What the ASC Industry Keeps Asking About Labor Costs: A Conversation with SMP’s Julie Brinegar

Interview by Michael Winkleman, CMO, Surgical Management Professionals.

Follow Becker’s ASC Review long enough, or spend any time in ASCA’s member community, and a pattern shows up. The same handful of questions keep surfacing in different forms: why are labor costs climbing, what counts as good utilization, and how do you tell a staffing problem from a scheduling problem before it costs you a quarter.

Two recent posts from ASC administrators capture it well. One asked for better benchmarking figures on multi-specialty center labor costs and hours per case, covering both clinical and business office staff. Another wanted labor costs broken out as a percentage of revenue,  specifically covering the administrator, DON, billing staff, scheduling staff, receptionist, and clinical staff, and asked that the figure exclude benefits so it could be compared cleanly across centers.

These aren’t hypothetical questions. Becker’s has reported that labor costs have risen 25 to 60 percent in many markets, with RN, scrub tech, and anesthesia hourly rates all surging, and that many ASCs are now dealing with double digit annual wage inflation for registered nurses and staff on top of anesthesia shortages and subsidy pressures. Given how often these questions come up, both in the industry press and in conversations among ASC leaders themselves, we sat down with Julie Brinegar, SMP’s Director of Operations, and asked her to answer them directly.

Julie’s spent her career on every side of this issue. She started as an OR nurse, moved into nurse management, then ran ASCs herself as an executive director before joining SMP. When a board wants a real answer instead of a guess, she’s usually the one giving it.

“Is there a reliable labor cost benchmark for multi-specialty centers?”

This is close to word for word what we’re seeing administrators ask. Julie’s answer is that the benchmark most people are looking for doesn’t really exist, and here’s why.

“There isn’t going to be any good resource for a benchmarking number because of the variability. There is a firm that provides benchmarking data with numbers, but again, is it going to be a reflection of an all-orthopedic ASC or a multi-specialty one?”

That variability is exactly why she starts somewhere else entirely.

“It directly reflects operational efficiency. It reflects any deficiencies in the vertical scheduling within your facility.”

She’s talking about labor cost per case, broken down by service line, not a single blended number across the whole center. An all pay center and a spine and orthopedic facility will never post the same number, and pretending they should is exactly how a rising number goes unexplained for months.

SMP’s COO, Allison Stock, made a related point to Becker’s earlier this year when asked how ASCs can get ahead of rising costs in 2026:

“ASCs that understand their costs at the case and service-line level can make smarter decisions around staffing, supplies, and scheduling before costs get out of hand.”

“What should actually be included when we calculate this, and what gets missed?”

This is essentially what the second administrator was asking, wanting a labor figure that captured administrator, DON, billing, scheduling, receptionist, and clinical staff, while excluding benefits so the number could be compared cleanly. Julie’s answer suggests the opposite approach might actually serve them better.

“What gets missed is benefits, all of those extra ancillaries that need to be included in overall setting.”

Her reasoning: leaving benefits out might make the number easier to compare across centers, but it also makes it a less honest reflection of what a center actually spends to run.

“It doesn’t necessarily show that downtime that you have in between cases, which does go into overall staffing costs.”

Take turnover times for total joints running long as an example. The instinct is to look at the OR team and assume they’re slow. Often the real cause sits further back, in how the block schedule was built for that day.

“You have a whole team of people sitting in the OR waiting for a block for a patient, which is appropriate for the procedure, but it’s still a labor cost that doesn’t necessarily reflect the true number of what it does cost to do that case.”

It looks like a staffing issue. It’s usually a scheduling issue.

“How do we know if this is a staffing problem or a scheduling problem?”

This distinction comes up constantly, and Julie draws the line clearly.

“A scheduling problem is, gone are the days where we let surgeons be able to schedule whenever they want as a convenience.”

They’re related, she said, but not the same thing. A center can build a tightly vertical schedule and still not have enough staff to run it. It can also be fully staffed and still lose money because the schedule itself is inefficient.

Her first move when the number climbs isn’t to look at headcount.

“I think the first thing I would look at is scheduling. Are there opportunities to close down rooms? Are there opportunities to have those conversations with the surgeons to do minor flexes in their schedule?”

Peter Bravos, MD, Chief Medical Officer at Sutter Health Surgery Division, landed on nearly the same answer when Becker’s asked him a similar question. His focus wasn’t cost cutting either, it was throughput:

“Optimizing block utilization, aligning anesthesia coverage with demand, reducing late starts and using data to manage access more proactively allow ASCs to spread fixed costs across more cases.”

“What’s a good utilization benchmark, and does it really matter?”

This is the number Julie says actually matters more than a blended labor percentage. The answer, per ASCA’s published standards, sits in a fairly specific range.

Industry benchmarks generally place full utilization in the 70 to 80 percent range, with single-specialty centers expected toward the higher end and multi-specialty centers toward the lower. Most administrators set that same 70 to 90 percent target and track how many physicians are actually hitting it.

Julie’s take is that hitting the number once isn’t the point. Consistency is.

“If you’re at 30 percent and then the next week you’re at 70 percent, and it just makes it really unmanageable to staff for those types of situations.”

She uses that same benchmark in conversations with physicians directly.

“If their utilization isn’t at the gold standard of 70 percent or higher, then you can certainly show in that reflection right away that we can’t staff appropriately for that.”

“How lean is too lean?”

ASCs run lean by design. The harder question, one we see physicians and administrators wrestle with constantly, is where lean turns into understaffed.

“You don’t want to have staffing for the what if scenarios, because ASCs have the tendency to run lean from a labor standpoint.”

Push too hard without any give built in, and the cost shows up somewhere else: morale, turnover, eventually patient care.

“You have to have your second string of players be ready to come in because it’s going to get to a point where it’s just going to become the norm for those types of days. And you don’t want it to be the norm.”

“What about the cost side that isn’t labor, does that factor in here too?”

Julie’s focus is labor, but she’s not alone in tying it to the bigger cost picture. Andrew Lovewell, CEO of Columbia Orthopaedic Group, made a related point to Becker’s about how standardization and data discipline touch every line item, not just payroll:

“Centers that leverage their relationships with their physicians and create standardization, narrow vendor variation, and actively use case-level cost data to negotiate pricing will materially outperform those that don’t.”

Matt Cavanagh, a principal at CliftonLarsonAllen, put it in similar terms when discussing case mix and supply strategy:

“Standardizing implants and preference cards, tightening case-costing, and steering surgeons toward higher-value procedures lets centers grow margin without growing overhead.”

The common thread across all of it, labor included, is the same one Julie keeps coming back to: know exactly where the money is going before you try to cut it, or benchmark it against someone else’s center.

“Can you give us a real example of a center that actually fixed this?”

Every version of this question ends with some form of “show me it working.” Julie gave us one, without naming the facility.

Julie pointed to one SMP-supported center that reviews its schedule a full week in advance. The team closes rooms that aren’t needed and adjusts staffing accordingly, not just for internal staff, but for contracted anesthesia coverage too, since that’s a labor cost most centers track separately and shouldn’t. The result shows up in overall salaries and wages per case: the number drops either because staff are appropriately pulled off a day that doesn’t need them, or because the people who do come in end up using their full eight-hour shift on actual patient care instead of standing idle between cases.

“What should physicians be doing differently?”

We closed with the question every one of these threads eventually circles back to. Julie’s answer wasn’t about numbers.

“I think if the physician has a little bit more engagement in driving where that patient’s going to go on the day that they should go there, it’s going to have the biggest impact.”

Most physicians hand scheduling entirely to their clinic staff and never revisit it, even though clinic schedulers have enormous influence over how a day unfolds. A little more physician involvement in that one decision moves labor cost per case further than most operational fixes.

If Your Center Is Asking the Same Questions

These aren’t new questions. They’re the ones we keep seeing surface, whether it’s in Becker’s coverage or in administrators asking each other directly where to find a number that probably doesn’t exist. If your board is asking them too, start with utilization by service line before you touch your staffing model or go looking for an external benchmark. It’s usually not a staffing problem. It’s a scheduling problem that hasn’t introduced itself yet.

Happy to walk through what that looks like for your center specifically. Reach out anytime.

Talk With SMP About Optimizing Your ASC’s Operations.

Julie Brinegar, MBA, BSN, RN, CASC is Director of Operations at Surgical Management Professionals, where she brings executive and clinical leadership experience from MercyOne, Surgery Center Cedar Rapids, and Iowa City ASC.