Patrick Garman, Executive Administrator, Spartan Health Surgicenter

Summary

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Becker’s Healthcare Podcast — Episode Summary

Guest: Patrick Garman, Executive Administrator, Spartan Health Surgicenter
Host: Gracelyn Keller, Becker's Healthcare
Date: November 24, 2025
Location: 31st Annual Business and Operations of ASCs (recorded live)
Length: ~11 minutes

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Episode Overview

This episode delves into growth drivers, challenges, and innovations shaping the Ambulatory Surgery Center (ASC) sector. Drawing on decades of experience, Patrick Garman shares insights into operational trends, technological adoption, collaboration models, and evolving financial pressures, especially on anesthesia services. The discussion emphasizes the industry’s rapid evolution, clinician-focused business models, and the critical nature of cost containment and efficiency for ASC survival.

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Key Discussion Points & Insights

1. Spartan Health Surgicenter: Background (00:53–01:19)

• Patrick introduces Spartan Health Surgicenter:
  • 20 years in operation
  • Joint venture with a hospital partner
  • Multi-specialty focus: GI, ophthalmology, pain management, orthopedics
  • Facility size: 15,000 sq ft, three operating rooms, two procedure rooms
  • Location: Southwest Pennsylvania
• “We celebrated our 20th year last September…we do a lot of GI ophthalmology, pain management and orthopedics.” (00:55, Patrick Garman)

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2. ASC Market Growth Drivers (01:19–03:06)

• Market is projected to hit $60.8 billion by 2030.
• Significant forces fueling growth:
  • Physician choice: New, entrepreneurial doctors driving ASC expansion
  • CMS model changes: Broader list of outpatient-eligible procedures (e.g., total joints, potentially cardiac cases)
  • Efficiency & Cost savings:
    • Surgery centers lauded for transparent, lower-cost care
    • Suggests hospitals could learn from ASC operational models
  • For-profit vs. non-profit mindsets:
    • “So all surgery centers are for profit. Very, very few are not for profit. The majority of the acute care hospital settings…are not for profit. So it’s a totally different mind frame, a totally different established setup.” (02:46, Patrick Garman)
• Memorable moment: Reflection on how far outpatient surgery has come, especially in orthopedics.

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3. Technology’s Role: AI, Robotics & EHR (03:06–06:02)

• Electronic Medical Records: Now standard, essential for efficiency
• AI & Robotics:
  • Mixed adoption and impact:
    • Attractive for marketing (“state of the art”) and patient perception
    • Downsides: Expensive, can slow down efficient surgeons, not always cost effective
    • Some large centers/hospitals push AI and robotics for differentiation
  • “If the surgeon values his or her time…and they move with precision and speed, adding artificial intelligence or AI at that cost is actually going to slow them down. That’s a fact.” (03:46, Patrick Garman)
• Other specialty tech innovations (GI, ophthalmology, gynecology, pain management) continue to drive better outcomes.
• Competition among vendors benefits ASCs, yields continual progress:
  “It’s an exciting place for us to be at right now because all of the vendors…are all striving to be as good as they possibly can.” (05:23, Patrick Garman)

Standout Transformative Innovation (06:02–06:54)

• Transition from paper to electronic systems:
  • Resistance from some older physicians, but now universally adopted
  • “The paper chart format is really a thing in the past…” (06:29, Patrick Garman)
• AI and robotics remain at a 50/50 adoption threshold due to cost and value uncertainty

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4. Collaboration & Partnership Models in ASCs (06:54–08:30)

• Joint Ventures: Must align with surgeon interests—doctors are “the single most important component.”
  • Hospitals/management companies may offer attractive terms (insurance contracts, supply chain benefits, inpatient privileges), but ultimate decision rests with the physicians or groups.
  • “I’ve been in the field 35 years. The doctors rule.” (07:23, Patrick Garman)
• Partnerships should be customized—no universal solution; stakeholder discussions are crucial.

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5. Pressing Challenges: Anesthesia & Reimbursement (08:35–11:10)

• Anesthesia costs are becoming “an unsustainable expense.”
  • Post-COVID workforce reductions, rising costs, and declining reimbursements exacerbating the problem
  • Intrastate conflicts between anesthesiologists and CRNAs led to a lack of focus on their own reimbursements, resulting in perpetually declining rates
• Surgery centers now sometimes required to subsidize anesthesia for sustainability, leading to financial strain
  • “In order to sustain their costs and the expense of providing the necessary anesthesia so we could do surgery, we have to sustain that with a stipend. And sometimes it gets uncontrollable.” (09:54, Patrick Garman)
• Revenue cycle challenges:
  • Necessity of diligent collection processes to ensure timely payments and manage rising overhead costs
• Final recommendation:
  • Model selection (solo practice, management company JV, hospital partnership) should always be made by engaged physician stakeholders

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Notable Quotes & Memorable Moments

• On industry evolution:
  “Twenty years ago was unheard of, able to do orthopedic joints. Now my facility is doing them…Now there’s discussion about having cardiac procedures done in a surgery center setting, which is a phenomenal development and achievement.” (01:59, Patrick Garman)

• On physician-driven models:
  “The doctors, the surgeons are the single most important component. Without the doctors writing the prescription or the order to have the surgery performed…that’s where it starts.” (07:16, Patrick Garman)

• On anesthesia cost crisis:
  “I’ve never seen [anesthesia] reach a point where it’s [such] an unsustainable concern.” (10:35, Patrick Garman)

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Segment Timestamps

• 00:53–01:19: Spartan Health Surgicenter snapshot
• 01:19–03:06: ASC market trends and growth drivers
• 03:06–06:02: Technology’s evolving role (EHR, AI, robotics, specialty advancements)
• 06:02–06:54: Standout transformative tech and digital adoption
• 06:54–08:30: Collaboration, joint ventures, and physician-centered models
• 08:35–11:10: Financial headwinds—anesthesia, reimbursement, and revenue cycle

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Summary Takeaways

Patrick Garman paints a dynamic portrait of a maturing ASC sector where physician entrepreneurship, nimble operations, and technological progress fuel expansion and efficiency. Yet, steep anesthesia costs and reimbursement pressure are urgent issues threatening sustainability. His recurring theme: ASCs should always be structured around the clinicians who power them, leveraging partnerships and technologies that truly align with patient outcomes and operational realities.

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Transcript

[A]

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[B]

Is Gracelyn Keller with the Beckers Healthcare Podcast and we are recording live at the 31st annual Business and Operations of ASCS. I'm currently joined by Patrick Garman who is the Executive Administrator at Spartan Health Surgery Center. So Patrick, thanks for being here to kick us off. Can you please share a little bit about yourself and your work in the ASC space?

[C]

Surely. Thank you for the invite. Spartan Health Surgery center is in its 20th year. We celebrated our 20th year last September. We're a joint venture with a hospital partner, multi specialty facility. 15,000 square feet, three ors, two procedure rooms. We do a lot of GI ophthalmology, pain management and orthopedics. We're located in the Pittsburgh, Pennsylvania market. Southwest Pennsylvania.

[B]

Wonderful. Well, thank you for taking the time and let's start our conversation with the ASC market in the US it's projected to reach $60.8 billion by 2030 and continues to experience strong year over year growth. From your perspective, what are the most significant trends in market forces driving this expansion and how should ASC leaders be preparing today?

[C]

Well, I think a lot of what's going to propel this movement is physician choice, a transient physician population. As the older physicians retire, the newer, younger doctors are coming out of their fellowships and their residencies. Some of them are very entrepreneurial in spirit, which is a very good thing for the surgery center market. Every couple years the CMS Medicare model releases more procedures that can be done, allowed to be done in the outpatient setting. That's providing some great opportunity for surgery centers. 20 years ago was unheard of able to do orthopedic joints. Now my facility is doing them. A lot of facilities are being done. They're doing safely and actually better. Now there's discussion about having cardiac procedures done in a surgery center setting, which is a phenomenal development and achievement. The cost savings is very apparent. It's very transparent. Surgery centers have a role in saving the healthcare system billions of dollars a year. The efficiency Model pretty much was invented by surgery centers. If hospitals only would take the chance, the opportunity to look at how surgery centers run in efficienc method, they would probably reduce their cost as well. So all surgery centers are for profit. Very, very few are not for profit. The majority of the acute care hospital settings in the United States are not for profit. So it's a totally different mind frame, a totally different established setup.

[B]

Absolutely. And from AI and robotic surgeries to advanced EHR systems, technology remains both a make or break factor and a critical driver of ASC operations at scale. So how do you see deeper tech integration shaping the way ASCs deliver care and manage their business over the next few years?

[C]

I think the technology that I've seen for a long time, it was electronic medical records. Everyone's up to speed, should be up to speed on that. Artificial intelligence for the surgeon. It works one of two ways. It's an attractive marketing tool. It's. There's some glamour to it, it's terribly expensive. It is prohibitive in that it slows the surgeon down. So if the surgeon values his or her time and they're efficient and they have great outcomes and they move with precision and speed, adding artificial intelligence or AI at that cost is actually going to slow them down. That's a fact. Some of the hospital settings or the large surgery centers that include AI, robotics, things like that, especially robotics and orthopedics, they're doing it because nobody else is doing it. And they're doing it because it's an attractive, there's some traction. Some patients are saying, hey, I like this concept. I heard it's state of the art. It's a thing of the future. I'm going to go to a doctor that engages with that technology. So there's the place for it right there. The flip side of that is it's time consuming, it slows the doctor down, is not cost effective. So it's kind of a happy medium. The rest of the technology coming across the table is going to be from gi, from ophthalmology, gynecology, the whole spectrum. There's always advancements in medicine. There's always advances in pain relief, orthopedics, especially when you're having your shoulder, knee or hip replaced, the patient is in a great deal of pain. That medication, that interventional pain relief is very critical. It's the difference between a successful outcome and a painful one. So those are the kind of technology improvements that we need to watch, we need to enhance, and quite honestly, we'll let the vendors compete with one Another who comes out with the best products. An exciting place for us to be at right now because all of the vendors, all of the labs, all of the companies are all striving to be as good as they possibly can. They're always out offering the newest, latest platform to trial. And it's all it is. It just benefits us in the industry to watch this technology unfold. Was on. It wouldn't, didn't happen 40 years ago, 20 years ago. So every two to three years it continues to happen. It's very exciting to see and it helps our patients out some.

[B]

And kind of a follow up to that. I'd love to dig in a little deeper. Can you identify one specific technology or innovation that stands out to you as especially transformative?

[C]

Well, to go from paper to electronics is very, very important. There was a lot of fight, a lot of pushback from the doctors. They didn't want to have to slow down. They didn't. They'd rather whip a page and sign something and they don't have to type up this laptop and do all this stuff. But physician offices led the way. Almost every physician office I know of, there's a laptop in the doctor's office, whether it's a pediatrician, a gp, orthopedic, neurology, whoever, that's way it's happening. The hospitals all have sophisticated electronical backgrounds now. So the paper chart format is really a thing in the past as far as other technology go, getting back to artificial intelligence and robotics, that's still finding its way. Because of its cost, because of its expense, it's finding its way. Not everyone's embraced it, others have. So it's kind of 50. 50.

[B]

Absolutely. And with 60% of health systems considering ASC joint ventures and many ASCs already partnering with systems in their communities, what opportunities do you see for collaboration, whether with providers or vendors, to strengthen patient care and operational efficiency?

[C]

Forming a joint venture with either a hospital system or a management company has to fit the needs of the doctors. The doctors, the surgeons are the single most important component. Without the doctors writing the prescription or the order to have the surgery performed, whether it's an admission to the hospital or a procedure in the surgery center, that's where it starts. It's all centered around the doctor, in my opinion. I've been in the field 35 years. The doctors rule. So that's why hospital groups try to employ them. That's why surgery centers were invented as an extension of physician, you know, practice and entrepreneurial spirit. So leave it up to the doctors. If the Doctors want a collaboration if they think it makes sense to partner with a management company to get enhanced insurance contracts or cost savings on purchasing supplies, things like that, a bigger, larger network. If it makes sense to partner with the local hospital, because the hospital would, would, you know, find a creative way to get them privileges and have them earn a stipend for doing inpatient care at the same hospital. There's all that stuff will play out, but it has to be focused. Start on the doctor, whether it's a group of physicians all aligned or just an individual surgeon.

[B]

And is there anything we didn't touch on or any final thoughts you'd like to share as we wrap up this conversation?

[C]

Yes, it's a painful one. Anesthesia is becoming an unsustainable expense. Okay. Five, six years ago, pre Covid, it was not an issue that we really, really had to concern ourselves with. But as in most professions, you have one segment of the population retire either replaced properly with enough volume or not. And so the cost of anesthesia continues to rise. That's also offset with declining reimbursements for anesthesia. For too long. Anesthesiology as a profession was caught up in this battle between the physician anesthesiologist and the CRN certified registered nurse anesthetists. Okay. Both qualified individuals. The majority of the procedures performed in a surgery center are performed by CRNAs. But they spent so much time feuding from state to state around the country, they took their eye off the ball. They did not pay attention to their own reimbursement. So the anesthesia reimbursement continues to plummet while hospitals get increases every year, the surgery center gets a little bit of a bump. Some of the doctors get a bump, some of them don't. In the right direction. Anesthesia reimbursement continues to plummet. So now in order to sustain their costs and the expense of providing the necessary anesthesia so we could do surgery, we have to sustain that with a stipend. And sometimes it gets uncontrollable. That's a major issue. I've heard about it all day to day from a variety of different settings. I don't remember discussing it this seriously before. And this I've been. This is my 12th straight year coming in June and October. I've never seen it reach a point where it's unsustainable concern. That's one the paper payer reimbursement issues. Yeah, everybody has revenue cycle challenges. We have to make sure that we're getting paid for what we do because whoever we buy supplies from sends us an invoice and they're going to get paid regardless of we get paid. That's an ongoing challenge for us. We have to make sure that we're doing a diligent job. And then it just like I said, leave it up to the doctors to figure out exactly what kind of a model they want. If they want to be a solo, no partners necessary, employ good people, form their own governing board, that's fine. If they want a joint venture with a management company of which there are several good prominent large ones around the country, or a local regional hospital, that's fine too. So that determination will be made once the people that are the true stakeholders sit down at the table and figure out how they're going to do with how they're going to go forward.

[B]

Absolutely. Well, Patrick, thank you so much for sharing these thoughts and insights today on the podcast and joining me again. We are recording live at the 31st annual business and operations of ASCS.

[C]

Thank you for having me.