Initial staffing should be minimal and may include only a clinical manager, business office administrator, two staff per surgery suite, and one preop/recovery staff member per room. Hire only staff to open the initial number of rooms and identify a reliable PRN staff to support initial opening of the ASC. Develop a plan to reduce cost of supplies. Investigate membership in group purchasing organizations that may offer members discounted costs on supplies. The cost that you will incur on each type of case is a critical component in establishing facility fees. Establishing fees prior to opening gives you a clear advantage in negotiations with payers. Policies and procedures must be developed to meet requirements of licensure, Medicare Certification and accreditation — and, most importantly — to provide the foundation for the organization’s operations. Contracting does not occur overnight. Developing relationships with payers prior to opening will pave the way for smoother negotiations.