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

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.

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)

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.

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

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.

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

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)

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

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.