Ambulatory Endoscopy Centers: Why They Work and What They Need
The U.S. ambulatory surgery center (ASC) trend continues to build momentum. And with growing demand for colorectal cancer screening and other GI procedures, it’s not surprising that ambulatory endoscopy centers (AECs)—same day care facilities that specialize in gastrointestinal and other endoscopic procedures—are staking more claims on the healthcare landscape.1 In this episode of the DeviceTalks’ OlympusTalks podcast, Nalini M. Guda, MD, FACG, AGAF, FJGES, MASGE, President of GI Associates in Wisconsin; and Neil Parikh, MD, Chief Innovation Officer with Connecticut GI, part of GI Alliance where he chairs the innovation committee, shared their appreciation for working in a specialized GI center without hospital bureaucracies. Their challenges, including staffing turnover and training, are the “what else” beyond products and technology that Olympus’ Director of Strategic Marketing in GI Diane Locher and her team work to address for AECs who partner with Olympus.
Three Problems that AECs Solve
About 68% of ASCs that billed Medicare in 2023 specialized in a single clinical area, the most common being gastroenterology and ophthalmology.2 The shift toward ambulatory care is fueled by lower overhead costs and efficiencies associated with a specialized same-day procedure facility. Medicare reimbursement is lower compared to hospitals, but savings are theoretically borne out in efficient patient throughput, higher procedure volume, and lower administrative burdens.3
“When you come to an ambulatory endoscopy center, everybody there is focused on one task, which is endoscopy, as opposed to being in a multispecialty facility,” said Parikh. And it’s not just the doctors. “It’s really a team approach,” he stressed. “It’s the nursing staff, the technicians, the anesthesia staff. It’s everybody [focused on] one goal,” Parikh explained, adding that this helps to streamline patient throughput. “It’s access, it’s cost…and…patient satisfaction, I think all three of those [things] which are probably the major pain points in gastroenterology right now, are all solved by an AEC,” said Parikh. “The AEC, specifically [is beneficial] for routine procedures [and] allows for a more patient-centered, patient satisfaction experience,” he explained. There’s also no hospital parking garage.
‘You Could Be Bumped’
Parking woes are one thing, but schedule unpredictability in hospitals can skyrocket dissatisfaction, observed Guda. He noted that a patient’s colonoscopy could be postponed due to an emergency. But in an AEC, “If you say, ‘come at eight o’clock, you’re procedure will be done,’ and you’re done by 10 o'clock and you go home, that’s a much more predictable thing,” he said. “That’s a lot more in your control [in an AEC] as opposed to … a hospital-based facility where you know there’s always another emergency or something more serious that trumps … your routine screening colonoscopy. Not that screening colonoscopy is any less important, but there is a potential that you could be bumped,” said Guda.
Help Wanted, Again
Increased demand for the convenience of ambulatory care requires the workforce, yet staff retention is an issue. In 2021, Ambulatory Surgery Center Association’s post-COVID survey indicated that a fifth of ASCs had a 20% turnover rate (from Becker’s ASC)4 and a 2025 OR Manager Salary/Career survey5 indicates the trend continues for doctors, nurses, techs, and nonclinical staff.
Parikh blames the COVID-19 pandemic on colonoscopy screening backlogs and the loss of gastroenterologists. “There was already a diminishing pool of gastroenterologists,” he recalled, explaining that COVID accelerated retirement for many. What’s more, “The fellowship numbers haven’t changed significantly” to meet the demand, he observed.
Hear Dr. Parikh’s additional comments on COVID-19, patient backlog, and GI burnout.
Competition with other facilities also poses challenges. “There are too many opportunities,” for staff, noted Guda. Thus, onboarding and training are significant hurdles for practices like his.
Locher has heard as much from Olympus AEC partners. “Beyond the products, we try to help with the efficiencies such as training and onboarding for new staff through virtual training, on-site clinical and education teams, infection prevention and technical support teams,” she explained. “We want to ensure that the center and the care providers can focus on the patient, and we look for those other areas where we can help improve that efficiency for them.”
Freedom and Responsibility
For those who chose growth in their AEC, “The advantage that I feel in being independent is that we have a lot more freedom,” remarked Guda. “With freedom, of course, comes responsibility.” Guda said at his AEC “We engage ourselves actively with hospitals, the hospital committees, looking at the needs, so that we collaborate and work with them together.” With outside input, “the providers feel that they own the practice, so they take more ownership responsibility. They have more skin in the game, if you will, and I think decisions come much quicker” compared to hospital committees, Guda said.
Listen to Dr. Guda discuss how new technology is vetted at his practice.
“The real beauty of what I get to do is that every quarter I meet with seven endoscopists across the country who practice everywhere, and we talk about what works and what doesn’t work for us and when we want to vet a technology, vet a process, we don’t need to reinvent the wheel every time,” said Parikh.
AECs of the Future
So where is the current AEC business model headed? “I think traditionally the AEC has been in the colorectal vertical,” observed Parikh. “I think the next few verticals you’ll see is pancreatobiliary … endobariatrics,” and radiofrequency ablation and cryotherapy for Barrett’s esophagus, he suggested.
Locher agrees. “It’s exactly correct that procedures are rapidly migrating into the AEC and, as has happened with other verticals, more complex procedures will continue to do the same,” she said. “Our role is to … understand what that means for the centers and how they’re going to deploy that technology.” Which comes down to training and education, she adds. “Our focus is on staying close to the physicians, close to the practice, and being able to ebb and flow and grow with them.”
Dr. Nalini M. Guda and Dr. Neil Parikh are paid consultants of Olympus Corporation, its subsidiaries, and/or its affiliates. The positions and statements made herein by Dr. Guda and Dr. Parikh are based on their experiences, thoughts, and opinions. The podcast was paid for by Olympus.
References
- Goudra B. Setting Up an Ambulatory GI Endoscopy Suite in the USA-Anesthesia and Sedation Challenges. J Clin Med. 2024 Jul 25;13(15):4335.
- Medpac.gov. Ambulatory surgical center services: Status Report. Chapter 10. Mar 25, 2025.
- KNG Health Consulting, ASCA. Reducing Medicare Costs by Migrating Volume from Hospital Outpatient Departments to Ambulatory Surgery Centers. Published October 2020. Accessed October 17, 2025.
- Robertson M. 11 Stats on ASC employee turnover. Becker’s ASC Review. Aug 24, 2021.
- Saver, C. ASC staffing woes persist in era of increased surgical volume. OR Manager. April 14, 2024.
