How to Start an Ambulatory Surgery Center

How to start an Ambulatory Surgery Center

How to Start an Ambulatory Surgery Center

Starting an ambulatory surgery center should never be taken lightly and without precautions. There’s a lot of thought and careful planning. It’s supposed to be a well-organized facility where people with real medical problems can rely. So, this article will focus on how to start an ambulatory surgery center and everything in the process.

We’ll help explain the starting point while elaborating on all the smallest details associated with it. Plus, you’ll get real advice from experienced surgery center consultants to pinpoint the process’s most important aspects. Following these guidelines will also help prepare you for any setbacks you may face along the way. 

Continue reading to discover everything there is to know about how to set up an ambulatory surgical center!

How to Start an Ambulatory Surgery Center

Ambulatory surgery center development is a complex process that requires careful planning and strategizing. Like any investment, thorough research and preparation are important before you open the doors for the patients.

If you have no experience in hospital management, we always recommend hiring a professional consulting service. The right surgery center consultants will have the needed expertise to guide you through the process while explaining each crucial step.

Furthermore, they’ll help you achieve the best final results and prepare you for any issues. With their vast knowledge of surgical facilities, you’ll have better chances of avoiding setbacks and getting your ASC booked as soon as it opens.

That being said, the key steps in starting an ambulatory surgery center are the following:

  • Market research
  • Business plan
  • Regulatory requirements

Market research

The first step in any ASC development process is thorough market research. In this phase, you’ll inform yourself about all the essentials and identify the target market and competition. 

Moreover, you’ll be able to discover the most recent market trends and decide on which elements you should focus on.

Working alongside a surgery center consultant will minimize the time of this process. Instead of spending countless hours researching yourself, an experienced professional will already know all the market details. 

Thus, they’ll happily share their industry knowledge, give you insight into the specifics, and help explain any difficult concepts. 

How to conduct market research

Before conducting proper market research, you’ll need to identify your goals. Focus on the matters most important to your business to avoid wasting time on useless information. 

If you need insights in multiple fields, focus on each task separately. There are two main ways to gather the needed information. 

The first one is known as primary information and is gathered by directly interacting with the customers. It’ll give you essential insight into their views to organize your strategy better. Additionally, it’s a great way to discover any potential issues or questions your business has to address before opening day.

On the other hand, secondary information is usually gathered through external sources. Numerous studies and research done by other businesses in the field can be found online and are available at your disposal. 

After gathering the needed data, the next step is to organize and analyze it. Even though it’s a straightforward process, it should be done precisely. 

Once you have the final results, you should implement them in your strategy and make the necessary changes. 

Identifying the target market and competition

When it comes to identifying the target market and competition, it’s best to focus on your local region. This way, you’ll get well-acquainted with any regional competitors and get an insight into who your patients are. It’s a great way to determine if the idea appeals to the public and how the final design should be positioned on the market. 

Furthermore, it opens up various marketing opportunities that can be tailored to your advertising strategy.

The target market is the group of people who are most likely to buy your product or service. Even though each customer and patient has their own needs, they’re still connected through similar characteristics. 

So, the best way to lead your ambulatory surgery center in the right direction is by discovering these shared similarities. Here are the key steps during this process:

  • Analyzing your service and customer base
  • Thorough competitor analysis
  • Finalizing the market research
Analyzing your service and customer base

Discovering what type of person is more likely to invest in your business. It can be their age, gender, hobbies, or even lifestyle. By defining and learning each characteristic, you’ll know how to provide a better service.

Thorough competitor analysis

Analyzing who you’re up against will give you transparency in the industry. It will give you a heads-up regarding pricing, forecasting, trends, and customer targeting. 

The best questions to ask yourself during this phase are:

  • Who are you currently up against?
  • Who are they targeting?
  • What are their products and services?
  • What are the features that make you and them stand out in the market?
Finalizing the market research

By segmenting and organizing the potential customers, you’ll be able to craft buyer personas. These ideal customers should have an elaborate selection of characteristics, needs, and challenges. 

The segments that each persona should have are:

  • Demographics: The age, gender, education, and income of the group.
  • Psychographics: The hobbies, values, lifestyle, and concerns of the group.
  • Geography: The city, country, area, and population of the group.
  • Behavior: The buyer’s intent, usage, and purchase of the group.
Most recent ASC trends
Source: Photo Contributor: DC Studio

Most recent ASC trends

Regardless of your business, each industry has its own specific trends and advancements. If you’re interested in ASC development and wellness clinics, you must focus on these sectors’ most recent medical trends. 

For example, some of the most recent news in the ambulatory surgery center industry are:

  • Recovering from the COVID-19 pandemic.
  • The shift of higher-acuity cases.
  • Most popular procedures.
Recovering from the COVID-19 pandemic

With the pandemic’s devastating effect in 2020 and 2021, the medical field took a big toil. The ASC industry had a noticeable increase in case volumes in almost all specialties. 

As of 2022, cases returned to pre-pandemic levels, even though most businesses were still growing. 

One of the biggest issues this industry went through was the shortage of medical personnel and supplies. That’s why it’s believed that in 2023, the primary focus will be returning those levels to balance and dealing with labor and supply costs.

The shift of higher-acuity cases

The second important trend is the shift of higher-acuity cases. These patients are characterized by severe and dangerous conditions that need fast and effective treatments. 

The number of such patients shifting from in-patient and hospital-based outpatient facilities to ASC continues to grow. The specialties influenced the most by this shift were cardiology, orthopedics, and spine procedures.

Moreover, many people choose ASC as their primary option to get treated in a high-quality and low-cost environment. Focusing on such procedures also benefits both organic growth and M&A opportunities.

Most popular procedures

Lastly, focusing on the trend for the most popular procedures is always smart. With the shift in higher-acuity cases, several specialties played a key role. Out of them all, the biggest improvements were seen in orthopedics.

These procedures are performed on the musculoskeletal systems, including the bones, joints, and adjacent soft tissues. Diseases, trauma, disorders, and accidents are the most common issues. 

So, there’s been a noticeable rise in arthroscopy, soft tissue repair, bone fracture repair, and hip and knee replacement surgeries.

Business plan

The second step you should take in your ASC development process is crafting a business plan. Such planning is crucial for any new business or strategy, regardless of the industry. 

This document elaborates on the business, the products or services it provides, the main income, the staff, the operations model, and everything else that goes into it.

Even though it may seem complex if you haven’t created a business plan before, several crucial steps go into it. 

The ones that’ll benefit you the most are:

  • Describing your company
  • Listing your product and services
  • Defining your mission
  • Defining the financial projections
  • Outlining the management and organization
  • Crafting a logistics and operations plan
  • Drafting an executive summary

Describing your company

The first step in your business plan should be describing your company. The two main objectives are elaborating on who you are and what you plan on doing. This practice opens up the opportunity of evaluating your ideals, principles, and cultural philosophies. 

The information this part should include is the following:

  • Business structure
  • Business model
  • Industry
  • Historical background

Listing your product and services

The second step is to compel a list of your product or services. In this section, try outlining all the important features and details that may lure in customers. 

Doing so may pinpoint your strengths and weaknesses. You can focus on improving the specific sections by discovering what your business may lack. This further opens your business to innovations that can be used to your advantage. 

Listing your product and services
Source: Photo Contributor: Tekkol

Defining your mission

Next, you should focus on defining your objectives. The best way to start this process is by exploring your company’s values and what they offer. During this process, you should keep all the people your business is accountable to in mind. This can include employees, suppliers, investors, customers, and owners.

 After listing all the important people, you should focus on how you’d like your business to interact with them. By finding ways to conduct business with them, you’ll notice that your core values will appear. 

After settling for the ones that make the most sense for your company, it’s time for you to craft a mission statement. The mission statement should explain these goals and why your business exists in a single sentence.

By now, you should’ve already decided what you want to achieve with your business. Remember that you should focus on short and long-term goals to achieve the best results. The shorter ones are typically realizable within a year and should focus on specific tasks. 

On the other hand, long-term goals are set within a five-year timeframe and include bigger innovations and changes.

Lastly, ensure your mission is specific, realistic, measurable, and within a timeframe.

Defining the financial projections

After defining your main objectives, the next step is developing a financial projection plan. This type of analysis will evaluate and predict future incomes and expenses for your business. 

After discovering how your financials stand, deciding how to invest, manage your budget, and craft operating plans will be easier.

If you don’t have any prior experience in defining your financial projections, remember that several elements play a key role. Even though the details may vary based on your plan, always try to include the following:

  • Income statements
  • Balance sheets
  • Cash-flow statements

After you’ve defined these three major views of your financials, you can also focus on making assumptions about the following:

  • Debt to equity
  • Supply cost per case
  • Revenue per case
  • Staffing
  • Equipment requirements
  • Payor mix

Outlining the management and organization

The management and organization should define who’s running your company and act as an overview of its legal structure. 

It’s best to use an organizational chart to plan the internal structure. This should also include your employees’ roles, relationships, and responsibilities. 

Having a clear view of each person on your team lets you know how they can contribute to your success.

Crafting an operations plan

Next, you need to craft an operations plan. You’ll need to implement these workflows to turn your plan into reality. Doing so will help you better understand your supply chain and set contingency plans in case of potential uncertainties. 

Furthermore, crafting such a plan will make it easier to define the price of your services and cover your costs.

The elements you should include in this portion of the plan are the following:

  • Suppliers
  • Inventory
  • Facilities
  • Equipment

Drafting an executive summary

Lastly, you should draft an executive summary after you’ve covered all the required details. This written report will give you an overview of the main points in your business plan. 

In this section, highlight all the key points you’ve compiled during your business plan research within a page.

Regulatory requirements

When starting an ASC, covering all the regulatory requirements is of utmost importance. Remember that they’re highly regulated based on federal and state laws that cover even their day-to-day operations. 

To avoid any issues, there are two segments you should focus on:

  • Understanding the state and federal regulations.
  • Obtaining the necessary licenses and certifications.

Understanding the state and federal regulations

State and federal regulations are set in place to ensure the safety of the patients and the quality of the services. In order to obtain any further certification, these rules must be obliged. To get a better understanding, they can be found on the online Federal Register, 42 CFR 416

Since these regulations can be confusing at first, it’s best to have a consultant review them with you. They’ll help explain anything you don’t fully understand to achieve a flawless workflow. 

Some of the most important regulations include:

  • Compliance with state licensures
  • Governing body and management
  • Quality assessment and performance improvement
  • Patient rights
  • Medical records
  • Patient admission, assessment, and discharge
  • Emergency Preparedness
  • Infection control

The state requirements are based on your specific location. To ensure you don’t miss anything, it’s best to once again go over them with a professional consultant. 

Obtaining the necessary licenses and certifications

After discovering the required regulations, you must obtain the necessary licenses and certifications. Most states require a Medicare certification to get a state license. This means that you must comply with all the state ASC laws. 

Furthermore, failing to do so may lead to huge fines since many states have licensure inspections.

To acquire a Medicare certification, you’ll need to follow these crucial steps:

  • Obtain a National Provider Identifier: To start the process, you must first apply for an NPI through NPPES’s online system
  • Enroll in Medicare: Enrollment can be done through the online PECOS or by submitting an 855b form to Medicare’s Administrative Contractor. This enrollment has to be verified every five years, so you should expect your ASC to be contacted when it’s time for revalidation.
  • Comply with the Conditions for Coverage: Includes following the Federal Register regulations.
  • Compliance Survey: Your ASC will oblige under a compliance service even if it’s already open. If the Medicare team isn’t able to do it, the task can fall to AAAHC, AAAASF, or HFAP.
Facility Planning and Design
Source: Photo Contributor: Terelyuk

Facility Planning and Design

After completing all the needed research and paperwork, it’s time to focus on the facility planning and design. 

During this step, you’ll need to plan out the following:

  • Efficient design
  • Staffing and credentialing
  • Financial management systems
  • Marketing and promotion

Efficient design

First, you should plan the interior’s design to have an uninterrupted workflow. While the style should offer patients a tranquil and peaceful aesthetic, the functionality should be on point. 

To ensure that everything functions flawlessly, remember these tips:

  • Collaborate with your staff and physicians to get useful insights.
  • Focus on efficiency by creating proper flow and balance.
  • Designate enough space for storage and equipment.
  • Designate an area for fulfilling your staff’s needs.
  • Offer flexibility based on specialties.
  • Never forget the patient’s comfort, needs, and experience.
  • Always plan ahead for future expansions.

Staffing and credentialing

To ensure your patients get the best possible care, you must have a professional team by your side. Thus, focusing on hiring properly certified staff is of utmost importance. 

Start by defining the type of care you want to offer the patients. Then, begin identifying licensed healthcare providers that practice within the state laws. Ensure you double-check any certifications, education, and training.

To keep track of all the personnel, it’s best to hire someone to deal with credentialing every physician at the center. Not only will new clinicians go over the process easily, but you can also keep the files updated with the latest information. 

Since it may take up to 90 days for an ASC to gather the needed credentials, they can grant temporary surgery permission. However, you should always do a thorough background check beforehand.

Financial management systems

Since you’ll be working with transactions daily, having an efficient financial management system is a must. These systems create, store, connect, and report various financial transactions.

Therefore, choosing suitable accounting software will benefit your business greatly. Not only will it aid with organization, but it’ll also help optimize profitability, determine tax obligations, and measure cash flow. 

Furthermore, with the rise in demand for reporting and data output, financial management systems continue to evolve to meet the need. 

Keeping up to date with the latest software is a crucial requirement. It’ll ease the effort put into month-end, quarter-close, and annual close reports. 

Additionally, it’ll help track income, expenses, and balances to ensure your ASC is working properly.

Marketing and promotion

Lastly, before opening your ASC, ensure you take the time to craft a marketing strategy. This is the best way to gain exposure and reach a broader audience. Those without experience will benefit most from hiring a professional marketing team to help with the cause. 

Furthermore, already having a business plan will make it easier to define your marketing objectives.

Remember that it takes time before you start seeing the results of your efforts. But by showcasing your unique features and services and tailoring your strategy to fit the buyer personas, you’ll reach your ideal customers. 

Always try to be honest with your audience, and you’ll surely see a spike in their interest.


After discovering how to start an ambulatory surgery center, it’s always recommended to begin the process alongside a professional consultant. 

If you’ve read the article, you know that you’ll need to deal with various complicated requirements and documentation along the way. 

As you can notice, market analysis, a business strategy, and regulation compliance are crucial aspects of establishing an ambulatory surgery center.

Thus, having a helping hand that can explain each step will only help your business achieve the best results!

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