Becker's Healthcare Podcast: Breaking Barriers in Health System ASC Development

Date: November 18, 2025
Host: Erica Spicer Mason (Becker’s Healthcare)
Guests: Erin Mirsky & Cordell Mack (Managing Directors, VMG Health)

Episode Overview

This episode delves into the rapidly evolving landscape of Ambulatory Surgery Center (ASC) development within U.S. health systems. Erica Spicer Mason is joined by Erin Mirsky and Cordell Mack, managing directors at VMG Health, who bring decades of combined experience in consulting, valuation, and transaction advisory. Together, they explore the drivers behind accelerated ASC growth, highlight key barriers and opportunities for health systems, and offer strategic recommendations for successful ASC expansion and partnership. The guests also provide forward-looking insights on future trends, physician alignment, and the importance of local-market nuance in ASC strategy.

Key Discussion Points & Insights

1. Backgrounds and Experience

• Cordell Mack: 23 years in healthcare consulting, former physical therapist, extensive view on evolving care models, expertise in ambulatory strategies ([00:44–01:31]).
• Erin Mirsky: 20 years in transaction advisory/valuation for health systems, investors, and operators; deep involvement across healthcare verticals with a focus on compliance, business valuation, and strategic planning ([01:50–03:07]).

2. Driving Forces Behind ASC Growth

• Technology and Patient Comfort: Advances enable higher-acuity procedures outside hospitals; COVID-19 accelerated this trend ([03:47–04:17]).
• Policy and Regulatory Shifts:
  • Medicare changes, site-neutral payment proposals, the inpatient-only rule are moving more procedures out of traditional hospital settings ([04:20–05:18]).
  • “Policy is continually pushing more cases outside of the hospital to ASCs.” — Cordell Mack [04:32]
• State-Level Reforms: Relaxation of Certificate of Need (CON) laws in some states opens opportunities for ASC development ([05:30–05:51]).
• Payer Dynamics: Insurers increasingly require certain procedures (e.g., colonoscopies) to be done in ASCs through stricter pre-authorization ([05:10–05:31]).
• Physician and Patient Preferences:
  • Easier access, parking, faster perioperative experience draw patients and physicians to ASC environments ([05:52–06:24]).
  • “There’s a lot of factors that are driving why physicians also want to access care in an ASC setting.” — Cordell Mack [06:18]
• Private Equity and Competition: Rapid entry and expansion by private equity-backed platforms and management companies increase competitive pressures ([07:05–07:38]).
• Physician Alignment: ASCs naturally align the incentives of payers, patients, health systems, and physicians ([08:41–08:56]).

3. Barriers to Successful ASC Development

• Regulatory Complexity and Inertia: Varies by state and federal policy shifts ([06:48–07:03]).
• Market Dynamics: Competition rising due to new entrants, PE-backed platforms, and shifting state policies ([07:05–07:51]).
• Physician Alignment Complexity: Fluctuates based on employment models, practice lifecycles, and organizational readiness ([08:57–09:44]).
• Legacy Structures: Established health system schedules, compensation models, and need for careful, phased disruption to core operations ([15:39–17:30]).
• “Healthcare remains local… ASC distribution or ASC development is very uneven.”
  — Cordell Mack [18:16]

4. Strategic Guidance for Health System Leaders

• Clarity on Objectives:
  • Define the scope and ambition (single-site vs. multi-state strategies) before structuring partnerships or acquisitions ([09:47–10:30]).
  • “Getting those things defined and some clarity around them is a really good first step to figuring out exactly what you need…” — Erin Mirsky [10:15]
• Assess Current Capabilities:
  • Inventory ambulatory and procedural business, understand site-neutral volumes primed for migration ([11:31–12:16]).
  • “Organize all the deck chairs to really, really know your market, understand the volumes… and then be really honest about what competencies you have or don’t have.” — Cordell Mack [13:55]
• Partnership and Joint Venture Readiness:
  • Evaluate internal decision-making agility, partner responsiveness, and enterprise competence ([12:32–13:58]).
  • Consider existing employed physician relationships and how new ASC ventures may redefine or complement those ties ([13:59–14:53]).
• Market-by-Market Approach:
  • “There’s really not a one size fits all. Being very intentional about your approach will pay off in the long run.” — Cordell Mack [19:11]

5. Practical Examples of Success

• Prioritization and Phased Expansion:
  • Successful systems expand first into adjacent geographies, minimizing disruption to existing operations and gradually building trust with core physician groups ([15:39–17:30]).
  • “Getting some wins and starting these new businesses was really important in building trust with physicians.” — Erin Mirsky [16:55]

6. Future Trends and Proactive Steps

• Subspecialty Focus:
  • Growth of single-specialty centers for areas such as total joints, spine, and cardiac electrophysiology ([20:10–20:39]).
  • “We’re going to continue to see more subspecialty focus inside the ASC space.” — Cordell Mack [20:12]
• Reimbursement and Managed Care Strategy:
  • The disconnect between hospital and ASC reimbursement may drive more careful managed-care negotiating and value-based planning ([21:03–21:41]).
• Workforce Shortages & Physician Syndication:
  • Increasing use of ASC ownership opportunities to attract and align employed physicians amid talent shortages ([22:15–23:08]).
• Execution and Adaptation:
  • Key challenge will be rapid, market-specific execution, especially aligning with strong physician partners ([23:14–24:34]).
• “There’s certainly a lot of tailwinds… it’s really going to come down to execution on how do you align with the right physician partners.” — Erin Mirsky [24:10]

Memorable Quotes

• Cordell Mack [04:32]:
  “Policy is continually pushing more cases outside of the hospital to ASCs.”
• Erin Mirsky [08:50]:
  “The ASC models are really good at aligning interests of payers, patients, health systems and physicians. So all the stakeholders really win in the ASC environment.”
• Cordell Mack [13:55]:
  “Organize all the deck chairs to really, really know your market, understand the volumes… and then be really honest with yourself about what competencies you have or don’t have.”
• Erin Mirsky [16:55]:
  “Getting some wins and starting these new businesses was really important in building trust with the physicians.”
• Cordell Mack [19:11]:
  “There’s really not a one size fits all. Being very intentional about your approach will pay off in the long run as compared to making short-term, opportunistic decisions.”
• Cordell Mack [20:12]:
  “We’re going to continue to see more subspecialty focus inside the ASC space.”
• Erin Mirsky [24:10]:
  “There’s certainly a lot of tailwinds… it’s really going to come down to execution on how do you align with the right physician partners and the right institutional partners to deliver on an ASC strategy.”

Timestamps for Key Segments

• Introductions and Guest Backgrounds: 00:00–03:07
• Forces Driving ASC Expansion: 03:47–08:56
• Barriers and Competitive Dynamics: 06:47–09:44
• Advice for New ASC Initiatives: 09:45–14:53
• Case Study of ASC Development: 15:39–17:30
• Local Market Nuance and Customization: 18:16–19:40
• Future Trends and Strategic Recommendations: 20:10–24:34

Conclusion

This episode provides a rich, pragmatic roadmap for health systems navigating the complexity of ASC development in today’s climate. Success requires clarity of vision, nimble execution, alignment with key clinical stakeholders, and relentless attention to local-market context. Disruption is accelerating via policy, technology, investor interest, and evolving patient/physician preferences, making now a defining period for ASC strategy in U.S. healthcare.