CMS’ proposed 2027 payment rule, and its continued phase-out of the inpatient-only list opens the door for more procedures to move into ASCs — but not every practice is positioned to walk through it.
David Carmichael, administrator and CEO of Birmingham (Ala.) Obstetric Gynecology, said his practice does not currently own an ASC, though it’s weighing whether that could change.
“Our practice does not currently own an ambulatory surgery center, although we are actively evaluating long-term opportunities as more gynecologic procedures become appropriate for outpatient settings,” he said.
He doesn’t expect the shift to show up in a single year’s numbers.
“For women’s health, I believe the larger impact will occur over the next five to 10 years rather than in 2027 alone,” Mr. Carmichael said. “As minimally invasive gynecologic surgery continues to evolve, more hysterectomies, pelvic reconstructive procedures and other complex gynecologic surgeries can safely be performed outside the traditional inpatient hospital environment.”
“I do not expect a dramatic one-year shift in surgical volume, but I do expect this proposal to accelerate investment in physician-led outpatient surgery programs and partnerships between hospitals and independent physician groups,” he said.
That acceleration, though, may not lift every practice equally.
“One aspect that deserves attention is the continuing consolidation of physician practices,” Mr. Carmichael said. “There are simply fewer independent OB-GYN groups today with enough surgical volume to justify developing an ASC or entering into a joint venture with a hospital. Many smaller independent groups are effectively left on the outside looking in.”
He doesn’t think the dynamic is unique to women’s health.
“While my perspective is from women’s health, I believe this trend extends across multiple specialties,” he said. “As physician consolidation continues, it may unintentionally reduce the number of independent groups able to take advantage of policies intended to expand outpatient surgical care.”
It’s a dynamic that compounds an already uneven picture. Kara Newbury, chief advocacy officer of the Ambulatory Surgery Center Association, told Becker’s that CMS’ own payment update varies widely by specialty under the proposed rule, with some codes seeing double-digit increases and others facing cuts. For a well-capitalized group weighing an ASC investment, that variance is one more factor to model. For a smaller practice without the volume to build a business case in the first place, it may not matter either way.
Mr. Carmichael said the practices that do move forward will need more than operating rooms to make the leap worthwhile.
“For ASCs, success will depend less on adding operating rooms and more on building the infrastructure needed for higher-acuity patients, including anesthesia, recovery protocols, care coordination, quality reporting and data systems that demonstrate excellent outcomes,” he said.
For now, Mr. Carmichael’s practice is watching and waiting, one of many independent groups trying to determine whether the outpatient shift is an opportunity within reach, or one more advantage tilted toward those with the scale to build it.
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