How ambulatory shifts are reshaping perioperative strategy

The shift toward ambulatory surgery is no longer a trend on the horizon — it is actively reshaping how perioperative leaders think about capacity, staffing, physician alignment and where growth comes from. As CMS and commercial payers continue to push procedures into lower-cost settings, health systems are being forced to rethink traditional surgical growth models, deciding which cases belong in the main OR, which are best suited for ASCs, and how to build the operational discipline to make both settings perform at their highest level. Becker’s asked perioperative leaders how ambulatory shifts are affecting their strategy. The responses reveal a field navigating complexity — from maintaining selection discipline in ASC case mix and managing the true cost of anesthesia in ambulatory settings, to leveraging wearables, predictive analytics, and standardized pathways to reduce variation and improve surgical readiness. Four perioperative executives shared how their organizations are adapting. The leaders featured below are speaking at Becker’s Perioperative Summit, set for Sept. 14-15 at the Hilton Chicago. If you would like to join the event as a speaker, please contact Scott King at sking@beckershealthcare.com. As part of an ongoing series, Becker’s is connecting with healthcare leaders who will speak at the event to get their perspectives on key issues in the industry. Editor’s note: Responses have been lightly edited for clarity and length. Question: How are ambulatory shifts affecting your strategy? Nikki Washington DNP, MSN, RN. Director of Surgical Services for St. Joseph’s Medical Center Stockton (Calif.): Ambulatory migration, along with changes in reimbursement models, is significantly changing hospital perioperative strategies. As CMS and commercial payers continue to incentivize lower-cost care settings, many high-volume elective procedures are shifting to ambulatory surgery centers. This trend requires health systems to rethink their traditional growth models. Our strategy focuses on expanding high-acuity and complex surgical services, including robotics and advanced specialty programs. We also aim to enhance operational efficiency, strengthen physician alignment, and ensure that patients receive care in the appropriate setting. Organizations that will thrive are those that can anticipate these market changes, adapt their surgical offerings, and balance growth across both hospital and ambulatory environments. Mohamed Rehman, MD. Chair of Anesthesiology and Pain Medicine Department for Johns Hopkins All Children’s Hospital (St. Petersburg, Fla.): OR capacity is often lost not in the operating room itself but in the variation across the perioperative continuum. Inconsistent preoperative optimization, fragmented communication, inefficient scheduling, and prolonged turnover times all contribute to preventable delays and cancellations. At our institution, we are addressing this through a multidisciplinary preoperative optimization clinic and standardized, evidence-based perioperative pathways to reduce variation and improve surgical readiness. Looking ahead, our research indicates that continuous physiologic data from wearables, foundation models trained on multimodal perioperative data, and mature Human Digital Twins have the potential to transform perioperative care from reactive to predictive — identifying patients at risk of cancellation, prolonged recovery or complications before they occur and enabling more precise, data-driven scheduling and resource allocation. The future of OR efficiency will be driven not only by better processes but also by intelligent systems that continuously learn and optimize care. Stephen Estime, MD. Associate Chair of Anesthesiology and Critical Care for UChicago Medicine: Ambulatory surgery centers can make procedural services significantly more efficient when offloading the right patients, surgeons, and procedures from the main OR. ASCs work well when patients are straightforward, surgeons are comfortable operating outside of highly resourced quaternary care centers, and procedures are reliable and predictable. The efficiency gains disappear quickly when that selection discipline breaks down or is less rigorous. The staffing piece is where I spend a lot of time thinking about as an anesthesiologist. Anesthesia is one of the most expensive resources in any procedural setting, and the ASC is no different. Procedural inefficiency takes many forms: inappropriate booking, cases running late, high turnover, gaps between cases. All of it erodes margin. One challenge is that those costs aren’t felt equally. Proceduralists and surgeons don’t always feel those costs directly, and the incentive to schedule cases with anesthesia efficiency in mind isn’t often prioritized. That’s a structural problem that requires someone to actively enforce the discipline and getting that right is central to any serious ambulatory strategy. Courtney Pearson. Assistant Vice President of Operations, Perioperative Service Line for MedStar Health (Columbia, Md.): Ambulatory care is reshaping perioperative strategy by shifting appropriate procedures to ambulatory surgery centers and hospital outpatient departments, allowing hospitals to focus on higher-acuity cases. This requires optimizing site-of-care decisions, maximizing OR capacity, and aligning physicians across inpatient and ambulatory settings. Standardized clinical pathways, equipment and workflows improve quality, efficiency and resource utilization across the continuum. Cross-trained teams, predictive analytics and advanced scheduling tools further support operational flexibility and patient access. Ultimately, success depends on delivering the right care in the right setting while balancing quality, patient experience and financial performance. At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.