Evolution is a necessary part of running any business. Nearly 40 years ago, Apple Inc. staked its future on selling DIY personal computers to hobbyists. Today, after numerous iterations, the $171 billion company is one of the world’s largest manufacturers of smartphones – and apparently isn’t resting on its laurels. In recent months, Apple agreed to pay $3 billion for Beats by Dr. Dre, marking its formal entrance into the headphone and streaming music markets. Ambulatory Surgery Centers are no different. First opened decades ago to trim costs and improve patient satisfaction for fairly basic surgeries, ASCs today are used for a broad range of sophisticated spine, neck and other procedures that are made possible by new minimally invasive techniques and anesthesia advances. But the industry now stands at a crossroads. Cost pressures are greater than ever before. And like all healthcare organizations, ASCs are grappling with the dramatically new landscape brought on by the Affordable Care Act. It’s an exciting time, but one that requires creativity, patience, teamwork and the ability to meet the following three big challenges head-on: Lower reimbursements: In the last decade, ASCs have had to do more with less. In 2003, ASCs were paid 87 percent of the total payment received by hospital for the same outpatient procedure, according to the Medicare Payment Advisory Commission. Today, ASCs are paid just 55 percent of what a hospital is paid. Of course, part of this is due to the tremendous success ASCs have achieved in lowering overall costs. But not all surgical procedures are created equal, and policymakers must adjust reimbursements appropriately, so procedures that are best performed in an ASC do not make their way back to the hospital. Industry maturation: Fewer ASCs are being built today than in the past. While more than 2,000 Medicare-certified ASCs were built between 2000 and 2013, only 50 were built during the past three years. There are a variety of reasons for this plateau, including out-of-network payment restructuring by insurance companies, lower reimbursement rates, market saturation and a tepid economy. Hospitals employing more physicians: Overall, many physicians in the United States are looking for stability and certainty in the ever-changing healthcare reimbursement landscape. At this same time, hospital systems are buying up private practices and expanding their operations. According to the healthcare staffing firm Jackson Healthcare, the percentage of physicians employed by hospitals between 2012-2013 increased from 20 percent to 26 percent. While these issues are complex, they’re not insurmountable. New strategies and models pioneered by Regent Surgical Health allow ASCs to lower costs, leverage recent transparency initiatives, and achieve previously unrealized efficiency that can create more opportunity in a more mature marketplace. Regent’s continued success in launching joint ventures is an example of how we’re leading the way. In May, we opened the Plaza Ambulatory Surgery Center in Portland, Oregon, our 18th hospital/physician joint venture. Regent’s joint-venture ASC business model is a proven ownership structure that meets the challenges of the current marketplace, while promoting excellent patient care, creating successful, lasting businesses, and providing physicians an opportunity to develop and invest in their local practices.