On the Brink

On the Brink of a Business Plan

As we wrap up the first season of the podcast, it’s worth reflecting on the ground we’ve covered. We’ve dug into the forces reshaping surgical practice—how patient expectations are evolving alongside the push toward outpatient care, and what that means for how surgeons deliver services. We’ve also tackled the harder conversations about reimbursement pressures and provider burnout, issues that threaten the long-term sustainability of healthcare in communities across the country. Today we’re looking forward. Our guest is Greg Venn, CEO of Nexcore, who has spent more than 25 years working in healthcare real estate. He’s seen firsthand how the physical infrastructure of healthcare has evolved and has a clear perspective on where things are headed. His experience spans the development and investment side of the industry, giving him a unique vantage point on the decisions that will shape surgical practices for years to come. In this conversation, we’re focused on giving surgeons the insight they need to navigate what’s next—particularly when it comes to ambulatory surgical centers. As ASCs continue to grow in importance, understanding the real estate and investment landscape behind them becomes essential. Greg’s perspective will help connect the dots between infrastructure trends and the practical realities of running a surgical practice in the decade ahead.

On the Brink of the Future of ASCs

Declining reimbursements and rising costs have left many surgeons searching for strategies to secure their practice’s future. In this episode, we explore why real estate investment has become an essential component of financial planning for surgical practices, not a peripheral consideration. Dr. David Mack, an orthopedic surgeon with decades of experience in both medicine and real estate, shares his journey from small practice to thriving multi-physician establishment. He offers candid insights on what it takes to move from tenant to owner, including developing a clear vision that goes beyond aesthetics to encompass clinical workflows and long-term goals. He also addresses the real challenge of building consensus among physician partners. The through-line: surgeons possess expertise that translates well to evaluating real estate opportunities. With trusted advisors and a proactive mindset, physicians can move beyond perpetual rental arrangements toward ownership models that strengthen their finances and their ability to deliver exceptional care.

On the Brink of Belief

Dr. Eric Haas has spent his career at the forefront of colon and rectal surgery, but his ambitions extend beyond the operating room. As founder and president of the Houston Colon and Rectal Surgical Group, he recognized that leasing clinical space came with limitations—for his practice and his patients. That realization sparked a journey into healthcare real estate development that would reshape how he delivers care. In this episode, Dr. Haas walks Carolyn through building a purpose-built facility designed to bring specialists together under one roof. His vision centers on collaboration: surgical and gastroenterological services working in concert, creating a seamless experience for patients who often navigate fragmented care. It’s an approach reflecting a broader shift in healthcare, where integration is producing better outcomes. But vision alone doesn’t build buildings. Dr. Haas opens up about the practical realities: finding the right land, aligning with partners who understand healthcare development, and navigating a process most clinicians never encounter. His story is inspiration and instruction for any physician considering a similar path.

On The Brink of Designing Your ASC

Episode 6: On The Brink of Designing your ASC Guest: Drew Garst, Principal & National Healthcare Leader of ASCs, Boulder Associates Drew has designed 400+ surgery centers across the country. He's seen what works—and what tanks a project before construction even starts. Your architect choice matters more than you think. ASC design is its own animal, and getting it wrong costs you time, money, and headaches. Most surgeons overestimate their OR size. Drew shares how mockups saved one project 120 square feet per room—with zero loss of functionality. We also dig into the equipment trap: delay those decisions and you'll pay the price in change orders and construction delays. Smart developers build in "soft spaces" from day one—strategically positioned areas that can expand naturally as your practice grows. And if you're thinking any healthcare architect will do, think again. Hospital design and ASC design are fundamentally different disciplines, and the nuances matter. The bottom line: start with vision, not square footage. The right partner asks what outcomes you want before drawing a single line.

On the Brink of a Blueprint

Planning a medical facility or ambulatory surgery center isn’t just about picking a floor plan—it’s about orchestrating a complex collaboration between healthcare providers, architects, and contractors to avoid costly mistakes down the road. In this episode, we’re joined by Steve Christoff, Senior Vice President of Design and Innovation at Nexcore, who brings decades of experience designing outpatient centers that actually work for the people using them. Steve breaks down why the most successful medical facilities start with a clear understanding of desired outcomes. What are you really trying to achieve? Once you answer that question, everything else—from layout to workflow to technology integration—falls into place. But here’s the catch: there’s no one-size-fits-all solution. Steve explains why cookie-cutter designs often miss the mark, and how tailoring facilities to the unique needs of each healthcare provider and patient population leads to better outcomes and greater efficiency. We also explore the importance of thinking ahead. Healthcare is rapidly shifting from inpatient to outpatient settings, and your facility needs to evolve with it. Steve discusses how smart design creates flexible spaces that can adapt to future clinical innovations without requiring expensive renovations. Throughout the conversation, we dive into key performance indicators that separate truly effective facilities from those that just look good on paper. If you’re planning a medical facility or simply want to understand what separates great healthcare spaces from mediocre ones, this episode reveals the strategic thinking that drives real results.