Podcast Summary: Becker’s Healthcare Podcast

Guest: Greg Schooler, COO – Cincinnati GI, CGI Anesthesia Associates, Anderson Endoscopy Center, LLC
Host: Grace Lynn Keller (Becker's Healthcare)
Date: November 16, 2025
Event: 31st Annual Business & Operations of ASCs

Episode Overview

This episode features Greg Schooler, a veteran leader in ambulatory surgery centers (ASCs), discussing the rapid growth and transformation of the ASC market in the U.S. Schooler shares his unique perspectives from 35+ years in medical and operational management, shedding light on significant trends, technology integration, business strategies, partnerships, and the crucial role of staff retention and culture.

Key Discussion Points & Insights

1. Greg Schooler’s Background & Experience

• Schooler recounts his extensive career building, operating, and advising various ASCs across specialties such as eye, GI, pain, and neurosurgery (01:00).
• Experience spans private equity, nephrology group roll-ups, and medical management of large multidisciplinary groups — nearly 35 years in leadership roles.

2. ASC Market Growth and Industry Trends

• The U.S. ASC market is projected to reach $60.8 billion by 2030, with ongoing strong growth (01:52).
• Key Growth Drivers:
  • Insurance Incentives: Insurers promote ASCs due to cost effectiveness and comparable/better quality. Example: United Healthcare waives pre-certifications for ASC procedures (02:14).
  • Payment Disparities: Hospitals often receive 2-3x reimbursement rates over ASCs for the same procedures due to lack of price parity, providing a financial edge for ASCs currently (02:30).
  • Independence Challenge: Schooler warns that the primary risk for ASCs is being acquired by hospitals or private equity, reducing independence (02:53).

“The challenge for ASCs… is to avoid being gobbled up… by a hospital or by a private equity firm.”
— Greg Schooler (02:53)

3. Technology Integration: The Role of AI and Advanced EHRs

• Early Adoption: Anderson Endoscopy was first in Cincinnati to use AI-enhanced colonoscopy (GI Genius by Medtronic) (03:35).
• AI Charting: Use of AI for chart notes boosts efficiency and billing accuracy, especially helpful for mid-level providers (03:51).
  • AI integrates spoken interaction with charting, suggesting accurate codes (E&M, ICD-10), improving revenue cycle and reducing administrative burden.
• Equipment Innovations: Ongoing scope and imaging improvements in GI enhance quality of care (04:18).
• Transformative Innovation: Schooler believes AI is the most transformative current tech, especially for aiding less-experienced physicians in adenoma detection (ADR) (05:04).

“You can walk in the room… talk to the patient. It’ll take all that information… integrate all that into a chart note… It really saves a lot of time because it does a very good job of doing that.”
— Greg Schooler (03:44)

4. Evaluating Collaboration and Joint Ventures

• Skepticism Toward Partnerships: Schooler is wary of formal collaborations or sell-outs to hospitals/PE, citing higher per-capita costs when market penetration of hospital or PE-owned ASCs is high (06:24).
  • Independence Recommended: He advocates for maintaining independence unless organizational circumstances (aging physicians, need to monetize a thriving center) warrant a sale.
• Types of Collaboration: While not averse to strategic relationships:
  • Participation in PHOs and ACOs brings thousands of covered patients and offloads regulatory burden (07:20).
  • Warns that selling majority ownership risks governance and cultural mismatch (07:47).
• Operational Efficiency: Schooler recalls bringing hospital nurses to his center and highlighting superior efficiency and culture in independent ASCs, as opposed to hospital-based centers (08:13).
• Quality Outcomes: Anderson Endoscopy has been ranked Ohio’s top quality center by Newsweek/Statista for four years, buoyed by high case volumes and excellent results (08:51).

“Our efficiency is pretty amazing in a private center… The more you do, the better you do. That’s true in almost any specialty.”
— Greg Schooler (08:35)

5. Staffing & Culture: Keys to Success

• People Matter Most: The enduring lesson for Schooler is that the quality of staff—nurses, CRNAs, physicians—determines a center’s value and success (09:11).
• Retention & Fit: He illustrates with a story of turning down a free center with $300k and equipment because it lacked quality doctors, emphasizing that skilled, dedicated personnel are the real asset (09:39).

“The key to all the success… is the employees you have working there. Your nurses, your anesthetists. … That is the key.”
— Greg Schooler (09:11)

Notable Quotes & Memorable Moments

• “There's no price parity right now… most of the hospitals… are probably bringing in two to three times the money that we get paid for the equivalent procedure.” (02:30)
• “I think the challenge for ASCs going down the road is to avoid being gobbled up… by a hospital or by a private equity firm.” (02:53)
• “If you have a center with… a profile of physicians throughout their career… I think there’s plenty of things you can do to keep that center independent.” (07:15)
• “The key to success is having great employees and creating an [environment] so those people will be recruited and retained.” (10:00)

Timestamps of Important Segments

• 01:00 – Schooler’s background and ASC experience
• 01:52 – State of the ASC market & drivers of growth
• 03:35 – Early adoption of AI and tech in GI & administrative operations
• 05:04 – The transformative impact of AI in clinical practice
• 06:24 – Perspectives on independence vs. collaboration/joint ventures
• 08:13 – Case study: efficiency culture in private vs. hospital settings
• 09:11 – Staff and culture as ultimate value drivers
• 09:39 – Memorable story: why staff trump facilities

Takeaways

• The ASC market is thriving due to payer-driven cost containment, but risks consolidation.
• Technological adoption (AI, EHRs, advanced instrumentation) is non-negotiable for efficiency and quality.
• Independence remains viable—and often preferable—with the right mix of staff and strategy.
• Staff culture, retention, and efficiency are enduring determinants of ASC value and success.

This episode will be especially useful for ASC leaders, healthcare entrepreneurs, and anyone interested in the operational realities and future trends of outpatient surgery.