In addition to financial squeezes, ASCs will have other challenges on the horizon in light of economic uncertainty and measures taken by the current administration.
Forty ASC leaders and physicians told Becker’s what they think will be their biggest headwind in 2026.
The leaders featured below are speaking at Becker’s 31st Annual: The Business and Operations of ASCs, Oct. 16-18, 2025, at the Swissotel in Chicago.
If you would like to join the event as a speaker, please contact Scott King at sking@beckershealthcare.com.
As part of an ongoing series, Becker’s is connecting with healthcare leaders who will speak at the event to get their perspectives on key issues in the industry.
Editor’s note: Responses have been lightly edited for length and clarity.
Question: What’s the biggest headwind ASCs will face in the year ahead, and why?
Lacey Dyer. Vice President of Clinical Operations, Advanced Center for Joint Surgery (Uniontown, Pa.): The change in insurance contracting dictating the Site of Service payments will produce a lot of volume coming over from HOPD’s and inpatient settings. The need to be ready and efficient with the case mix and volumes is critical. Also, any attempts to make an HOPD change to an ASC will require a significant change in the culture, especially of true efficiency.
Alex Andrade. COO, Medical Associates (Dubuque, Iowa): The biggest headwind ASCs will face in the year ahead is staffing, both availability and cost. Persistent workforce shortages, particularly among nurses and surgical techs, will pressure centers to balance labor expenses with access and quality. At the same time, reimbursement models are lagging inflation, creating margin compression. To address these challenges, we are launching AI programs to tackle operating issues such as scheduling, staffing optimization, and real-time decision support—helping sustain performance and growth despite these headwinds.
Les Jebson. Administrator, Orthopedics and Sports Medicine Network, Prisma Health (Greenville, S.C.): Workforce Shortages: Finding and retaining skilled staff, particularly nurses, surgical technicians, and especially anesthesiologists, remains a critical challenge. ASCs promote potential lifestyle advantages but compete with hospitals offering higher salaries and benefits. Rising operational costs are probably the biggest headwind, the aforementioned labor shortages coupled with supply chain disruption and inflationary increases on medical supplies and implantables.
Madeleine Bennett. Director of Nursing, Physicians Endoscopy Center, One Nineteen (Birmingham, Ala.): I believe the biggest headwind for ASCs this year will be navigating the growing strain on our workforce while maintaining the highest standards of care. Staffing is stretched and volumes continue to rise, both of which can lead to burnout. What keeps me hopeful is knowing that people enter this field because they care deeply about others. If we, as leaders, invest in our teams by listening to them, valuing their voices, and creating a culture where they feel supported and connected, we can turn this challenge into an opportunity. A highly engaged, cared-for team will always deliver exceptional care to patients, even in the face of headwinds, which is what our patients deserve and a challenge I feel passionate to meet head-on.
Sev Hrywnak, MD. Owner and CEO, Advanced Ambulatory Surgical Center (Chicago): In my view, the biggest headwind for ambulatory surgical centers (ASCs) in the coming year is reimbursement pressure, especially from payers (Medicare, Medicaid, and commercial payers) reducing or lagging payment for ASC services while costs keep rising. Several related factors drive this:
Medicare/OPPS and ASC payer policy: The ASC payment landscape has been tightening, with updates that often lag inflation and can include resets or changes to add-ons and packaging. If the net payment growth is slower than rising labor, supply, and facility costs, margins compress.
Inflation and cost pressures: Wages, benefits, anesthesia and nursing staff shortages, and supply costs (implants, disposables) are rising. If reimbursement doesn’t keep pace, per-procedure profitability tightens. Commercial payer dynamics: Payer mix instability and negotiation pressure with commercial payers can erode margins, especially in markets where hospitals push to shift more procedures to their own outpatient departments (HOPDs) or where high-deductible plans shift some costs to patients.
Jennilee Caffey. Regional Administrator, Baylor Scott & White Sports Surgery Center, The Star (Frisco, Texas): Ambulatory surgery centers enter the coming year facing their most pressing challenge: a widening financial imbalance between reimbursement and operating costs.
While Medicare and commercial payers have provided only modest reimbursement increases—and in some cases actual reductions and bundling—the cost of operating a center continues to climb. Staffing and anesthesia remain particularly difficult, with wage competition driving up expenses and many centers now paying stipends to secure anesthesia coverage. Rising supply and equipment expenses, fueled by inflation, further tighten margins that are already narrow.
Independent centers feel this pressure most acutely, lacking the economies of scale available to joint venture facilities. Inflation-driven cost increases, operational inefficiencies, credentialing delays, and prior authorization hurdles compound the challenge, eroding both efficiency and financial stability. For many centers, partnering with a proven industry leader such as USPI can provide the scale, resources, and operational expertise needed to weather these headwinds and sustain growth.
The demand for outpatient surgical care remains strong and continues to rise. However, the long-term sustainability of ASCs will depend on how effectively they navigate this financial squeeze—balancing cost management, workforce stability, and payer negotiations in an increasingly challenging environment.
Kayla Carey. COO, Ambulatory Anesthesia Care (Rosemont, IL): The most basic but biggest headwind is that operational costs keep rising. The combination of labor shortages, rising overhead, and compression from reimbursement likely means ASCs need to pivot the business model. The impact of tariffs on supply chain costs (or delays or backorders) and other economic uncertainty will put more pressure on the already tenuous position this year.
Janet Carlson. Vice President, Ambulatory Surgery Centers, Commonwealth Pain & Spine (Louisville, Ky.): The 3 biggest headwinds for rising ASCs are: staffing shortages and retention (physicians and registered nurses have never recovered from COVID related work demands, in a nutshell, we are tired), shrinking reimbursements as ASCs are paid a fraction of hospital rates (ASCs are at high risk for underpayment and revenue loss), and ever increasing operational costs driven by rising staff wages, healthcare inflation, and rising prices for equipment and medical supplies. ASCs are consistently threatened by stagnant reimbursement rates, team member satisfaction, escalating costs, market consolidation and competition, supply chain disruptions, payer credentialing, prior authorizations, and overall operational stability.
Wael Barsoum, MD. Orthopedic Surgeon, Cleveland Clinic Florida (Weston, Fla.): The biggest headwind ASCs will face in the year ahead is rising operational costs, specifically as it relates to labor and supplies. Staff shortages and retaining skilled staff continue to be a challenge. In addition to the increased cost for supplies, supply chain shortages and delays are disruptive to overall facility operations.
Regulatory changes, such as the removal of the IPO list and the inevitable site neutral payment reform, will result in more payer audits and market competition pressures from health systems continuing to buy/invest in ASCs. As payers continue to change their policies, administrative burdens such as prior authorizations will also likely increase.
Sherman Tran, MD. Managing Partner, Spine Sports Surgery Center (Daly City, Calif.): The biggest headwind for ASCs is rising costs with flat reimbursements, creating severe margin pressure. Staffing shortages and supply delays add strain, but the cost–reimbursement squeeze is the most urgent challenge to sustainability.
Heather Colon. CEO of Orthopedic Surgery Center, Palm Beach County, Specialized Outpatient Surgery Center for Children and Adults (Boynton Beach, Fla.): One of the biggest headwinds ASCs will face in the year ahead is physician practice sustainability. Running an independent practice isn’t what it used to be. Between labor costs, tech upgrades, and compliance demands that seem to multiply overnight, more and more physicians are leaning on hospital systems or outside partners just to stay afloat. That dependence chips away at their independence, which in turn chips away at ours.
Management companies can be a real lifeline. They bring structure, resources, and a playbook that keeps things moving. But when those management companies are tied to a big hospital system, that’s when the plot twists.. Cases that should be in the ASC pipeline suddenly get funneled back into the hospital department (with those nice, higher reimbursements). But let’s not forget our younger physicians. It’s not that they don’t want opportunities in ASCs; it’s that many are simply limited by the practices or systems that employ them. In other words, it’s hard to invest in an ASC when your employer decides where you operate.
At the end of the day, physician independence fuels ASC success. Without it, we risk losing volume and the culture of efficiency (yes, the kind that lets us start on time, finish on time, and go home early to spend time with family). The challenge ahead is protecting that independence while still leaning on management companies that are truly ASC focused (cough: SCA Health). If we can do that, we’ll keep doing what we do best – delivery high quality care, faster than a hospital can find an open OR.
John Prunskis, MD. Medical Director and Principal, DxTx Pain and Spine (Barrington, Ill.): The biggest headwind ASCs will face in the year ahead is from lobbyists in Washington who want to keep pricing disparity between hospitals and ASCs for identical procedures. The price disparity is unfortunately helping bankrupt Medicare.Also competing against so-called “not-for-profit” hospitals will continue to be difficult since current laws offer them an unfair advantage.
Edward Dixon. Manager, Sterile Processing Department, Sutter Health (Sacramento, Calif.): The biggest headwind for ASCs in the year ahead will be the reciprocation of cases back to the hospital setting. Physicians today have more choices than ever in where to perform their cases, and it is our responsibility to ensure they feel confident and comfortable bringing appropriate cases to the ASC rather than defaulting to the hospital. There are a variety of reasons why we see cases shift back to hospitals, ranging from perceptions about available equipment to concerns about patient needs such as overnight stays. The key to overcoming this challenge is data. By carefully tracking and analyzing the factors that influence physician decision-making, we can identify patterns, address concerns, and create targeted strategies to increase ASC case volume. In the end, having the right data allows us to not only tell the story but also to take meaningful action to strengthen the role of ASCs in patient care.
Nyleen Flores. Administrator and COO, Lake Oconee Orthopedics (Greensboro, Ga.): The biggest headwind ASCs will face in the coming year is the tightening squeeze between payer contracts and the employed physician pipeline. Reimbursement rates in many ASC contracts have not kept pace with rising costs, creating unsustainable financial pressure. At the same time, as more physicians become employed by large health systems, ASCs struggle to secure consistent physician alignment and case volume. Without competitive contracts and strong physician partnerships, ASCs risk losing both financial viability and their ability to deliver high-quality, cost-effective care.
David Wohns, MD. Division Chief, Cardiovascular Medicine and Department Chair, Cardiovascular Health, Corewell Health (Grand Rapids, Mich.): Some potential headwinds for CV ASCs:
- Financial headwinds: rising costs for supplies, facility maintenance and staffing while reimbursement rates may decline.
- Workforce shortages in the healthcare industry may strain ASCs ability to recruit and retain staff as competition grows.
- As Cardiovascular ASCs expand more broadly, migration from hospital-based cath labs may not be as rapid as projected
- States with CON laws may create delays in the migration from hospital-based cath labs.
Sumana Moole, MD. Physician and Founder, Merus Gastroenterology & Gut Health, LLC (Johns Creek, Georgia): The biggest headwind for ASCs in the coming year is the impending ‘great squeeze’, a dangerous combination of significantly declining reimbursement rates and relentlessly rising operational costs. The recent Medicare proposal to slash payments for procedures in ASCs while simultaneously increasing them for office-based services is a direct threat to our financial viability. It not only jeopardizes the sustainability of existing centers but also stifles innovation and expansion, ultimately threatening patient access to the high-quality, cost-effective care that ASCs provide.
Our strategy is twofold: First, unite for advocacy to reverse unfair cuts and achieve site-neutral payment. Second, innovate our operations to control costs without sacrificing quality. This is vital for our financial survival and our patients’ access to care.
Pradnya Mitroo, MD. President, Fresno Digestive Health (Fresno, Calif.): The greatest headwind facing ASCs is staffing shortages and absenteeism. When staffing levels are inadequate, it becomes difficult to fully utilize block time and run the schedule at maximum efficiency. Unplanned absenteeism adds another layer of disruption—creating unpredictable gaps that derail the day’s workflow, force overtime, and drive up the cost per case. Ultimately, these staffing challenges reduce throughput, increase expenses, and undermine operational performance.
Carrie Marut. Administrator, Mentor Surgery Center (Mentor, Ohio): I feel that one of the biggest headwinds facing ASCs will be rates of reimbursement and the cost of anesthesia. In our ASC, our patients are 50% Medicare and the reimbursement for anesthesia on Medicare does not seem to cover the cost of having an anesthesia provider in the room. This causes the ASC to come up with the difference in the reimbursement to provide care. It is a true financial challenge to organizations and the ASC will need to find ways to reduce cost and increase reimbursement to cover the cost of anesthesia providers. In the end it is the patients who suffer with higher out of pocket costs and a reduction in their access to cost effective care.
Owen Prunskis. Co-Founder and Managing Partner, DxTx Pain & Spine (Barrington, Ill.): I am, of course, a big believer that ASC reimbursement should be closer to parity with HOPD rates for all of the reasons that Becker’s readership would be familiar with. That said, I believe patient selection may be one of the most under-discussed risks to ASCs. With more procedures moving off the inpatient-only list, there may be a temptation to shift aggressively into the ASC setting. That’s broadly the right trend: ASCs deliver better quality, lower cost, and higher patient satisfaction.
However, if physicians push too far and take cases that really should remain in a hospital setting, we risk an increase in complications that could spook policymakers and slow the momentum. The opportunity is to be disciplined and thoughtful about patient selection using an evidence-based approach, because if we get that right as an industry, the ASC model only continues to strengthen for patients, physicians, and payors alike.
Angie Jiménez. CEO, Puerto Rico ASC Holding Co. (San Juan, Puerto Rico): I consider the biggest headwind ASCs will face in the coming year to be the financial pressure from rising operating costs combined with shortages of specialized clinical staff.
On one hand, expenses for medical supplies, pharmaceuticals, and new technologies continue to increase, while reimbursement rates from insurers and government programs are not keeping pace. On the other hand, the shortage of nurses and surgical technicians creates challenges in maintaining operational efficiency and forcing ASCs to compete with hospitals and other providers for talent—often at higher wages.
Stan Plavin, MD. President and Owner, Technical Anesthesia Strategies and Solutions; Owner, Oral Surgery Anesthesia Associates; Physician and Owner, Ambulatory Anesthesia Partners: As a former ASCA board member and 25-year plus veteran of the ASC realm, my perspective has always been relatively optimistic.In answering your question and providing what I feel are the biggest headwinds for ASCs over the next year or so; I have to start with what I do on a daily basis, provision of physician-centered anesthesia care. We, as a specialty, continue to be in short supply; often causing disruptions in scheduling of surgeries; for not only hospitals, but also ASCs.
Many of the large corporate anesthesia groups have to focus their attention on maintaining their commitments to their hospital relationships. This does greatly affect downstream relationships and opportunities. The ASCs and OBLs are often the ones greatly affected. In order to meet those needs for ASCs, I urge you to attend the Business of ASCs meeting which will provide perspective and context. In addition to continuity of Anesthesia services, I do feel that the Surprise Billing Act and the lack of engagement by commercial payers has and will continue to have a negative effect on many ASCs.
Many physician practices depend upon the ability to derive ancillary revenue opportunities from their ASCs and this has become much more challenging. These are just a couple of headwinds facing our industry. I still believe that the ASC industry will continue to navigate these challenges and continue to be a successful alternative to hospital care.
Sean Gipson. Division CEO and President, Remedy Surgery Centers (Dallas): As we look ahead to 2026, ambulatory surgery centers (ASCs) continue to play a vital role in the transformation of surgical care delivery. Offering cost-effective, high-quality, and patient-centric alternatives to hospital-based outpatient departments, ASCs are well-positioned to thrive in a value-based care environment. But despite their strengths, the coming year presents a formidable challenge—one that cuts to the heart of their financial viability.
The biggest headwind facing ASCs in the next 12 months is clear: mounting reimbursement pressure from both public and private payers. For years, ASCs have operated within a reimbursement framework that fails to keep pace with the rising cost of doing business. The annual updates from the Centers for Medicare & Medicaid Services (CMS) have been modest at best—and often insufficient to account for inflation, wage growth, and supply chain costs. In 2025, CMS’s adjustments to ASC payment rates were minimal, and there is growing concern that the 2026 update will again fall short of reflecting real-world economic pressures.
Private payers, which often peg their rates to CMS benchmarks, have followed suit. As a result, many ASCs face tightening margins despite taking on more complex procedures and expanding their clinical capabilities.
A defining trend in recent years has been the migration of higher-acuity procedures—like total joint replacements and spine surgeries—into the ASC setting. While this shift has broadened the clinical scope of many centers, it has not been accompanied by a proportional increase in reimbursement.
In fact, the opposite may be true. ASCs taking on more complex surgeries must invest in advanced equipment, staff training, and infrastructure upgrades, all while grappling with reimbursement structures that fail to reflect this added complexity. Bundled payments and risk-sharing models are also being introduced with limited support or financial flexibility, making it harder for ASCs to absorb variability in patient outcomes or resource utilization.
Adding fuel to the fire is the increasing consolidation among commercial payers. As insurers grow larger, they wield greater negotiating power—often pushing ASCs into unfavorable contracts or excluding them from narrow networks altogether. Utilization management tools like prior authorization continue to be barriers, limiting access and creating administrative burdens that cut into efficiency and revenue.
The impact of these reimbursement headwinds is structural, not cyclical. ASCs are finding that they must work harder to protect margins, invest in new capabilities, and maintain clinical excellence—while being paid less, or the same, for doing more. While other challenges persist—labor shortages, regulatory uncertainty, and growing competition from health systems—none is as existential, or as urgent, as the need to secure sustainable payment models.
To weather this storm, ASC leaders must sharpen their focus on payer relations, contract negotiation, and cost management. Those that can align with employers, explore direct-to-consumer models, or participate in innovative value-based care arrangements may find opportunities for growth even amid reimbursement stagnation. The fight for fair and forward-looking reimbursement is not new—but in 2026, it may well determine which ASCs emerge stronger, and which are forced to scale back or consolidate.
Melissa Rice. ASC Administrator, Loyola Ambulatory Surgery Center, part of Trinity Health (Maywood, Ill.): A major challenge ASCs will likely face in the coming year is navigating payer dynamics, particularly with the shift toward value-based care and bundled payments. These models can create financial uncertainty and require significant operational adjustments. Additionally, ASCs may encounter increased competition from hospital outpatient departments and health systems expanding their footprint in the ambulatory space. Staying agile and investing in data analytics and patient engagement will be key to maintaining profitability and quality outcomes.
Waymond Boyer. CEO, Encore Surgical Institute (San Antonio): The biggest challenge we are facing on a daily basis, and fully expect this to be an issue not only next year but also for the years to come begins and ends with Insurance companies. The constant back and forth with payer contracting, credentialing, and reimbursement is such a burdensome game that is only exacerbated by the fact Insurance companies hold all the cards and have the ability to change the rules whenever they feel it is necessary. Healthcare operates on such small margins that any change in revenue cycle could mean the difference in needing or not needing an FTE in a specific role. The cost of everything has increased over the years, but unlike most companies around the world, we are not able to pass along these increases in our fees. This means we must follow every claim possible to ensure we are paid for services rendered and be diligent in educating our team members on any future changes within specific insurance requirements to avoid denials and delays in revenue cycle.
Patty Shoults. Corporate Director, Ambulatory Surgery Centers, AdventHealth (Altamonte Springs, Fla.): A major challenge that stands out is the issue of anesthesia shortages and the associated stipends. These factors may significantly stifle growth and result in tighter room consolidations. It will be crucial to find a balance in offering operating room time to intermittent utilizers while ensuring that the rooms are fully utilized. The economics of having partially empty rooms will be difficult to absorb and could pose a significant challenge for many ASCs.
Helen Lowenwirth. Administrator, East Side Endoscopy (New York City): The challenges of assuring anesthesia coverage and the escalating cost are the biggest headwinds for all ASCs and will determine the future success of many ASCs. In the past anesthesia coverage was never a concern and often a profit center. Now it often dictates the OR schedules and comes with higher costs with stipends and minimum coverage requirements putting more pressure on margins. Payers are also becoming much more aggressive, carving out procedures, denying coverage and limiting services specifically for anesthesia which is putting ASC operators in a very contentious position with our patients.
Megan Friedman. Chair and Medical Director, Pacific Coast Anesthesia (Los Angeles): The biggest headwind ASCs will face in the coming year is managing rising case demand amid a limited clinical workforce, outdated scheduling systems, constrained resources, increasing labor and supply costs, and declining reimbursement. Many centers are operating near capacity, yet still rely on rigid block time and inefficient case distribution, which limits throughput and scalability. To navigate these pressures, ASCs must recognize the value in, and partner closely with their anesthesia leadership—who have visibility across all service lines—to identify where and how to schedule more efficiently. Just as critical is streamlining turnover times and monitoring supply cost per case. Without this kind of operational alignment, financial sustainability will become increasingly difficult.
Jessica Lam. Practice Manager, Pacific Coast Anesthesia (Los Angeles): ASCs will continue facing serious pressure from staffing shortages, declining reimbursement, and rising labor and supply costs—especially in high-volume, multispecialty environments. Anesthesia plays a central role in keeping operations on track—not just by delivering care, but by overseeing the full flow of the day across all rooms and service lines. While surgeons often focus only on their own schedules, anesthesiologists see the entire landscape: staffing gaps, turnover delays, and throughput bottlenecks. If you’re not closely aligned with your anesthesia team, you’re far more likely to experience inefficiencies, cancellations, and dissatisfaction from both surgeons and anesthesiologists in an already tight market. Additionally, as more complex patients shift into outpatient settings, it’s no longer just about filling shifts—it’s about ensuring the anesthesiologists covering ASCs are capable of managing higher-acuity cases safely and efficiently. This requires a strong operational partnership with the anesthesia team. In our experience, leveraging their insight and coordination protects the bottom line far more effectively than any off-the-shelf tool or non–clinically validated cost-cutting initiative.
Vijay Sudheendra, MD. President, Narrangansett Bay Anesthesia (Providence, R.I.): My take on the challenges is this: rising operating costs, stagnant or reduced reimbursements, and staffing shortages are the top concerns right now and will likely remain so in 2026 and beyond. I see three key trends playing out in the future:
– Inflation will keep driving up healthcare operating costs to unprecedented levels.
– Payer policies are shifting rapidly, with more emphasis on value-based models, but without a corresponding increase in reimbursement.
– The tight labor market and shortages of anesthesiologists are pushing compensation up, making subsidies or stipends necessary and blowing budgets out of water.
What Does This Mean for ASCs?
Unless ASCs can find innovative ways to deliver care, manage their revenue cycle extremely well, or partner with larger entities, these challenges will likely lead to slower growth, more consolidation, and difficulties in maintaining the current quality and volume of patient care throughout 2025 and beyond.
Ali Ghalayini. Administrator, Advanced Spine Center of Wisconsin (Neenah, Wis.): The biggest challenge ASCs will face in the coming year is growing cost pressure that’s outpacing stagnant reimbursement rates. Labor costs are rising due to staffing shortages, especially among nurses and surgical techs. At the same time, supply chain inflation and higher facility overhead, like insurance and utilities, are squeezing margins even further.
On the revenue side, reimbursement is not keeping up. CMS updates remain below inflation, and many commercial payer contracts are outdated or locked into multi-year terms. Even as ASCs take on more complex, higher-reimbursing cases like total joints and spine, payers are pushing back with tighter site-of-service policies and medical necessity reviews.
Together, these trends threaten the financial stability of ASCs. Without aggressive management of expenses, smarter case mix planning, and strategic renegotiation of payer contracts, many centers could see flat or declining EBITDA, even if case volume holds steady.
Neil Mangus. Senior Director of Business Development, Ambulatory Surgery Centers, Orlando Health (Orlando, Fla.): As in most health care operations, the cost of care has quietly become a major disruptor in the ASC space. Rising costs across staffing, supplies, and equipment are squeezing margins, and reimbursement hasn’t kept pace.
Still, there are encouraging glimmers of hope. The continued migration of high-acuity procedures in orthopedics and in cardiology and vascular care to the outpatient setting provides a strong tailwind. Our ASCs are also becoming more sophisticated, using technology to optimize case costing, streamline workflows, and improve scheduling. Value-based care models and strategic hospital partnerships are also opening new doors for sustainability. But we need to stay vigilant. The ASCs that will thrive are those that stay agile, invest in operational intelligence, and build smart partnerships to navigate what’s ahead.
Neeraja Kikkeri, DDS. Owner and CFO, North Texas Team Care Surgery Center (Mesquite, Texas): The biggest headwinds facing ASCs in the coming years are the combined pressures of reimbursement, workforce, and compliance. Commercial payers are tightening contracts while CMS continues to restrict covered procedures, leading to shrinking reimbursement and rising denials. At the same time, anesthesia and nursing shortages are driving labor costs to unsustainable levels, compounded by supply chain volatility and inflation. Added regulatory and reporting requirements increase administrative burden, while hospitals and PE-backed systems expand their reach, making competition fiercer. Together, these factors put independent ASCs under significant strain to maintain long-term sustainability. To address these pressures, we have long offered transparent, cash-bundled pricing that attracts patients nationally and provides TPAs and employers with cost-effective alternatives to traditional insurance-based care.
Shobhit Minhas, MD. Orthopedic Surgeon, Fox Valley Orthopedics (Geneva, Ill.): The biggest headwind ASCs will face in the year ahead is preserving healthy financial margins in the face of rising operational costs. Expenses such as staff wages, supply chain disruptions, equipment pricing, and overall overhead continue to increase. Meanwhile, CMS reimbursement for ASC procedures has experienced only modest growth and remains insufficient to keep pace with inflation and escalating costs. Addressing these challenges will require a strong focus on improving operational efficiency, maintaining exceptional standards of care, and using clinical outcomes and cost-efficiency data to demonstrate value to payers. Exploring strategic partnerships or joint ventures with third-party entities may also play a key role in strengthening financial sustainability. Despite these pressures, ASCs remain essential providers of high-quality, cost-effective surgical care, and I believe they are well-positioned to become the “crown jewels” of surgical healthcare delivery in the years ahead.
Paul Lynch, MD, DABA, Founder and Chief Executive Officer, US Pain Care (Scottsdale, Ariz.): The most significant headwind for ASCs in the coming year is the growing mismatch between operating costs and reimbursement. While operating costs, including labor, technology, and supplies, have all continued to rise, payer reimbursement has remained stagnant and, in some cases, actually decreased. This imbalance has challenged the long-term stability of ASCs and limited their ability to invest in innovation. It is necessary for ASCs to learn to control costs while also maximizing reimbursement to remain successful and sustainable.
Miguel Afonso, Clinical Director, Gastroclinic (Recife, Brazil): ASCs in Portugal face growing pressure as operating costs rise faster than reimbursements, with staffing shortages adding to the challenge. The key to navigating this environment will be driving efficiency through innovation. Artificial intelligence, from smarter scheduling to reducing cancellations, offers a real opportunity to boost throughput while protecting care quality.
Niazy Selim, MD. Surgeon, Selim Surgery Center (Lake Charles, Louisiana): 1- Supply chain shortages:
In the past few years, the Healthcare industry has been experiencing extensive delays and shortages in essential medications and medical supplies. Not only prices have more than doubled in some items but also “On Back Order” notices have become the normal displayed warning on many essential medications. This problematic behavior existed before the tariffs. So, we can’t blame the new policies for it. Sometimes, I personally wonder if we are still practicing medicine in the United States of America, the most developed country in the world. The price hikes cannot be simply justified in my opinion.
2- Insurance companies:
We have been experiencing extensive procedures denials or difficulties in obtaining “pre-authorization”. The pre-authorization scam has been discussed in the Becker 2024 Chicago meeting. Also, delayed payments for procedures that have been already performed is becoming the norm. Although there are regulatory rules in the state of Louisiana that mandate the insurance companies to pay within 30 days after the service, this very rule is not followed.
Tara Good-Young. CEO, PDI Surgery Center (Santa Rosa, Calif.): ASCs are facing a paradox of growth without support.
Rising supply costs, escalating staffing expenses, and stagnant reimbursements are eroding financial stability, forcing a trade-off between cost containment and quality care.
Supply chain disruptions have made “just-in-time” inventory obsolete; now, centers must overstock critical items to avoid cancellations, tying up capital while ARs balloon from insurance delays and denials.
This isn’t new, but it’s intensifying. As high-acuity procedures shift to ASCs, the promise of efficiency is undermined by infrastructure that hasn’t kept pace. Demand is surging, yet the financial, supply chain, and talent ecosystems remain out of sync.
John Russell. Executive, Operations, Sutter Health (Sacramento, Calif.): Improved access for patients continues to remain a big opportunity. Sutter Health’s commitment to improving surgical access is alive and well—and backed by bold action and strategic innovation. Here’s a breakdown of how we’re tackling this challenge: Sutter is working to embed outpatient surgery centers within broader healthcare hubs. This model improves coordination, reduces travel time for patients, and streamlines pre- and post-operative care. By rethinking scheduling and resource allocation, Sutter also aims to maximize the use of existing ORs.
Jonathan Brown, MD. Board Member, U.S. Orthopaedic Partners; Orthopedic Surgeon, Bienville Orthopaedic Specialists (Gulfport, Miss.): In the next year, ambulatory surgery centers (ASCs) will face challenges eroding profitability. Rising labor inflation will continue driving up wages amid staffing shortages, while escalating supply costs strain budgets. Increased capital expenditures for advanced technology will squeeze margins, requiring enhanced efficiency and cost management for sustainability.
Narasimhan Jagannathan. Professor, University of Arizona College of Medicine – Phoenix; Division Chief, Anesthesiology, Phoenix Children’s Hospital (Phoenix): The biggest headwind ASCs will face in the year ahead is staffing-particularly anesthesia coverage. The nationwide shortage of anesthesiologists and CRNAs is driving up labor costs, while reimbursement rates from payors and Medicare are not keeping pace. This imbalance threatens margins and may force centers to limit case volume, delay expansion, or lean on less experienced providers. For anesthesia groups, balancing safety, efficiency, and financial sustainability in this environment will be the central challenge.
Thomas Hutchinson, Administrator, Surgery Center of Central Florida (Maitland, Fla.): There are many hurdles each ASC faces individually including staffing, scheduling, and supply chain issues. However, I believe the biggest headwind that ASCs collectively face is the potential of reimbursement cuts. While we all do our best to negotiate with our suppliers to increase our margins, I fear this will eventually deteriorate our reimbursement. ASC’s have all been aggressive and lobbied for better pricing on supplies, and while many of our vendors have partnered with our ASCs to accomplish this, at some point we will be put in the position of payers coming to the realization that we are paying a fraction of the price for the same materials. To combat this, I think volume-based rebate programs are a huge benefit and buffer to our industry. If the ASC can cover the invoiced price and later recoup a rebate either quarterly or biannually, this will preserve the vendor pricing but also allow the ASC and the vendor to partner; allowing the rebated price to create the margin we need. I believe that rebate programs work well for both the vendor and the buyer keeping negotiated prices confidential while also keeping ASCs within necessary profit margins.
E.J. Ledesma. Chief Executive Officer, 360 Orthopedics (Sarasota, Fla.)
Operational costs will continue to rise, primarily labor (wages & benefits) and supply costs. Combined with declining reimbursement, ASC’s will need to explore non-traditional ways to bend the cost curve and, at a minimum, maintain margin. This may include hybrid staffing models, artificial intelligence (AI) for scheduling and patient engagement, at-risk payment models, and direct to employer-based bundles.
