ASC Experts: An Interview with Robert McGee on Building for Healthcare
By Campbell Helm
Robert McGee is a healthcare engineering specialist who has played a central role in the development of dozens of Article 28 Ambulatory Surgery Centers (ASCs) and Office-Based Surgery (OBS) facilities. In this interview, he shares key insights into the unique challenges of ASC infrastructure, real estate considerations in New York City, and what separates a successful healthcare buildout from a failed one.
Q: Robert, to start, how did you find your way into the healthcare side of the engineering field? Was healthcare always your focus, or did your work in the built environment gradually lead you here?
I got into healthcare design in 2015, and since then, it has been my primary area of practice.
Q: How many Article 28 facilities and Office-Based Surgery (OBS) suites have you helped build to date? Are there other types of healthcare environments you’ve worked on as well?
I’ve completed approximately one ASC project per year over the past decade, along with four OBS projects. I've also worked in a variety of other healthcare environments outside of surgery centers.
Q: From an engineering standpoint, what are the biggest differences between an Article 28 ASC and an OBS facility? Where do the two diverge most in terms of infrastructure or design?
The biggest difference is regulatory. Because Article 28 facilities are eligible for government reimbursement, the design requirements are more stringent than OBS facilities. It’s in the details, such as the specific air outlet types required in ORs and higher air filtration standards. Interestingly, OBS design is trending toward stricter standards as well, particularly around air changes in procedure rooms.
Q: We hear a lot of clients say, “I have an OBS that’s ready to convert into an ASC,” but that’s rarely true. Where do most people go wrong in that transition?
I think it’s a misunderstanding of the regulatory process. ASCs involve a much longer, more involved approval process at the state level. In contrast, OBS accreditation is typically much less stringent.
Q: Real estate in New York is always tight. What advice would you give to someone looking for space that could work for an ASC? Are there any red flags they should avoid early?
Infrastructure is key. Many buildings marketed as potential healthcare spaces don’t have the infrastructure needed. I would be wary of any broker or agent urging you to sign a lease quickly. Always involve an engineer and architect before advancing lease negotiations to ensure adequate power, HVAC, plumbing, and life safety systems are available or can be added.
Q: In your experience, how involved should surgeons or clinical leadership be during the design and engineering phase of an ASC? Have you found that early clinical input improves outcomes, or can it sometimes complicate the process?
Client involvement is critical. The only way to properly design an ASC is to understand how it’s used. Knowing the client’s workflow, the practice, and the supporting staff improves the odds of a successful and functional build.
Q: What’s the number one challenge you face when building out a new ASC? Is it code compliance, infrastructure, client expectations, or something else? What is the biggest issue that you’ve faced on a project from an engineering perspective?
Expectation management. We strive to create smooth projects because clients remember how the process felt. That’s why we try to work with partners we’ve had success with architects, owner reps, and especially general contractors, who bear the biggest responsibility in bringing the project to life.
Q: How has healthcare engineering evolved since you started?
Are we dealing with more regulations now, or just different ones? The types of buildings being considered for OBS and ASC projects are becoming more challenging. The regulations are not only increasing but also evolving in complexity.
Q: When you’re brought in to assess an ASC you didn’t design, what kinds of issues do you typically find?
There’s a wide range. Some facilities show a complete lack of understanding of healthcare design standards. Others simply need minor upgrades to bring systems up to modern code as required by inspectors, especially in older buildings.
Q: During the application process, what’s your view on submitting full engineering and architectural plans before contingent approval?
It depends on the team. If we’re working with experienced architects and owners who understand healthcare, we’re more willing to proceed with design before getting contingent approval. Experience makes a big difference.
Q: Looking ahead, how do you see ASC and OBS facility design evolving over the next five to ten years?
Are there trends or technologies on the horizon that you think will reshape how these spaces are engineered? We see OBS facilities trending closer to ASC design standards. Accrediting agencies like QUAD-A are already introducing more rigorous standards. I think we’ll continue to see OBS settings designed to ASC level compliance in anticipation of future needs.
Q: What is the importance of a good engineer on projects?
A good engineer produces comprehensive designs where each decision benefits all trades. It’s not just about what works on paper; it’s about integration, coordination, and foresight.
Q: How can a bad engineer impact a project?
A bad engineer rushes through design under the guise of efficiency and works in isolation. That often leads to problems during construction that should have been addressed in the design phase, surface later, and increase cost and timelines.
Q: Last question: What advice would you give to a young engineer trying to get into healthcare facility work?
Stay curious. Pay attention. This field is challenging, but also incredibly meaningful. The work you do directly benefits society, and you’ll grow tremendously as an engineer if you embrace complexity.