Build the Surgery Center
Your Specialty Deserves.

An ambulatory surgery center (ASC) is a licensed outpatient surgical facility that provides same-day surgical and procedural care outside of a hospital setting. ASCs are certified by the Centers for Medicare and Medicaid Services (CMS) and accredited by bodies such as AAAHC or The Joint Commission. The benefits of physician ownership include: reimbursement for the facility fee that would otherwise go to a hospital (typically 40 to 60 percent of the hospital rate, which is still substantially profitable at an outpatient cost structure); greater control over scheduling, staffing, and clinical protocols; improved patient experience and satisfaction; and the ability to build a valuable real estate and operating asset that can be sold or partnered separately from the physician’s clinical practice.

A Certificate of Need (CON) is a regulatory approval required in some states before a new healthcare facility — including ASCs — can be established or expanded. CON requirements vary significantly by state: some states have eliminated CON for ASCs, while others maintain strict review processes that can take 12 to 24 months and involve competing applications, public hearings, and appeals. New Jersey, New York, and several other northeastern states have active CON programs that affect ASC development timelines and feasibility. CON status is one of the first factors we assess in any ASC feasibility engagement, as it fundamentally affects project timeline, cost, and competitive dynamics. We have experience navigating CON processes in all active markets we serve.

ASC construction costs vary significantly based on specialty, number of operating rooms, market, and infrastructure requirements. A single-OR multispecialty ASC in the northeastern United States typically runs $2.5 to $5 million in construction cost for the shell and medical buildout, not including land, design fees, equipment, or working capital. High-acuity specialties such as orthopedics and spine, or ASCs requiring advanced imaging infrastructure, will cost more. Multi-OR facilities scale proportionally but typically benefit from some shared infrastructure cost savings. Total project cost including land, design, regulatory, equipment, and contingency generally ranges from $4 to $12 million for a 2 to 4 OR facility in our markets. We provide a detailed, project-specific budget as part of our feasibility analysis.

The highest-performing ASC specialties in terms of case volume, reimbursement, and return on investment include: gastroenterology and endoscopy (high volume, efficient room turnover, strong Medicare reimbursement); ophthalmology, particularly cataract surgery (extremely high volume, highly efficient, strong commercial and Medicare rates); orthopedics and spine (high reimbursement per case, rapidly growing outpatient migration from hospital settings); pain management and interventional procedures (high volume, lower room intensity, strong reimbursement); and plastics and cosmetic surgery (largely fee-for-service, independent of payer contracts). We conduct specialty-specific volume and reimbursement analysis as part of every ASC feasibility study.

ASCs must be accredited by an approved accrediting body as a condition of Medicare participation. The three most widely recognized ASC accreditors are the Accreditation Association for Ambulatory Health Care (AAAHC), The Joint Commission, and the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). The accreditation process typically takes 6 to 12 months from initial application through survey completion. Preparation involves developing clinical policies and procedures, establishing a Quality Assurance and Performance Improvement (QAPI) program, conducting staff training and mock surveys, and demonstrating compliance with the accreditor’s standards. We coordinate accreditation readiness as part of our ASC development project management from design through opening.