While the bulk of the ASC industry’s major regulatory news is slated for later this year, there are several ongoing points of advocacy and policymaking shaping financial and operational outcomes for ASCs.
“We’re in a little bit of a wait-and-see period with regards to federal rulemaking, because we’re expecting the Medicare physician fee schedule, as well as the hospital outpatient department and ASC rules in, hopefully, early July,” Kara Newbury, chief advocacy officer for the Ambulatory Surgery Center Association told recently Becker’s. She added that ASCA is commenting on the inpatient prospective payment system in response to CMS’ request for information regarding its recently announced joint replacement model.
Ms. Newbury noted that it could be a challenging year for healthcare policymaking, as Capitol Hill remains focused on an array of other high-profile funding issues. Nonetheless, ASCA is paying close attention to several issues impacting leaders nationwide.
Here are three other policy developments ASC leaders are watching:
1. The No Surprises Act: Several physician groups have recently expressed concerns about the No Surprises Act’s independent dispute resolution process, and similar questions are being echoed in the ASC industry.
Fort Worth, Texas-based Radiology Associates of North Texas recently projected more than $51 million in avoidable administrative costs tied to current No Surprises Act arbitration batching rules and unpaid IDR awards. The physician-owned radiology practice said it prevailed in approximately 95% of finalized IDR disputes involving Blue Cross Blue Shield of Texas, yet more than $3.5 million in awarded balances remains unpaid, including nearly $1.64 million outstanding for more than 120 days.
“We’ve been hearing a lot of problems with private payers,” Ms. Newbury said. “I think that a lot of it is backlash to how the No Surprises Act has been implemented. But we had been hearing for a while from new ASCs that some payers were not willing to negotiate with them and have in-network contracts with new facilities. But now we’re hearing some issues even with existing facilities when they’re trying to renegotiate or update their contracts.”
The American Medical Association, 50 state medical societies and 46 healthcare organizations urged congressional leaders to support bipartisan legislation aimed at strengthening enforcement of the No Surprises Act in an open letter released May 11.
The organizations said physicians continue to report that health plans improperly bill patients, delay payments beyond the law’s required 30-day time frame or refuse to pay after physicians prevail in the IDR process. The groups said those practices create financial strain for independent physician practices with limited ability to challenge insurer noncompliance.
“The IDR process is like baseball arbitration — the provider goes in with their number, and the payer goes in with their number, and they pick one. So there’s no middle ground,” Ms. Newbury said. “We’ve had some conversations with some of the payers, and they’re very concerned with some of the awards that are being granted. And I understand that, but I think we can solve a lot of this if they all work together, and if the payers were maybe more open to having contracts and being in-network with facilities and providers.”
She added that the issues persist on both sides, and solutions to IDR-related issues ultimately hinge on all parties acting in good faith.
2. Site neutrality: “Site neutrality is still something that we’re watching,” Ms. Newbury said, adding that during ASCA’s recent ASCA + [Society for Ambulatory Anaesthesia] 2026 conference in Washington, D.C., ASCA leaders shared research with CMS Administrator Mehmet Oz, MD, that highlighted ASCs’ multi-billion dollar cost-savings potential through improved reimbursement structures. According to the research, yearly savings from procedures being performed at ASCs rather than HOPDs is projected to grow from $5.6 billion in 2025 to $12.5 billion in 2034.
These projections could rise further if reimbursement policies continue to keep ASCs tied to the hospital market basket, Ms. Newbury said.
“We think the research shows that the policy has worked and that it’s generating savings by encouraging ASCs to do some of the volume that hospitals were doing,” Ms. Newbury added.
Hospitals currently receive about 60% higher Medicare payments for similar services due to facility-fee differences — a structure lawmakers say incentivizes hospital acquisition of physician practices. New site-neutrality reforms are expected to lower hospital payments, rather than boost ASC payments to HOPD levels.
Many see the shift to site-neutral payments as key to the larger shift toward value-based care, with private practice physicians and ASC leaders frequently identifying the payer landscape as the biggest hurdle towards implementing those initiatives.
“Site-neutral payments, I think, are the lower hanging fruit. That’s an easier problem to solve once we neutralize the payments for procedures done agnostic of their site,” Nikhil Shetty, MD, COO of Midwest Interventional Spine Specialists in Munster, Ind., told Becker’s. “I think we can see big cost savings right then and there. From there we can then move toward a value-based system where we take care of a patient with a bundle payment across a series of related events to a related healthcare issue where we eliminate unnecessary services, coordinate care and reduce complications.”
3. Prior authorization: Ms. Newbury said that some ASC leaders have been experiencing issues with CMS’ Wasteful and Inappropriate Services Reduction, or WISeR, model, an AI-assisted prior authorization initiative under traditional Medicare.
CMS launched WISeR at the start of 2026, with plans to run the model through the end of 2031 in Washington, New Jersey, Ohio, Oklahoma, Texas and Arizona. The model applies prior authorization requirements to select traditional Medicare services and relies on for-profit contractors using AI tools to process requests and reviews. Democrats have attempted to block WISeR through multiple legislative avenues since CMS announced the model last June, including appropriations amendments and standalone legislation, without success.
“Based on [ASCA’s] conversation with Dr. Oz, before he leaves his post, I know it’s his goal to have a very efficient prior authorization process in place,” Ms. Newbury said. She added that the federal government’s recent crackdown on alleged healthcare fraud in prior authorization and other regulatory processes is something to watch, even though the investigations may not be focused on ASCs specifically.
“We don’t have a history of fraud like some other industries have, and we haven’t seen a lot of facilities being accused of fraud,” she said. “But I think it’s always worth noting to be precise and clear in your billing.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.