Referral Patterns

   • "With the shift to the ASD for care, my question is how will physicians that are employed by hospital react? Often it's easier and quicker to get a case on at the ASC. But will the hospitals want those employee physicians to utilize an ASC? So that's going to be kind of something to watch..." (01:25)
   • Focus on evolving relationships between hospitals, physicians, and ASCs as more procedures migrate out of the hospital environment.

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Excitement and Cautious Optimism About New Procedures (02:11–02:28)

• Ashley: "Really, just the addition of more procedures that really excites me. It's gonna open up a lot of doors that we can fill our rooms. So I'm really cautiously excited right now because there's still a lot to think about when it comes to that."
  • Emphasizes a "double-edged sword": opportunity to expand services, but challenges with scaling up safely and efficiently.
• Host Francesca echoes widespread industry sentiment: "That kind of double edged sword response from a lot of leaders..."

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Approaches to Growth and Planning Ahead (02:47–03:26)

• Ashley describes current strategies for expansion:
  • "So right now I run a single specialty ASC here in North Carolina and at the end of the year our certificate of need laws are changing. So I'm looking to see how this is going to benefit us and allow us to grow naturally." (02:47)
  • Announcement of additional physician positions joining soon, setting the stage for growth in the coming year.
  • "We've also added two new positions coming on board later this month and then another next year. So we have plenty of growth in our future." (03:03)

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Regulatory Change: Certificate of Need (CON) Laws (03:11–03:45)

• Francesca requests clarification on North Carolina’s legislative changes.
• Ashley: "After the end of the year, starting January 1st, the laws of the certificate need is going to go away in North Carolina. So us being a single specialty surgery center, it opens us up to being maybe a multi specialty ASC. So that's something we're going to have to look at and really see if that's in our plans." (03:26)
  • Anticipates significant operational and strategic opportunities as regulatory barriers are lifted.

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Notable Quotes & Memorable Moments

• “I'm anxious to see how the new procedure codes added to the ASC list is going to work out. We're seeing that more complex cases can be safely done in the ASC setting.” — Ashley Hilliard (00:56)
• “There's going to be an increased cost, and we need to make sure that our reimbursement reflects this.” — Ashley Hilliard (01:12)
• “Will the hospitals want those employee physicians to utilize an ASC? So that's going to be kind of something to watch as well as more comes out of the hospital and into the ASC world.” — Ashley Hilliard (01:31)
• "I'm really cautiously excited right now because there's still a lot to think about when it comes to that." — Ashley Hilliard (02:17)
• “Starting January 1st, the laws of the certificate need is going to go away in North Carolina. ...It opens us up to being maybe a multi specialty asc.” — Ashley Hilliard (03:26)

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Timeline of Key Segments

• 00:00–00:37: Introduction & Ashley’s background
• 00:37–01:50: Top three trends in ASCs and healthcare
• 01:50–02:28: Excitement and concerns surrounding expanded ASC procedure lists
• 02:47–03:26: Planning for growth and hiring
• 03:26–03:45: North Carolina’s Certificate of Need law changes and their implications

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Tone and Language

The conversation maintains a professional, optimistic, and candid tone throughout, blending industry analysis with real-world administrative concerns. Ashley approaches each topic with practical insight, balanced anticipation, and an openness to change, providing a valuable peer perspective for other healthcare leaders.

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This summary was designed to offer an engaging and comprehensive look at this episode for listeners and healthcare professionals interested in the evolving ASC landscape.

Transcript

[A]

Hello, this is Francesca Matthews with the Beckers ASC Review podcast. I'm thrilled to be joined today by Ashley Hilliard, mba, msn, rn, cpan, the administrator of Piedmont Outpatient Surgery Center. Ashley, thank you so much for being here today.

[B]

Thanks for having me on the podcast. As you said, my name is Ashley. I'm currently the administrator at Piedmont Outpatient Surgery Center. We are located in Winston Salem, N.C. i've been an administrator for about four years, RN for 23 years, and as you mentioned, I hold a master's degree in Nursing leadership as well as an mba.

[A]

Excellent. Yeah. Thank you so much for joining us again and thank you for that introduction. Just kind of moving forward here in our discussion. As an administrator and somebody with a lot of experience in medicine, what are the top three trends you're following in healthcare and ASCS today?

[B]

Well, first, I'm anxious to see how the new procedure codes added to the ASC list is going to work out. We're seeing that more complex cases can be safely done in the ASC setting. So it's going to be interesting to see how this increases in volume. Second, with more procedures able to be done in the asc, I'm really watching to see if reimbursements are going to change when we add more complex cases. There's going to be an increased cost, and we need to make sure that our reimbursement reflects this. And then finally, with the shift to the ASD for care, my question is how will physicians that are employed by hospital react? Often it's easier and quicker to get a case on at the asc. But will the hospitals want those employee physicians to utilize an asc? So that's going to be kind of something to watch as well as more comes out of the hospital and into the ASC world.

[A]

Absolutely. That's all really interesting and kind of falls in line with conversations I've been having with ASC leaders over the last few weeks, especially just everything related to, you know, procedure migration and the recent CMS updates. So, yeah, that's definitely resonating with our, with our audience there. And what are you most excited about right now in healthcare and ASCs?

[B]

Really, just the addition of more procedures that really excites me. It's gonna open up a lot of doors that we can fill our rooms. So I'm really cautiously excited right now because there's still a lot to think about when it comes to that. So I'm excited about more cases, but cautiously excited, definitely.

[A]

And again, just been hearing, I think that kind of Double edged sword response from a lot of leaders. You know, it's again very exciting for there to be so many procedures added to the list, but it'll mean sort of scaling up and you know, being prepared for all that as a healthcare leader. And then how are you thinking about growth over the next 12 months?

[B]

So right now I run a single specialty ASC here in North Carolina and at the end of the year our certificate of need laws are changing. So I'm looking to see how this is going to benefit us and allow us to grow naturally. In addition to that, we've also added two new positions coming on board later this month and then another next year. So we have plenty of growth in our future.

[A]

Yeah, absolutely. And just a little more I'm curious on the CO N laws, something I read about a lot here at Beckers. Could you elaborate maybe just a little bit more on the change in laws and what expectations you might have if you have any yet.

[B]

So really after the end of the year, starting January 1st, the laws of the certificate need is going to go away in North Carolina. So us being a single specialty surgery center, it opens us up to being maybe a multi specialty asc. So that's something we're going to have to look at and really see if that's in our plans.

[A]

Absolutely, yeah. Now there's try to keep everyone updated. I know there's a number of states with kind of fluctuating certificate of need laws this year, so a lot of people are in a similar position. That is actually all I have for you today. Ashley, thank you so much for joining us. It's been a pleasure speaking with you and I look forward to connecting with you again in the future.

[B]

Thank you so much for having me.