Contract negotiations between ASCs and payers are becoming increasingly complex as both sides sharpen their strategies in a tighter reimbursement environment.
ASC leaders describe a landscape in which insurers are flexing scale, data analytics and network design to contain costs and steer volume, while centers counter with outcomes data, operational discipline and lower total cost of care. At the same time, high-performing ASCs argue that predictable throughput, surgeon alignment and measurable quality outcomes can shift the leverage calculus, particularly in markets where they are essential network partners.
Three leaders joined Becker’s to share where they see momentum building in the ASC-payer leverage struggle, and what will determine negotiating power in the years ahead.
Question: Where are payers gaining leverage over ASCs, and where are ASCs gaining leverage over payers?
Editor’s note: Responses were edited lightly for clarity and length.
David Jevesevar, MD. CEO of OrthoVirginia (North Chesterfield): This is a genuinely dynamic negotiation landscape right now, and pretending it’s one-sided in either direction does a disservice to the complexity.
Where payers are gaining ground: Data asymmetry remains the single greatest advantage payers hold. They understand utilization patterns, cost benchmarks and claims trends far better than most ASCs do. When a payer walks into a contract negotiation with claims analytics and a facility walks in with a spreadsheet, the outcome is predictable. Payers are also leveraging narrow network construction aggressively — particularly in markets with multiple competing ASC options — using the credible threat of exclusion to suppress rates. Tiered networks and reference-based pricing models are additional tools payers are deploying to commoditize surgical facilities.
Prior authorization is another pressure point. In orthopedics, we’ve seen a systematic expansion of PA requirements that creates administrative burden, delays care, and in some cases functionally redirects cases away from the ASC setting entirely. It’s not always about denials, it’s about friction. And that is only amplified by the increasing post-claim denials, which affect not only professional fees but ASC facility payment as well.
Lastly, I continue to read about employers and self-insured entities increasingly bypassing traditional payer intermediaries to contract directly, but we have not encountered the predicted mass migration away from the traditional payer structures. Perhaps it is state or regionally dependent.
Where ASCs are gaining ground: Quality and outcomes data is increasingly the ASCs’ most powerful negotiating asset — but only when facilities collect, validate and present it. At OrthoVirginia, we’ve invested substantially in outcomes infrastructure precisely because demonstrating superior results at lower cost is the most durable negotiating position available. Value-based contract structures, bundled payments, centers of excellence, and episodes of care are spaces where high-performing ASCs can differentiate themselves in ways that procedure-rate negotiations simply don’t allow.
Geographic market concentration also matters. In markets where a high-performing independent orthopedic ASC represents a must-have network partner — particularly in suburban or regional markets — the leverage calculus shifts meaningfully. The practices that will win this negotiation over the long term are those that stop thinking like facilities and start thinking like high-value care delivery systems.
Megan Friedman, DO. Chair and Medical Director at Pacific Coast Anesthesia (Los Angeles): Payers are gaining leverage through consolidation and tighter control over rate growth, particularly in markets where a small number of plans control most covered lives. Annual escalators are modest, and scrutiny around site-of-service differentials is increasing. That pressure limits margin expansion even as operating costs rise.
ASCs gain leverage when they can demonstrate predictable throughput, disciplined cost structure, and stable anesthesia coverage. Centers that deliver reliable performance and lower total cost of care strengthen their negotiating position. In today’s environment, leverage follows operational discipline and measurable value.
Cori Rist, RN. Administrator of Optimum Spine Center (Atlanta): Payers are gaining leverage through tighter reimbursement models, increased prior authorizations, and more aggressive rate negotiations. They’re also using more data to drive utilization management and contracting strategy. At the same time, ASCs hold leverage where it counts, cost efficiency and operational performance.
We deliver high-quality care at a fraction of hospital costs, with strong outcomes and patient satisfaction. As employers and health plans push harder toward value-based decisions, ASCs remain essential partners in controlling spend. Payers may influence reimbursement pressure, but ASCs drive efficiency, surgeon alignment, and the patient experience. That balance keeps the model strong.
