The regulatory climate in which an ambulatory surgery center (ASC) must operate is complex. Seemingly contradictory regulations at the federal, state, and local levels can be resolved by using the "greatest requirement" approach to facilitate flexibility in the long-term use of an ASC. A well-designed ASC should be profitable, flexible, and attractive to both surgeons and patients. The development team must keep the ultimate goal in mind: a high-performance facility with maximum efficiency, high patient satisfaction, and minimal staff turnover, resulting in lower operating costs and correspondingly higher profit potential. Planning a new facility can be accomplished most effectively through a series of ordered steps for decision making. The ultimate success of an ASC will lie in its ability to meet both initial expectations and longer-term demands for operational flexibility and financial integrity.