Michael Gale, Administrative Director at Sentara Obici Ambulatory Surgical Center

Summary

Summary of Becker’s Healthcare Podcast Episode: Michael Gale, Administrative Director at Sentara Obici Ambulatory Surgical Center

Podcast Title: Becker’s Healthcare Podcast
Host: Francesca Matthews
Guest: Michael Gale, Administrative Director at Sentara Obici Ambulatory Surgical Center
Release Date: July 26, 2025

---

Introduction

Francesca Matthews welcomes Michael Gale, the Administrative Director at Sentara Obici Ambulatory Surgical Center (ASC), to the Becker’s ASC Review podcast. Michael provides an overview of his extensive background in healthcare administration, highlighting his transition from California to Virginia and his diverse experiences across various healthcare settings.

Notable Quote:

"I was recruited here to Virginia from California about three years ago... It's a $13 billion company and growing and it's a multi-specialty ASC." (00:21)

---

Michael Gale’s Background

Michael Gale details his professional journey, emphasizing his role at Sentara Obici ASC and his previous positions, including running Endovascular Ambulatory Surgery Corporation and serving as a dialysis executive in Bakersfield, California. His expertise spans revenue cycle management, hospitals, ambulatory care environments, and large physician-owned practices.

Notable Quote:

"Before that, I've been at the C-suite level at various healthcare corporations... So it's been varied." (00:21)

---

Top Three Trends in Healthcare ASCs

Michael identifies three primary trends shaping the landscape of Ambulatory Surgical Centers:

1. Migration of Hospital-Based Procedures to ASCs:

   • Driven by CMS incentives, there is a significant shift of low to moderate acuity surgical procedures, such as total joint replacements, from hospitals to ASCs.
   • Higher acuity cases, like spine surgeries, are also increasingly being accommodated in ASCs.

   Notable Quote:

   "The migration of hospital-based surgical procedures to ASC is a big deal. It's being pushed by CMS." (01:59)

2. Cost of Anesthesia Services:

   • Managing anesthesia contracts and costs remains a critical factor for ASCs.
   • Efficient handling of anesthesia services contributes to the overall profitability of surgical centers.

   Notable Quote:

   "The cost of anesthesia services, anesthesia contracts with anesthesia companies, contracts with them." (01:59)

3. Total Joints as a Profit Opportunity:

   • Total joint procedures, including knees, shoulders, and upcoming hip surgeries, offer substantial profit margins without the need for extended hospital stays.
   • Capital investment in equipment is necessary but offset by the favorable margins.

   Notable Quote:

   "Total joints are a great profit. They have great profit margins. Right now I do total joints, knees and shoulders. And I'm going to start to do hips this year." (02:50)

---

Growth Prospects Over the Next 12 Months

Michael discusses the anticipated growth areas for Sentara Obici ASC:

1. Expansion in Endovascular Services:

   • Managing peripheral arterial disease through interventional radiology and vascular surgery.
   • Procedures such as stenting, balloon angioplasty, and atherectomy are becoming more prevalent in ASCs.

   Notable Quote:

   "The treatment of peripheral arterial disease... is still a good prospect." (06:07)

2. Integration of AI and Predictive Analytics:

   • Leveraging large datasets to enhance administrative workflows and clinical outcomes.
   • Predictive analytics can significantly improve patient care and operational efficiency.

   Notable Quote:

   "AI enhancements to things like administrative workflow... is something to be excited about to help accommodate growth here." (06:07)

3. Diversification into Neuro and Spine Cases:

   • Increasing the number of spine-related surgical procedures classified under orthopedic cases.
   • Maintaining growth in OBGYN and podiatry, which offer low overhead and good reimbursement.

   Notable Quote:

   "Some of the best margins that I have right now are neuro... technically, I think they're classified as ortho cases." (06:07)

---

Obstacles to Growth

Michael highlights several challenges that ASCs face in their expansion efforts:

1. Regulatory Hurdles:

   • Operating in states with Certificate of Need (CON) requirements complicates the approval and establishment of new ORs and procedure rooms.
   • The political and competitive nature of CON processes can delay growth plans.

   Notable Quote:

   "Having to get acquainted with [CON]... it can be quite political too." (06:07)

2. Physician Recruitment and Ownership:

   • The trend of physicians joining hospital systems reduces the pool of independent surgeons who can own and operate ASCs.
   • Legal barriers may prevent employed physicians from becoming owners, limiting ASC leadership opportunities.

   Notable Quote:

   "More physician surgeons are joining hospital systems... there are a limited number of independent physician surgeons to become owners." (10:25)

3. Market Saturation and Competition:

   • In densely populated areas, a limited number of ASCs can operate, leading to intense competition for approved ORs.
   • Navigating local market dynamics is essential for successful expansion.

   Notable Quote:

   "They’re all fighting for that number of approved ORs in that space." (06:07)

---

Enhancing Patient Experience

Michael emphasizes the importance of patient-centric approaches in ASCs:

1. Post-Operative Care and Education:

   • Effective patient education and support services, such as home health and physical therapy, are crucial for successful recovery.
   • Immediate ambulation and personalized discharge plans improve clinical outcomes.

   Notable Quote:

   "Some ASCs have allow for overnight stays... but in most circumstances with total joints, that's actually not necessary." (04:30)

2. Personalized Care and Concierge Services:

   • Operating ASCs with dedicated programs for specific procedures ensures that patients receive tailored attention.
   • Creating a welcoming and supportive environment reduces the intimidation associated with surgery.

   Notable Quote:

   "They feel that we're where we have a different kind of accommodation for what they're going through." (12:03)

3. Zero Day Stays:

   • Promoting same-day discharge enhances patient convenience and satisfaction.
   • Reducing the need for overnight stays minimizes patient disruption and streamlines operations.

   Notable Quote:

   "ASCs reduce the number or increase the number of zero day stays, which is a good thing for patients." (12:03)

---

Impact of CMS Policies and Future Outlook

The conversation touches upon the influence of CMS policies on ASC operations:

• CMS Incentives:

  • Policies encouraging the migration of higher acuity cases to ASCs create a favorable environment for expansion.
  • Inclusion of more procedures in the ASC-eligible list broadens the scope of services offered.

  Notable Quote:

  "The motivation of CMS to incentivize hospitals, inpatient facilities to move higher acuity cases over to the ASC side is a very exciting environment." (05:53)

• Technological Advancements:

  • Adoption of AI and machine learning in administrative and clinical processes promises enhanced efficiency and better patient outcomes.
  • Predictive analytics based on large datasets can revolutionize how ASCs manage patient care and operations.

  Notable Quote:

  "The large language models do and the predictive analytics need exceptionally large data sets... to accomplish what everybody's hoping for a positive impact on curative medicine." (04:37)

---

Conclusion

Michael Gale concludes by reiterating the tangible benefits ASCs offer to patients through improved convenience, personalized care, and efficient surgical procedures. He underscores the importance of maintaining high standards of customer service and adapting to the evolving healthcare landscape to ensure continued growth and patient satisfaction.

Notable Quote:

"We have to keep up with our customer service at an ASC and not treat it like it's an assembly line... it's not a cookie cutter environment anymore." (15:07)

Francesca Matthews thanks Michael for his insightful discussion, highlighting the dynamic nature of ASCs and their critical role in modern healthcare.

---

This episode offers valuable insights into the operational strategies, growth opportunities, and challenges facing Ambulatory Surgical Centers today. Michael Gale’s expertise sheds light on the evolving trends and underscores the importance of adaptability and patient-focused care in the healthcare industry.

Transcript

[A]

Hello, this is Francesca Matthews with the Beckers ASC Review podcast. I'm thrilled to be joined today by Michael Gale, Administrative director at the Centauro Obichi Ambulatory Surgical Center. Michael, thank you so much for being here today.

[B]

Thank you for having me.

[A]

To start off, could you please introduce yourself and tell us a little bit about your background?

[B]

Sure. Well, I'm a healthcare executive. I was recruited here to Virginia from California about three years ago. From Endovascular. I ran Endovascular Ambulatory Surgery Corporation and Sentara Obici is how it's pronounced. Santera, obviously. Hospital is where our ASC is on the campus of. There are eight other ASCs in my region, my Sentara region. It's a $13 billion company and growing and it's a multi specialty ASC. It's different from Endovascular. I have a lot of expertise in that field. Endovascular billing and coding can be quite complicated. So coming into a multi specialty environment was quite a variety of knowledge for me. So it's been very interesting. Before that I've been at the C suite level at various healthcare corporations, revenue cycle management, hospitals, of course, various ambulatory care environments, large practices, physician owned practices, regional, multi state. So it's been varied. I was even once a dialysis executive in Bakersfield, California.

[A]

Yeah, breadth of experience there and apologies for the mispronunciation. A little unnecessary Italian pronunciation there, but great. We'll keep it going then. What are the top three trends you're following in healthcare ASCs today?

[B]

Well, you know, the migration of hospital based surgical procedures to ASC is a big deal. It's being pushed by cms. Patients of a low acuity level are already here, so total joints are a good example of that. Higher acuity cases, like spine cases are in the works right now. That migration, I mean, is in the works right now. Some of the other things are the cost of anesthesia services, anesthesia contracts with anesthesia companies, contracts with them. And of course the total joints are. Speaking to total joints as an opportunity are a great profit. They have great profit margins. You don't have to have a 23 hour stay to be able to accommodate them. Right now I do total joints, knees and shoulders. And I'm going to start to do hips this year, so that'll be exciting for us. There are a lot of capital outlays for that, capital equipment outlays. So it's, it could be a challenge, but it's, it's, it's a good challenge to have. Since the margins are so good.

[A]

Mm, yeah, absolutely. A lot of, a lot of new things going on there, especially with. Yeah. CMS's recent announcement and a lot of new procedures being added to the covered procedures list for ASCs.

[B]

You know, I believe I read somewhere that, and I think it was on Becker's that there was a 300% increase in knee replacements in outpatient surgery setting between 2019 and 2023. That's a huge increase. And I know that this just occurred to me. I know that there has to be a significant emphasis on post operative care, patient education, things like home health and physical therapy afterwards. Immediate ambulation is important to work into discharge for total joint cases. So some ASCs, and I mentioned this because, you know, some ASCs have allow for overnight stays, depending on the state that they're in. This state doesn't do that. This station doesn't allow for that. Your certificate of need has to be amended for that to happen. But in most circumstances with total joints, that's. That's actually not necessary.

[A]

Yeah. And kind of with all these, you know, these trends are following, what are you most excited about right now?

[B]

Well, I'd have to, I'd have to go back to controlling cost of goods to accommodate total joints. I think the hip thing to say these days is AI, but really not. They need extremely large data sets. The large language models do and the, the predictive analytics need exceptionally large data sets, patient data sets, to accomplish what everybody's hoping that, hoping for an impact on a positive impact on curative medicine. Predictive analytics for that can have a significant impact on clinical outcomes. But I think right now the motivation of CMS to incentivize hospitals, inpatient facilities to move higher acuity cases over to the ASC side is a very exciting environment to be involved in right now. Having backs done, having neurosurgery and backs done in a surgery center just a few years ago used to be a significant challenge. It used to be a novel idea. Not anymore.

[A]

Yeah, absolutely. And kind of, with kind of still in this theme of what's now possible and sort of especially with the recent CMS announcement, how are you thinking about growth over the next 12 months?

[B]

Well, there's a lot to talk about there. Coming from endovascular, I can tell you that the treatment of peripheral arterial disease, peripheral vascular disease, these chronic disease states, these chronic conditions, they're not curable. You can only manage them. Getting into endovascular and ASC is still a good prospect. Having interventional radiologists and vascular surgeons to accommodate those cases is something that, although, like I mentioned in the beginning, can be complex, it has a significant upside for the patients. Those are, you know, stenting balloon angioplasty, atherectomy procedures, the placement of fistulas for dialysis patients, for example. That's the upper extremity work that can be done. And there's a lot of upside there on reimbursement. Some surgery centers function as office based labs, but the more profitable aspect of that care in endovascular is to function as an ASC, a full ASC place of service. 24. I think, as I mentioned, the migration of higher acuity cases to ASCs is important. AI enhancements to things like administrative workflow, that aggregation of data, the integration of AI into various EMR platforms is something to be excited about to help accommodate growth here. I think some of the best margins that I have right now are neuro, what we refer to as neural, but they're actually spine cases where we put the neural stimulators in the back. Technically, I think they're classified as ortho cases. We call them spine here, OBGYN and podiatry cases. The growth there is important to maintain and to seek out. Those are low overhead procedures, low cost of goods cases, OB and podiatry, and they're easily managed and they have good reimbursement markers for them. I think there are also obstacles to growth that should be mentioned. You know, that I came from a state, I came from a state on the west coast that, you know, had no certificate of need. It's a very mercenary environment out there. And there weren't a lot of hospital affiliations with ASCs. And because of the extreme population density, you know, you could manage with three or four ASCs in a relatively short, short area, a small area rather so. So I think having being in a certificate of need state, and I don't know the number of states that have certificate of need requirements, but having to get acquainted with it, it is a significant obstacle to growth. You have to have, I have two ORs and two procedure rooms, for example, and I have two other ORs that are built out, that are framed out and just have to be constructed. And you know, there's some technicalities there where you could call it a procedure room versus an OR and the state will accept it. But just speaking in generalities, all of these things need permission. And it can take us an extremely long time to go before the various city and state committees to satisfy that community, that community need assessment. And if there Are competing hospitals that also own ASCs, like in my case, you know, they're all fighting for that number of approved ORs in that space. And so it can be quite political too.

[A]

Yeah, I think it is good and very important that you mention that. I think this conversation has covered a range of subjects, but there's a lot of excitement around AI and like you said, these sort of lofty things that will be possible in the future. But it sounds like a lot of ASCs are still grounded in these realities of what state regulations permit and that kind of being where a lot of people are at still.

[B]

Yes, ma'. Am. I think I would also like to mention as a growth obstacle or as something that can be a challenge that more physician surgeons are joining hospital systems and there's meaning that there are a limited number of independent physician surgeons to become owners to feed a surgery center. And sometimes there are legal barriers to employed physicians that work in a hospital system to joining an ASC as owners. Sometimes that is the case. So that can be an obstacle to growth. But if you're constantly involved and seeking out that new participation amongst younger physician surgeons and you know, the lay of the land, you know what that challenge is going to look like, that recruitment effort is still very important to maintain. It's just that it's here on the East Coast. I've noticed these hospital affiliations and the purchase of large physician groups, especially those that have, that have physician surgeons within them, is far more common and more accelerated here than it is on the west coast, at least in my experience.

[A]

That's definitely very interesting. Certainly a dynamic that is shaping, shaping things in the state that you're in and sounds like the region, something that I'll be interested to look into a little more. Anything else to add here, Michael?

[B]

No, I think, you know, things like, minor things, I would call them, you know, things like zero day stays. You know, ASCs reduce the number or increase the number of zero day stays, which is a good thing for patients when they come to an area. So I just think there's a lot of, there are a lot of details about the convenience factor for patients. That ASC growth, wherever they are, wherever it happens in the country, drives for the benefit of patients. And I think that the drivers within our industry are interesting to talk about. But these, these tangible benefits to the patients are very tangible too. So we have a lot of, especially if you're on the ball, cooperating with your referral sources as an asc, with pre and post patient education, if you have a dedicated program you have a sort of a concierge attentiveness to patients, for example, that come through a total joint program at the ASC where people are sort of people going through that process, going through those surgeries are sort of segregated and have a. Have a different track so that we can attend to them, the physician can consult with them in a. In a more polished environment. That, that's something that I think deserves a lot more attention from ASCs. Because of the nature of some of these higher acuity cases that come to surgery centers and the track of patient education. It can be a very intimidating experience. And sometimes it's necessary to have those patients as they process through the facility at the asc, once we get our hands on them, that they feel that we're where we. We have a different kind of accommodation for. For what they're going through in the. And because it can feel overwhelming, all of the information you get, all of the aftercare instructions that you get, all of the things you have to adapt to. You know, it's just an intimidating experience to begin with. Even for modest cases that are of. Of low complexity, cases that are less involved even. That's an intimidating process. People have to get off from work. You know, they have their financial obligations on their side, the high deductibles in a lot of cases. So there's a lot to worry about. And I think we have to keep up with our customer service at an ASC and not. Not treat it like it's a. An assembly line where all patients, no matter what, what they're coming for, you know, get the same kind of treatment. It just. It's not a cookie cutter environment anymore.

[A]

Yeah, that personalization is, Is key there, it sounds like. Right. Well, that is all I have for you today. Michael, thank you so much for joining us. It has been a pleasure speaking with you, and I look forward to connecting with you again in the future.

[B]

I hope you have a good day.