Editor’s note: This response has been lightly edited for clarity and length.
Question: What specific legislative or regulatory barriers have been the most problematic in ASC development?
Dr. Shakeel Ahmed: Certificate-of-need laws, Stark law restrictions and site-neutral payment disparities remain the biggest barriers we face. Certificate-of-need laws are outdated relics that still exist in several states, requiring surgery centers to prove public need before opening — a monumental task that local hospitals successfully block in most cases.
The lack of site-neutral payments means Medicare continues to reimburse hospitals at significantly higher rates than ASCs, currently almost 80% more for the same procedures. In a fair system, this disparity would drive elective cases to outpatient settings, but that shift still hasn’t happened.
Meanwhile, anti-self-referral laws like Stark law and anti-kickback statutes make it difficult — or even risky — for physicians to invest in or directly access ASCs, even when they know they can provide better patient outcomes at a lower cost.
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.