This week at the New Jersey Association of Ambulatory Surgery Centers (NJAASC) Membership Meeting, we sat down with business office managers, administrators, and materials managers to workshop the financial realities they are facing. One theme rang clear: every decision in ambulatory surgery is being filtered through the lens of cost. From technology adoption to supply chain choices, administrators emphasized that survival depends on managing expenses while still delivering high-quality care.

If you did not have the chance to step away from your center to attend, do not worry - here are the key insights that stood out in the conversation.

Price as the Gatekeeper

When it comes to adopting new technology in ASCs, cost is the first and often final consideration. Features and efficiency gains may spark interest, but unless the pricing model makes sense, adoption will not move forward. Materials managers noted that this pressure shows up daily in how they manage inventory and supplies, often juggling tight budgets while trying to maintain quality.

Another layer of complexity comes from management companies like AmSurg and other management service organizations (MSOs) that negotiate bulk rates across their networks. While these contracts can lower costs, they also create more “shopping” options for supplies and technology. Leaders said the sheer number of choices can slow decision-making, with administrators stuck between taking advantage of negotiated deals and trying to keep purchasing streamlined at the facility level.

M&A as a Cost Strategy

Joint ventures and mergers between ASCs, hospitals, and MSOs are picking up speed. Leaders view these partnerships as a way to gain leverage, drive down supply costs, and create economies of scale that individual centers cannot achieve alone.

But consolidation comes with operational challenges. Multi-EMR environments are common when hospitals and ASCs partner, which can make data exchange between sites slow and fragmented. MSOs often bring a separate central billing office (CBO) into the mix, meaning billing and revenue cycle management shift away from the center. While this can create efficiency at scale, administrators cautioned that it can also widen the disconnect between the ASC and the teams actually managing claims and collections.

Administrators Under Pressure

Endoscopy centers illustrate how cost pressures play out in practice. Many are shifting from reusables to disposables after decades of relying on reusable scopes. Administrators and physicians noted that disposables can cut down on contamination risk and streamline compliance, with some describing them as reducing the “bubbles” of persistent microbial risk that linger even after reprocessing. Early studies back this up, showing lower contamination and fewer post-procedure fevers in patients using disposable scopes.

Still, disposables carry higher upfront costs, sometimes reaching hundreds of dollars per procedure, and create added waste streams. For administrators, the decision is less about clinical safety, where disposables are proving comparable to reusables, and more about whether the time saved in reprocessing and the reduction in regulatory risk offset the higher price.

The conversation also broadened beyond medical devices. Critical vendors such as laundry services, credentialing providers, and IT support play a vital role in daily operations. Leaders noted that while these services often get less attention than surgical supplies, inefficiencies here can quietly drive up costs and erode margins.

In short, ASC administrators are being asked to prove value in every choice, from supplies to vendor contracts to staff utilization, while operating under tighter margins and closer scrutiny.

The Denial Disconnect

Denials remain a major concern. While billing is often handled at the CBO level, it is the ASC that absorbs the financial hit when claims are rejected, especially on facility fees. Administrators voiced frustration that they are held accountable for revenue leakage without having direct control over the teams managing claims. The result is a gap between where billing happens and where the financial pain is felt.

For many leaders, this disconnect makes it harder to address problems early, track root causes, or push for changes in workflow. Without visibility into denials until after revenue is lost, administrators are left trying to explain shortfalls they had little ability to prevent.

Automating the Right Things

Not all tasks need automation. As one administrator noted, “I know how to credential. It is not super hard, and we are not adding new doctors every day.” Instead, leaders want automation aimed at the hardest, most expensive workflows, processes that directly affect throughput, revenue, and compliance.

The conversations in New Jersey made one thing clear: cost is the common denominator shaping the future of ambulatory surgery centers. Administrators are not rejecting innovation, but they are demanding proof that every investment protects margins, reduces denials, and keeps cases moving. As competition increases and margins tighten, ASCs that align cost discipline with smart adoption of technology, supply strategies, and vendor partnerships will not just survive but lead the way in redefining outpatient care.