Podcast Episode Summary

Podcast: Becker’s Healthcare Podcast
Episode: Janet L. Carlson, MSN, BSN, RN, NE-BC, FACHE, Vice President of ASC Operations at Commonwealth Pain & Spine | Advanced Surgical Institute
Date: November 22, 2025
Host: Francesca Matthews
Guest: Janet L. Carlson

Episode Overview

This episode features Janet L. Carlson, a seasoned leader in ambulatory surgery center (ASC) operations, discussing the latest trends shaping ASC management and growth. Janet shares her insights on the integration of AI, the shift in case acuity towards ASCs, strategies for community-focused expansion, and impending regulatory changes. She also highlights the evolving relationship between ASCs and anesthesia providers, emphasizing a patient-centered approach and new mandates around patient satisfaction.

Key Discussion Points & Insights

Janet’s Background and Role (00:20–01:15)

• Janet has been involved in all aspects of ASC operations since the early 2000s.
• Currently oversees the design, scaling, and operation of ASCs for Commonwealth Pain & Spine, operating under the Advanced Surgical Institute brand.
• Actively engaged in the development of four new ASCs across three states.

Top 3 Trends Impacting ASCs (01:29–04:47)

1. Artificial Intelligence in Healthcare

• AI as an adjunct technology is becoming increasingly essential.
  • Example: Automated call systems with AI improve patient communication and streamline responses.
    Quote:
    “Having an automated call system with an integrated AI feature that will help be responsive to patient calls…keep that communication going with patients…” (01:38 – Janet)
  • AI-driven EHR charting templates assist in reducing manual workload and improving case throughput.

2. Higher Acuity Cases Moving Into ASCs

• There’s a notable migration of complex procedures from hospitals to the ASC setting.
  • Historically began with total joint surgeries and spine cases; now expanding to cardiovascular, peripheral vascular, and interventional radiology.
  • Investment in advanced surgical technology, e.g., the da Vinci robot, allows ASCs to offer more precise, minimally invasive procedures.
  • Patients benefit from same-day discharge in a concierge-style setting.

3. Payer Trends and Revenue Cycle Management

• Ongoing need to navigate contract negotiations and ensure appropriate compensation.
  • AI is highlighted as a tool for proactive claims management from the moment a case is scheduled.
  • Quote:
    “Providers should be paid for the work and the care that they take care of these patients. And so making sure that you're getting paid for the actual services that you've done is key to your bottom line.” (04:23 – Janet)

Current Excitement: ASC Awareness and Capacity (04:59–06:28)

• Increased national awareness of ASCs, especially following the pandemic, has demonstrated their critical role in healthcare delivery.
• ASCs helped alleviate hospital capacity during COVID-19 by handling appropriate cases.
• This shift permits hospitals to concentrate on the sickest and most complex patients.

Quote:
“One of the silver linings of COVID was that many people learned overnight that there are 6,000 smaller independent hospital-like structures that are… able to decompress the big hospitals during COVID.” (05:06 – Janet)

Collaboration with Hospitals & Evolving Market Dynamics (06:37–07:16)

• The relationship between ASCs and hospitals should be viewed as complementary, not competitive.
  • The concept of “site neutrality” is discussed regarding payment systems.
  • The list of procedures eligible for ASC settings is expanding rapidly.

Quote:
“There are so many things and that list is expanding every day over who we can take care of in the ASC. And that's really what I'm excited about.” (07:10 – Janet)

ASC Market Growth and Strategic Expansion (07:50–10:05)

• Focused on expanding services into underserved, rural communities, reducing the need for patients to travel long distances.
• Strategic approach: establish clinics, develop referral networks, and then support ASCs where multiple clinics exist.
• Regulatory environment varies: working across both CON (Certificate of Need) and non-CON states.
  • Anticipates CON law amendments in some states, which will relax restrictions and allow ASCs to become truly multi-specialty, benefiting independent surgeons seeking operating time.

Quote:
“This is going to allow ASCs to be truly multi-specialty and meet the needs of the community and offer these independent surgeons a place to do cases.” (09:17 – Janet)

Emerging Priorities: Anesthesia Partnerships & Patient Outcomes (10:15–12:38)

• Growing importance of anesthesia as a partner in optimizing patients preoperatively and supporting post-op recovery.
  • Elective procedures allow for patient optimization, enhancing outcomes and satisfaction.
• 2025 will require ASCs to collect and report patient satisfaction scores publicly for the first time.
  • ASCs are prepared to showcase consistently high satisfaction rates.

Quote:
“ASCs routinely have very, very high patient satisfaction scores. And I think this is an opportunity for the ASC community to show off those numbers and the experience that we provide.” (11:40 – Janet)

The Evolving Role of Anesthesia (11:54–12:18)

• Discussion about the increasing use of the term “perioperative home,” reflecting anesthesia providers guiding patients through both the pre-op and post-op stages.

Quote:
“They’re an integral part of the whole patient experience and really contribute to the patient optimization preoperatively as well as to the outcomes postoperatively…” (12:18 – Janet)

Notable Quotes & Memorable Moments

• “Having an automated call system with an integrated AI feature… I think AI is something that we're just going to see more increased use of in the space…” (01:38 – Janet)
• “We're creating capacity so that they [hospitals] can truly focus on the sicker patients…” (06:16 – Janet)
• “There's plenty of room for everyone in the market.” (07:16 – Francesca)
• “ASCs are the perfect solution for those surgeons who are looking for a home and looking for guaranteed block time…” (09:45 – Janet)
• “Patient satisfaction—collecting and reporting the scores is a new requirement for 2025…” (11:24 – Janet)

Timestamps for Key Segments

• (00:20) Janet introduces her background & current role
• (01:29) Top 3 trends in healthcare & ASCs (AI, acuity shift, payer trends)
• (04:59) Janet discusses what excites her most: ASC awareness & capacity
• (07:50) Strategic ASC expansion and growth plans
• (10:15) Future priorities: anesthesia collaboration, patient optimization, new satisfaction requirements
• (11:54) The “perioperative home” concept and anesthesiology’s evolving role

Conclusion

Janet Carlson’s perspective underscores how ASCs are at the forefront of several major healthcare shifts: technology adoption, regulatory evolution, diversification of procedures, and a laser focus on patient outcomes and satisfaction. This episode provides tangible examples and a vision for ASCs as essential, community-serving resources, ready to take on a growing range of cases with the help of cross-disciplinary partnerships and technology-driven efficiencies.