ASCs are starting 2026 with growing momentum as more complex procedures shift out of hospitals and into lower-cost outpatient settings.
But that growth is colliding with intensifying financial and operational pressures, including rising labor, supply and implant costs, persistent anesthesia shortages, and widening reimbursement gaps with hospital outpatient departments.
Joe Peluso, administrator of Greensburg, Pa.-based Aestique Surgery Center, joined Becker’s to discuss how the accelerating pace of change is forcing ASC leaders to rethink how they balance expansion with long-term sustainability, particularly as higher-acuity cases increase resource demands without corresponding payment adjustments.
Editor’s note: This interview was edited lightly for clarity and length.
Joe Peluso: Change has become the standard in healthcare, but the scope and pace of change is accelerating in 2026. As ASCs enter 2026, they face a complex environment with rising healthcare costs, shifting patient expectations, new technologies, market workforce pressures and evolving federal policies presenting new challenges and opportunities for healthcare organizations such as ASCs. ASCs are experiencing several challenges including rising labor, supply and implant costs, payer contracting, billing and collection complexity, anesthesia shortages and margin pressure. These trends make it difficult to project ASC revenues along with the increasing complexities of billing and coding, and service lines vulnerable to economic downturns. Economic and workforce adjustments are needed to support growth. ASCs need to work closely with surgeons and anesthesia to choose high-value products and services that support excellent outcomes without compromising the sustainability of margins that will position ASCs for long term sustainable growth. The ASC industry is entering 2026 with plenty of momentum, but there are challenges that need to be addressed as we progress forward.
A major change that would positively impact ASCs challenges is to address the payment issue. ASCs are currently reimbursed at lower outpatient rates (on average 46 % less) than hospital outpatient departments, despite requiring similar resources for higher acuity cases with higher utilization costs.
The healthcare needs of the 65+ population are growing and are more complex. Seventy-nine percent have two or more chronic conditions that require specialized clinical procedures such as neurosurgery, orthopedics and cardiac care. Forty percent of ASC eligible procedures are currently being performed in HOPDs and those cases will steadily migrate to ASCs. CMS predicts that healthcare costs will rise to $8.5 trillion by 2033, with per capita expenditures at $24,200 or one fifth of the GDP.
The continuing shift of higher acuity and lengthy cases to ASCs, partly driven by an aging population, as CMS is eliminating the inpatient only list, will require the development of a “fair site neutral” payment system for outpatient procedures that also includes payment for extended stays (less than 24 hours). A broad range of spine and musculoskeletal procedures can be performed safely, with high quality, and at lower costs with “site neutral payments” for payers and patients.
