From new Mako installations, to Rosa knee systems, to spine robots from Globus Medical. surgical robots are rapidly arriving in ASCs.
For many freestanding ASCs, the financial case remains difficult, held back by a reimbursement structure that was built for hospitals and has not caught up to outpatient trends.
The payer problem
Freestanding ASCs sit at the bottom of a three-tier payer reimbursement structure, Shirin Towfigh, MD, a hernia and laparoscopic surgery specialist at Beverly Hills Hernia Center, told Becker’s. A robotic case performed at a main hospital generates the highest reimbursement. The same case at a hospital-based outpatient department generates less. And the same case at a freestanding ASC, the setting where patients often benefit most in terms of cost and convenience, generates the least. A robot does not change the tier.
According to a 2025 study published in Journal of Market Access and Health Policy, total Medicare reimbursement for a total knee arthroplasty is $13,837 compared to $10,339 in an ASC. Reimbursement for total knee replacements by commercial payers in HOPDs was $28,347 in comparison to $21,771 in an ASC.
“It makes no sense financially to do a robotic operation which is expensive in an environment such as a freestanding outpatient surgery center that gives you the lowest reimbursement for that operation,” Dr. Towfigh said.
As a result, the setting most aligned with the direction healthcare is moving is the one least rewarded for investing in the technology driving it there.
“If you become too heavily reliant on expensive technology, then the transition to the outpatient arena will be very difficult,” Kern Singh, MD, co-director of the Minimally Invasive Spine Institute at Rush in Chicago, told Becker’s. “ASCs don’t have the resources or capital to spend a million dollars on the robot when the procedures can be performed without that system.”
The industry has moved faster than payers to close the gap. Over the past decade, robot manufacturers have developed leasing arrangements, per-procedure pricing and case-volume rebate models that dramatically reduce or eliminate the upfront capital outlay.
But financing innovation solves only half the problem, Dr. Towfigh said.
“Insurance really has not done their job of allowing that to be a feasible financial situation,” she said. “So that’s a major roadblock right now.”
How data can help spine ASCs crack the code
Some ASCs are finding ways to make the math work through a more rigorous financial modeling.
Ortho Rhode Island’s approach offers one model. When the Providence-based orthopedic group earlier in 2026 became the first ASC in the state to bring in Stryker’s Mako SmartRobotics for reverse shoulder replacements, the decision was not built on just clinical reputation or surgeon preference. It was built around what the organization calls a “margin per minute” assessment — a framework that combines procedure cost, OR time and blended revenue to evaluate any new technology against every other case the center performs.
“We know every cost. We know how much time everything takes. We know the margin. We know our average revenue is blended,” Michael Bradley, MD, president and CEO of Ortho Rhode Island, told Becker’s. “We put those all together, and it creates basically a level playing field with every other procedure.”
When Ortho RI evaluates a robotics investment, Dr. Bradley said the organization works through three questions: Does it make you better, meaning it enables clinical capability the center could not reliably offer before? Does it make you faster, improving OR efficiency in a way that directly affects margin? And does it save you money?
“On most deals, you have volume commitments. We know those like the back of our hand,” he Bradley said. “There’s probably an associated fee per case that is added to it. We look at the efficiency of it, and if it’s still, at the end of the day, a valuable case to us, then it’s worthwhile to do that.”
Younger surgeons expect robots
Even where the reimbursement math is unfavorable, many ASC leaders say they are moving toward robotics regardless because their surgeons are leaving them little choice.
The physician pipeline has changed. Residents and fellows coming out of training programs today have spent their formative years on robotic platforms. Many have never performed certain joint replacement or spine procedures without one. When they enter practice and look for a center to affiliate with, the presence or absence of a robot is increasingly a deciding factor.
“A robotic portfolio in orthopedics especially is really important,” Michael Boblitz, CEO of Tallahassee Orthopedic Clinic, told Becker’s in 2022. “It provides a minimally invasive solution, but also the younger physicians coming out — that’s just how they’re trained. So if we really want to attract the best and be the best, and have the comprehensive service delivery of all the options and techniques, then a very robust robotic surgery platform is important.”
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