Top 6 Challenges When Building a New ASC


Building a new ambulatory surgery center (ASC) is no small project. After 35 years designing and constructing ASCs, AMSURG's Vice President of Real Estate and Planning, Daniel Buehler, offers an overview of the most common ways a development project can become derailed.

1. Team

"You have to hire the right people," Buehler said. Choosing a team with expertise in healthcare--and ASCs specifically--will drastically improve the development process for the physician owner. "Physician owners rarely have the time to lead a building project themselves, so having a nurse manager or center director driving the project on behalf of the physician can bring an in-depth knowledge about center operations and help to move the project along."

"This is one of the areas where AMSURG Facilities Management and Construction stands head and shoulders above the rest," Buehler confirmed. "When beginning a new building project, we will propose a complete team: architect, engineers, contractors, etc., all of which we have vetted and can confidently recommend."

"I would pit my AMSURG team against any in the world. Each project manager has at least 20 years' experience and we also bring invaluable clinical background knowledge as well."

2. Time

Once you have a team assembled, you want to start early, about 24-36 months before you want to see a patient, according to Buehler.

"Before you get started, you need to have a strategic planning session. What are your short and long term goals for the center? An achievable goal will provide focus for the project and get everyone on the same page."

3. Money

When building a budget for your project, be sure to include all the different kinds of costs: hard costs (construction, construction fees, permits), soft costs (consulting, design, legal), cost of money (interest, carry costs, construction loans), equipment costs, other start- up costs (phone systems, signage, etc.)

"When we get a new project underway, we put together a comprehensive budget that includes all of these costs so that our partners have a realistic expectation of costs from the beginning."

4. Size

"Size is the Achilles heel of ASC development. In the ASC world, bigger is not better. Better is better."

A larger space means higher costs, both up front and continually through rent, utilities, and operational costs. You end up needing more staff to cover more space, which is inefficient. But a smaller ASC can have leaner processes, staffing and costs, making it more profitable.

5. Design

A well designed facility will improve and streamline the processes of the center. Patients, staff, equipment and materials all flow into and throughout the ASC. "At the end if the day, though, everything we do is balanced against patient safety and quality of care. It all begins with careful and thoughtful design".

"What you want is a design that not only allows all of these flows to occur smoothly and simultaneously but also to complement one another," Buehler said. Working with an architect who has experience in designing surgery centers can end up having a big effect on operations long after move-in day.

6. Regulations

When building a new ASC, you have to take into account a variety of regulations from CMS, local, state and federal codes, as well as accrediting agencies. Navigating all of these sometimes competing requirements takes expertise, knowledge and an eye for detail.

"I am proud to say that we have never lost time moving into a center because of a mistake we've made with regard to regulatory requirements," Buehler said.

For more information about partnering with AMSURG to build an ASC, call 877-741-0085 or e-mail


More Resources


Physician Anesthesiologists Week Spotlights: Asha Padmanabhan, M.D., Steve Blicblum, M.D. and Jeffer

Read More


National CRNA Week Clinician Spotlights: Lori Ortman, Kelly Harden and Nate Georgette

Read More


AMSURG Research to Focus on Colonoscopy Screening Rates and Community Costs

Read More

ALL RESOURCES library_books