Becker’s Healthcare Podcast – Summary

Guest: Brett Maxfield, MS, CRNA, President & CEO, Maxfield Healthcare Solutions
Host: Francesca Matthews
Date: November 27, 2025
Episode Focus: Trends, challenges, and innovations in ambulatory surgery centers (ASCs) and the broader healthcare landscape.

Episode Overview

This episode features a dynamic and honest conversation between Francesca Matthews and Brett Maxfield, focusing on significant trends impacting ambulatory surgery centers, technological transformation through AI, financial pressures, regulatory shifts, growth strategies, and the essential need for disruption in healthcare. Brett brings his deep experience in clinical, operational, and leadership roles to offer candid insights about the sector’s present challenges and future opportunities.

Key Discussion Points & Insights

1. Brett Maxfield’s Background (00:20–01:59)

• Brett transitioned from clinical anesthesia to founding a consulting firm after facing personal health challenges.
• Currently oversees a multi-specialty surgery center, consults with 400–450 ASCs and practices worldwide, and holds leadership roles in organizations such as Quad A and the Idaho ASC Association.

2. Major Trends in Healthcare & ASCs (02:17–06:14)

• Rising Costs & Shrinking Reimbursement:
  • Post-pandemic, supply costs surged, and have not decreased:

    “I don’t know if the actual expense has stayed that high or if people just realized ... people pay these prices and just kept things high.” (02:31)

  • Reimbursement continues to fall, squeezing margins.
• Anesthesia Workforce Shift:
  • Post-pandemic “non-essential” label spurred many clinicians to leave hospitals and create office-based practices, draining anesthesia staff from hospitals:

    “What they failed to realize ... when those people left the hospital, it also meant they were going to take anesthesia with them.” (03:22)

• AI’s Growing Role:
  • AI is a new, powerful trend with major implications for efficiency and quality:

    “The newest, latest entry into the mix is AI ... going to change things within the ASC realm.” (04:13)

• Expansion of ASC-Appropriate Specialties:
  • Surge in procedures leaving hospitals, including vascular and GYN cases.
• Healthcare Affordability Crisis:
  • Personal premium example shows skyrocketing insurance costs pre- and post-Affordable Care Act:

    “For my family, it jumped from $800 a month to $2,500 a month ... now we’re sitting close to ... $4,000 a month for that same silver-type plan.” (05:32)

  • Result: “The average person making $46,000 a year cannot afford to make a $48,000 a year health insurance payment. It’s ridiculous.” (05:55)

3. Excitement about AI in Healthcare (06:29–08:15)

• Brett is “most excited” about AI’s potential, especially for:
  • Revenue cycle management—addressing inefficient denials/approvals.
  • Real-time quality assurance and data-driven scheduling.

    “The ability to control costs a little bit better within your systems, the ability to really ... have almost immediate input from your quality assurance programs.” (06:55)

  • Matching scheduling times to actual case lengths to minimize wait times and boost efficiency.
• Notes the risk of over-reliance on technology.

4. Technology Adoption & EMR Challenges in ASCs (08:15–09:33)

• Cost-prohibitive EMR systems hinder adoption by smaller and office-based practices.
• Need for affordable, disruptive tech solutions as many providers still lack EMRs.
• Personal dislike for EMRs from an anesthesia provider’s perspective:

  “You want to slow me down and make me inefficient, give me an EMR.” (08:53)

5. Growth Strategies for the Next 12 Months (09:49–12:44)

• Market uncertainty is causing some organizations to rush projects while others hesitate.
• Notable trend: Hospitals acquiring ASCs to align surgeons and keep facilities as ASCs (not HOPDs) to integrate physician investment and loyalty, not just increase billing rates.

  “They’re seeing that as an additional revenue stream ... hospitals have gotten smart and realized ... we can make HOPD. We could generate these hospital rates ... but ... we’re going to alienate these surgeons again ... so ... keeping them just an ASC ... to have an investment mechanism.” (11:04)

• Wry commentary on bribes in certificate of need (CON) processes.

6. Regulatory & Accreditation Developments (12:50–15:46)

• The historic fear of “unregulated” ASCs derailing hospitals did not come true.
• CON processes can be “just a bribe ... not an honest process” (13:12).
• Cites international and state examples—the UAE enforces safety and quality through mandatory accreditation instead of limiting entry.
• Concludes: Accreditation, not barriers, is key to balancing growth and safety in ASCs:

  “When you look at accredited versus non-accredited facilities, your morbidity and mortality drop off pretty significantly.” (15:43)

7. Need for Disruption & Educating Policymakers (15:54–21:44)

• Healthcare desperately needs disruptive forces, with ASCs as an engine for positive change—if done right.
• Policymakers (state legislators) often don’t understand how ASC/hospital reimbursement actually works:

  “It became very clear that they didn’t really know how any of that works.” (16:35)

  • After a short educational conversation, officials asked if the state could mandate cases to ASCs for cost savings—a single conversation could “save hundreds of millions of dollars” for Medicaid and taxpayers (18:51).
• Discussed stark inefficiencies in hospital care compared to ASC efficiency—illustrated with a hysterical “surgeon out to lunch” anecdote (19:29).
• AI could enable benchmarking and sharing best practices among clinicians.
• Reiterates: Ethical administration and supporting staff are crucial for delivering quality, efficient care.

  “Treat your people right ... and they’re going to do their best for you.” (21:12)

• Criticism of healthcare executive compensation and industry greed (21:30):

  “Who, what health insurance CEO really needs to be taking in $350 million a year ... while I don’t.”

Notable Quotes & Memorable Moments

• On Embracing Disruption:

  “Healthcare is in need of disruptors right now. I think that the trend to ASCs, as long as it’s done the right way, is definitely that potential disruptor.” (15:54, Brett)

• On Policy Gaps:

  “... They didn’t really know how any of that works ... they had no idea why it was that ASCs were cheaper. They just thought maybe we charged less, you know, on the goodness of our heart or something, right?” (16:35, Brett)

• On Systemic Inefficiencies:

  “You want to slow me down and make me inefficient, give me an EMR.” (08:53, Brett)

• On Rising Insurance Costs:

  “As soon as the Affordable Care Act ... passed, did anything but make things affordable ... for my family, it jumped from $800 a month to $2,500 a month ... now we’re sitting close to ... $4,000 a month…” (05:32, Brett)

• On Ethical Leadership:

  “Treat your people right ... and they’re gonna do their best for you.” (21:12, Brett)

Timeline of Major Segments

• 00:20 – Brett’s background and multifaceted career
• 02:17 – Top 3 trends in ASCs: Costs, anesthesia workforce, AI
• 06:29 – Enthusiasm for AI’s efficiencies & caveats
• 08:15 – Challenges of tech/EMR adoption in ASCs
• 09:49 – Approaches and hesitancy to growth in the next year
• 12:50 – Regulatory landscape, CON and accreditation
• 15:54 – Need for disruption and what policymakers misunderstand
• 19:29 – Anecdote: hospital inefficiency versus ASC
• 21:12 – Ethics and leadership in healthcare organizations

Conclusion

Brett Maxfield delivers an unfiltered, insightful analysis of the ASC space, highlighting the intersection of financial pressure, innovation, and regulatory oversight. He champions technological disruption—led by AI—for efficiency and quality, but remains clear-eyed about ethics and leadership. His stories and candor offer a fresh look at current and future challenges for outpatient surgery and healthcare more broadly. Perfect for listeners seeking a pragmatic, hopeful, and often humorous take on healthcare’s most pressing issues.