At 4:45 p.m., the last outbound route is being loaded for three ambulatory surgery centers. One orthopedic tray is marked available in the warehouse system. A second is listed as at the hospital. A third is somewhere between the distributor, the field representative, and tomorrow morning's first case.
The operations team can probably find enough instruments to cover the schedule. That is not the same as knowing whether the inventory is working.
For years, tray conversations have centered on shortage. Is the set missing? Did it arrive? Was it returned? Can someone scan the carton before the case? Those questions still matter. But the expansion of higher-acuity procedures in ambulatory surgery centers is creating a second problem that is easier to miss: device companies and distributors are carrying more inventory without a reliable way to tell which assets are productive, which are redundant, and which are merely moving around the network.
That turns utilization reporting from a finance exercise into an operating decision.
ASC growth changes the meaning of “available”
CMS added 271 procedure codes to the Medicare ASC Covered Procedures List for calendar year 2026, following the continued movement of procedures out of the inpatient-only framework. The changes include a large number of musculoskeletal procedures and other cases that can require significant instrumentation, implants, and case-specific support. The CMS Medicare payment systems overview and the MedPAC March 2026 report to Congress both describe the expansion of the ASC procedure environment.
The operational consequence is not simply that ASCs will order more sets. It is that the same set may now serve a more distributed network of sites with less slack, less storage, and fewer people assigned to supply coordination.
A large hospital may have several layers of inventory control, a dedicated receiving dock, and an SPD supervisor who knows the recurring loaner patterns. A small ASC may have one coordinator balancing scheduling, vendor calls, implant documentation, and the afternoon carrier pickup. A tray can be physically present and still be operationally unavailable because it has not been received, inspected, reprocessed, reconciled, or matched to the case.
That is why “available” is a weak inventory status. It can mean sitting on a warehouse shelf, sitting in a hospital receiving area, sitting in sterile processing, packed for a case, or listed in a spreadsheet because nobody has updated the last handoff.
When ASC demand rises, those differences become expensive. A set that cannot be located quickly may trigger an unnecessary loaner shipment. A duplicate kit may be purchased to protect against a recurring visibility failure. A rarely used tray may remain in circulation because nobody can prove how rarely it moves.
Movement data is not utilization data
Many teams already have pieces of the answer. A warehouse management system can show shipments. A barcode process can show scans. A spreadsheet can show assigned inventory. A field representative may have a good working memory of which sets are in which territory.
Those tools answer narrow questions. They do not necessarily explain how an asset is being used across its life in the network.
Utilization requires a wider view. How often did the tray leave the warehouse? How long did it remain at a hospital or ASC? Was it associated with a completed case, held as backup, sent back incomplete, or stranded after a schedule change? How many days did it spend in transit, at a dock, in sterile processing, or waiting for a return route?
This distinction matters because an asset can have a high movement count and still be a poor performer. A tray that repeatedly travels between a distributor and a hospital because of incomplete handoffs is not necessarily productive. It may be consuming freight, staff time, and sterilization capacity while serving fewer cases than expected.
The reverse is also true. A specialized set may move only a few times per quarter but be essential for a narrow procedure line. The right conclusion is not automatically to remove it. The right conclusion is to understand its role, its readiness requirements, and the cost of not having it when needed.
That is the difference between counting scans and managing an asset portfolio.
Recent sterile processing literature makes the operational stakes clear. A 2026 article in the AORN Journal describes how loaner instrument sets can disrupt SPD work when they arrive late, lack complete instructions, contain unfamiliar instruments, or create conflicts with existing schedules. The set's arrival is only the beginning of the work. Receipt, decontamination, inspection, assembly, packaging, sterilization, and return all consume capacity.
A utilization model that ignores those steps will overstate the value of inventory that is technically circulating but operationally difficult to prepare.
The budget question is owned inventory versus flexible capacity
For distributors and manufacturers, the familiar response to ASC growth is to add inventory. More procedures and more sites appear to justify more trays, more implant kits, and more regional stock.
Sometimes that is correct. But additional inventory can also mask a visibility problem.
If a company does not know where its sets are, it cannot tell whether demand is exceeding capacity or whether the existing capacity is being lost in transit, left at customer sites, or held in the wrong region. The purchase decision then becomes defensive. The business buys another kit because the first one cannot be trusted to return on time.
A better operating review starts with a shared asset history. For each tray or implant tote, teams should be able to see its current location, recent movement, time spent at each stage, and relationship to scheduled procedures. The goal is not surveillance for its own sake. The goal is to separate four different conditions:
- High-use inventory: assets supporting recurring cases and earning their place in the network.
- Necessary reserve inventory: assets held for coverage, specialty requirements, or schedule volatility.
- Idle inventory: assets sitting unused long enough to justify relocation, redeployment, or a different ownership model.
- Untrusted inventory: assets whose status is unclear, forcing the operation to compensate with duplicate purchases, emergency freight, or manual calls.
The fourth category is often the most expensive. Untrusted inventory creates the illusion that the business needs more physical assets when it may first need better visibility.
This is where automated tracking changes the quality of the conversation. A custom autoclavable tag that remains with the asset through sterile processing can preserve continuity where a paper record or exterior carton label often disappears from the workflow. Real-time location can reduce the time spent hunting. Utilization reporting can then build on that location history to show whether the asset is moving toward cases, sitting in a staging area, or remaining unavailable longer than the schedule can tolerate.
The economics should also be considered at the asset level. A system priced per asset can be evaluated against the cost of lost trays, unnecessary duplicates, idle kits, delayed cases, and staff time spent reconciling conflicting records. That is more useful than evaluating a platform by user count or by how many dashboards it can produce.
Readiness is the operating metric that connects the pieces
ASC leaders do not ultimately care whether a tray generated 18 location events last month. They care whether the right set was ready for the case, whether missing components were discovered early, and whether the team had enough time to correct the problem without disrupting the room.
Manufacturers and distributors should use the same standard. Utilization reporting becomes valuable when it is connected to case readiness. Which assets are assigned to upcoming procedures? Which are still moving? Which are at the wrong site? Which have not been confirmed through the necessary preparation steps? Which sets are repeatedly used as backup because the primary set is unreliable?
That shared picture should be available to operations, field teams, warehouse staff, and clinical customers without requiring each group to maintain a separate version. It should also show the difference between an asset that is physically nearby and one that is actually ready for use.
The ASC shift is therefore not just a reimbursement or site-of-care story. It is a test of whether the industry can manage distributed surgical inventory with the same discipline it applies to manufacturing and finance.
The sharper question is no longer, “Do we have enough trays?” It is, “Which trays are producing capacity, which are protecting capacity, and which are making us buy capacity twice?”
Until teams can answer that from one reliable operating picture, inventory growth will remain an expensive substitute for knowing where the work is.
