ASC Insights, Industry Trends & Real Talk from the Field
Event Date: May 13, 2025 | Location: The Palace at Somerset Park, Somerset, NJ
Featured In: The ASC Podcast with John Goehle, Episode 246
Sponsored By: Surgical Information Systems, RFX Solutions, MedServe, and Ambulatory Healthcare Strategies
Ambulatory Healthcare Strategies (AHS) delivers stress-free compliance and financial solutions for ASCs nationwide. In Episode 246 of the ASC Podcast with John Goehle—recorded live at the New Jersey Association of Ambulatory Surgery Centers (NJAASC) Annual Conference—we dive into real-world ASC challenges, expert strategies, and what’s ahead for the industry.
On the Ground at NJAASC 2025
Held at The Palace at Somerset Park, the NJAASC Annual Conference brought ASC leaders together for hands-on education and connection. From a deep-dive QI pre-conference session to a lively music trivia night (John came close, but didn’t take the trophy!), the event was packed with energy and value.
John Goehle, CEO of AHS, presented a session on Strategic Planning for ASCs, offering actionable tools to help centers navigate shifting regulatory expectations, workforce dynamics, and financial pressures.
🗓️ Don’t miss the next opportunity: Join us at the November 2025 Multi-State ASC Conference for deeper insights into compliance and growth. Register early at asc-central.com.
Expert Conversations from the Conference Floor
We spoke with several outstanding presenters who shared their hard-earned insights:
- Daren Smith (Surgical Information Systems) – Building a QI program that delivers measurable results
- Amanda Penrod (RFX Solutions) – Transforming leadership insecurities into authentic influence
- Jennifer Cantrell (Amsurg) – Inspiring teams through mission-driven storytelling
- John D. Fanburg (Attorney) – Legal and legislative updates impacting New Jersey ASCs
- Cori Prisco, RN, DNP, MSJ, CASC (Hudson Crossing Surgery Center) – A day-in-the-life perspective from the administrator’s seat
- Bonnie Lavoie – A moving tribute to the legacy of Jeff Shanton, past NJAASC President and fierce ASC advocate
📣 NJAASC offers valuable advocacy, education, and community. Learn more at njaasc.org/Join-us or view upcoming events at njaasc.org/Events.
Compliance Spotlight: Credentialing & Sedation Oversight
During the podcast, two increasingly common pain points for ASC leaders were discussed: credentialing gaps and RN-administered sedation.
Credentialing Missteps That Can Trigger Citations
One ASC failed to require privilege applications for contracted physicians and anesthesiologists—an oversight with serious compliance risk. To meet CMS and accreditation standards, every credentialing file must include:
- Completed and signed privilege applications
- Liability release and attestation forms
- Dated signatures prior to Governing Body approval
🔎 Tip: If it’s not in the file, it didn’t happen. Protect your center with AHS’s credentialing tools at ASC Central.
RN-Administered Moderate Sedation: Proceed with Caution
As anesthesia shortages continue, some ASCs are exploring RN-administered sedation. This can be compliant—but only when all safeguards are in place:
- RN must have specialized moderate sedation training and ACLS certification
- A dedicated RN (not the circulator) must administer and monitor sedation
- Physician must be privileged to oversee sedation
- Routine Code Blue drills must be conducted and documented
🚨 Surveyors are watching this closely—don’t get cited for cutting corners.
📘 AHS offers ready-to-use sedation protocols, training logs, and templates through ASC Central.
Focus Topic: Mastering Incident Reporting in ASCs
Incident reporting is one of the most frequently cited issues during surveys—and one of the most fixable.
What Qualifies as an Incident?
Per CMS §416.43 and AAAHC, ASCs must document any deviation from normal care, including:
- Equipment malfunctions
- Medication errors
- Patient falls or near misses
AAAHC Definitions:
- Incident – A deviation from routine care without resulting harm (e.g., wrong label caught in time)
- Adverse Event – Harm resulting from care (e.g., allergic reaction due to medication error)
💡 Tip: A “just culture” encourages staff to report near misses and concerns without fear.
How to Investigate an Incident Report
Every report must be reviewed promptly and thoroughly:
- Assign a trained QAPI coordinator or designee
- Review medical records and interview involved staff
- Conduct a root cause analysis (RCA) for sentinel events
- Complete the investigation within 30 days
From Reporting to Improvement: Using Your Data
Incident data is powerful—if used. Your QAPI team should:
- Identify patterns or trends
- Roll out training or policy updates
- Benchmark performance using AAAHC’s Quality Roadmap
Reporting to Committees & Agencies
Ensure your oversight and reporting structure is solid:
- QAPI Committee – Reviews all incidents quarterly
- Governing Body – Monitors trends and approves corrective actions
- State Agencies – Must be notified of certain adverse events per state requirements
📥 Download our free, HIPAA-compliant ASC Survey-Readiness Checklist to streamline your QAPI and incident response process.
Stay Connected
🎧 Listen to Episode 246 on Podbean or your favorite podcast platform
🔗 Follow AHS and the ASC Podcast on LinkedIn
Disclaimer: This blog is for educational purposes only and does not constitute legal or regulatory advice. Always consult qualified professionals for specific guidance.