Hillsboro Medical Center (HMC), a community hospital serving Oregon’s western Washington County, engaged a team of Oregon Health & Science University (OHSU) Healthcare Administration graduate students to assess endoscopy center operations during the spring of 2023. HMC’s objective was to understand the financial and operational impacts of transitioning all esophagogastroduodenoscopy (EGD) and colonoscopy procedures to a monitored anesthesia care (MAC) sedation model. The scope of the team’s evaluation included comparing current practices with local and national endoscopy sedation standards, analyzing the financial and operational effects of a MAC sedation model, and exploring non-sedation related opportunities for operational improvement at the facility. The OHSU team interviewed HMC employees and local healthcare institutions, conducted an extensive literature review, and performed an introductory financial and operational data analysis.