High-Acuity Procedures Are Coming to Your ASC: Is Your Controlled Substance Management Ready?
Ambulatory surgery centers are in the middle of a major shift. Procedures that were hospital-only just a few years ago - total joint replacements, complex spine cases, cardiovascular interventions - are now moving to the outpatient setting. CMS added 276 new procedures to the ASC-approved list in 2026, and the message is clear: ASCs are becoming the go-to setting for increasingly complex care.
This is a huge opportunity. High-acuity cases mean higher reimbursement, more volume, and a chance to differentiate your center in a competitive market.
But there's a catch: with complex procedures comes a significant increase in controlled substance use - and with that, a whole new level of compliance risk.
If your ASC is adding high-acuity procedures, your controlled substance management needs to evolve with you. Here's what you need to know.
Why High-Acuity Cases Change the Game for Narcotic Management
What Changes When You Add Complex Cases
When you're performing cataract surgeries or routine colonoscopies, your controlled substance usage is relatively predictable and low-volume. But once you start taking on total joint replacements, spine fusions, or pain management procedures, the stakes change fast.
You're dealing with:
Higher-potency medications like fentanyl, hydromorphone, and ketamine
Larger quantities being pulled, used, and wasted per case
More complex dosing that requires precise documentation
Greater diversion risk because of the volume and potency involved
Manual logs and paper tracking systems that worked fine for lower-acuity cases quickly become a liability. When you're managing higher volumes of Schedule II narcotics, the margin for error shrinks - and the consequences of mistakes get a lot more serious.
What Regulators Are Watching For
Increased Scrutiny for Facilities Adding New Procedure Types
As ASCs expand into high-acuity procedures, regulatory scrutiny is intensifying. Accreditation surveyors and state boards know that facilities new to complex cases are higher-risk, and they're paying close attention to controlled substance protocols.
Here's what they're looking for:
Complete documentation for every dose pulled, administered, wasted, and returned
Real-time accountability - can you account for every milligram at any moment?
Diversion prevention protocols that go beyond just counting pills at the end of the day
Waste witnessing procedures that are being followed and documented
Audit trails that can withstand scrutiny if something goes wrong
If your answer to "show me your controlled substance records" is a stack of handwritten logs in a binder, you're going to have a problem. Surveyors want to see systems that create accountability, not just after-the-fact record-keeping.
The Hidden Costs of Staying Manual
Why Manual Tracking Doesn't Scale
A lot of ASCs assume that upgrading to automated narcotic tracking is a "nice to have" - something they'll get around to eventually. But when you're handling high-acuity cases, the hidden costs of manual tracking add up fast.
Staff time: Nurses spend 30-45 minutes per day on manual narcotic counts, log entries, and discrepancy investigations. That's hours of productive time lost every week.
Wasted doses: Manual systems make it easier for partial doses to go undocumented or for syringes to expire before they're used. Even small amounts of waste add up.
Compliance penalties: A failed audit or accreditation finding can result in fines, mandatory corrective action plans, or in severe cases, loss of DEA licensure. The cost of non-compliance is exponentially higher than the cost of a tracking system.
Operational delays: When discrepancies pop up, manual systems require staff to trace back through logs to figure out what happened. That's time your OR isn't turning over.
When margins are already under pressure - which they are for most ASCs right now - these hidden costs become a real problem.
What "Ready" Actually Looks Like
Five Essential Capabilities Your System Needs
So what does it mean to be truly ready for high-acuity procedures from a controlled substance management standpoint? Your system should be able to do this:
Real-time tracking - Every withdrawal, administration, waste, and return is documented instantly, not at the end of the shift.
Automated accountability - The system knows exactly what's in the cabinet, who accessed it, and when, without relying on manual counts.
Audit-ready reporting - You can pull a complete report on any medication at any time, with full chain of custody documentation.
Diversion detection - The system flags unusual patterns or discrepancies before they become major problems.
Workflow integration - Narcotic documentation happens as part of the normal clinical workflow, not as an extra administrative step.
If you can't check all those boxes, your infrastructure hasn't caught up to the complexity of the cases you're taking on.
The Bottom Line
Expanding into high-acuity procedures is a smart move for ASCs - but only if your operational systems can support it. Controlled substance management is one of those behind-the-scenes functions that doesn't get a lot of attention until something goes wrong. And when you're dealing with higher volumes of potent narcotics, "something going wrong" can have serious consequences.
The question isn't whether you can afford to automate your narcotic tracking. The question is whether you can afford not to.
If your ASC is adding complex ortho, spine, cardio, or pain cases, now's the time to take a hard look at your controlled substance protocols. Manual logs got you this far - but they won't get you where you're going.
Ready to see how automated controlled substance tracking works in practice? Schedule a demo to see how MedServe helps ASCs manage high-acuity procedures with confidence.
