I have been in private practice for two decades in the Pacific Northwest. I started Transform in 2019 to provide value based care for those with obesity. We have offices and surgery centers in Seattle and Portland. Ambulatory or day-case bariatric surgery is safe, affordable, and imprroves access to care. We did the first outpatient gastric sleeve in 2008 and currently perform sleeve, bypass, SADI-S, and revisions in the ASC. Currently, 95 percent of our bariatric procedures are done in the ASC. We will soon have an ASC robotic surgery program. In 2023 I founded Transform Health Partners, a bariatric management service organization, MSO. It provides services for contracting, revenue cycle management, marketing, and administrative support for ASCs and to clinics whether it is a large multispecialty group or an independent practice. The future of our specialty is in the ASC with physician ownership and autonomy.