The cost pressures bearing down on ASCs are not uniform. What is squeezing a GI center is different from what is compressing an orthopedic program or a cardiology ASC, and the mix of pressures matters for how administrators respond.
GI: Reimbursement erosion on high-volume procedures
GI ASCs face a reimbursement problem compounding across years. Colonoscopy reimbursement has fallen more than 40% since 2001, even as ASC revenue growth has shifted the balance between professional and facility fees, according to a Medscape report. CMS implemented a 2.5% reduction to work RVUs for endoscopy and other non-time-based codes, arguing efficiency gains, which GI societies say undermines congressional conversion factor increases and risks further devaluation.
The physician pay side tells the same story. Average gastroenterologist compensation dropped from $512,000 in 2023 to $495,000 in 2024, a 3% nominal decrease. Adjusted for inflation, GI procedure pay dropped by 33% between 2007 and 2022, creating long-term instability for practices. The pressure is now reaching a structural tipping point.
“As costs increase and income remains static, there is an inflection point where providers in small practices either take a pay cut as a sacrifice for independence, exit the workforce or join a larger entity,” Surinder Devgun, MD, managing partner of Rochester, N.Y.-based Rochester Gastroenterology Associates, told Becker’s.
Orthopedics: Implant costs that don’t come down
Orthopedic ASCs face a different pressure point on the supply side. According to a December 2025 report from ASC supply purchasing company Advantien, implants are regularly among the highest cost expense items for ASCs and can sometimes exceed the total reimbursement for a procedure.
The COVID-era spike in implant costs has not reversed. On the supply side, implant prices, especially in orthopedics, spiked during COVID-19 and haven’t really come back down. At the same time, there’s a lot of new technology entering the space. Medical supply chain costs are projected to increase 2.41% in 2026.
Mike Boblitz, CEO of Athens, Ga.-based Athens Orthopedic Clinic, told Becker’s that rebate-driven pricing has contributed to higher implant costs for years.
“Implant costs have been inflated for years in exchange with ‘rebates’ that reward ASCs for utilizing higher cost products,” he said.
Cardiology: New procedures, unresolved payment
Cardiology ASCs are navigating a different cost equation, one driven by the gap between newly eligible procedures and payer readiness to pay for them. CMS’ proposed additions for 2026 include more than 200 cardiovascular procedures, such as electrophysiology ablations and device implants, but inconsistent payer coverage leaves ASCs unsure whether these procedures can be performed sustainably in outpatient settings.
Vance Chunn, CEO of Mobile, Ala.-based Cardiology Associates, told Becker’s that payers are scrambling when it comes to pricing and contracts, citing ASCs’ status as a “new space.”
The structural payment gap compounds the problem across all specialties. For 2026, the ASC conversion factor is $56.322, compared with $91.415 for hospital outpatient departments, a gap that ASC leaders say continues to underscore longstanding structural payment challenges, even as CMS acknowledges surgery centers can safely perform a broader range of procedures.
Alignment between Medicare and private payers remains a challenge. Tracy Helmer, administrator of Mesa, Ariz.-based Tri-City Surgical Centers, told Becker’s that the biggest payer issue his ASC is facing is “denials that do not fall in line with the Medicare payable procedures.”
Many private payers aren’t matching Medicare codes for cardiology procedures, Mr. Helmer said.
“For example, loop recorder implants are commonly denied for no prior authorization from private payers, yet, in the Medicare fee schedule, they require no authorization and there’s usually not a problem,” he said.
Anesthesia: The cost no specialty escapes
Cutting across GI, orthopedics and cardiology is an anesthesia cost problem that did not exist for most ASCs a decade ago. Payer policy changes are tightening anesthesia margins, with UnitedHealthcare implementing a 15% pay cut for independently practicing CRNAs in select states and eliminating payments for key modifiers. In some markets, anesthesia groups now require stipends or subsidies to staff cases. In others, consolidation has left ASCs with fewer options and higher prices
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.