ASC leaders across the country say 2026 will bring escalating financial and operational pressure, from anesthesia provider shortages and stagnant reimbursement to rising supply costs and tightening payer contracts.
To stay competitive, they are doubling down on efficiency, alignment and financial discipline while pushing payers and policymakers to recognize the true cost of ASC care.
Question: What is the single biggest obstacle your ASC is preparing for in 2026?
Editor’s note: Responses have been lightly edited for clarity and length.
Joe Carlon. President of Desert Spine and Sports Physicians (Phoenix): The issue we spend the most time preparing for is creating physician alignment. That alignment comes from the convergence of strong financial performance, operational excellence, superior patient outcomes and access to a robust peer network. If we create that environment for our physician partners across all centers, we believe we can consistently overcome the challenges facing us in today’s changing environment.
Suzi Cunningham. Administrator of Advanced Ambulatory Surgery Center (Redlands, Calif.): From my perspective, we are battling to maintain profitability against the odds.
Battle 1: Payer contracting. Payers hold all the cards. In many ways, they determine survival. If they offer reasonable reimbursement, we can sustain operations. But if they ignore contract amendment requests, go years without updates and then offer only a 3% increase on a long-stagnant agreement, it leaves us performing surgery for free — or at a loss.
Battle 2: Vendor pricing. Independent surgery centers lack the buying power of hospitals and large ASC groups, leading to higher costs for supplies, implants and drugs.
Battle 3: Medicare reimbursement disparities. ASCs receive about 50% less reimbursement than HOPDs or hospitals for the same procedures, implants and supplies.
These are the things that administrators are thinking about. Keeping our surgery centers profitable enough to keep providing vital care to our communities. We have proven that we provide better outcomes, easier and quicker access to care and we do it in a specialized environment. We are small but mighty! We need payers to pay us commiserate with the services we provide, we need our vendors to come up with a more competitive tier of pricing for ASC’s and we need our legislators to advocate for higher Medicare reimbursement.
Sean Gipson. CEO and ASC Division President of Remedy Surgery Center (Houston): The single greatest obstacle we are preparing for in 2026 is the continued compression between rising operational costs and stagnant reimbursement. This pressure challenges every aspect of ASC performance; from staffing and supply chain stability to our ability to invest in innovation and growth.
As a leadership team, we are proactively addressing this issue by strengthening our financial discipline, optimizing throughput and deepening our partnerships with physicians and vendors. We are also prioritizing staff retention and clinical excellence, because our people and our outcomes remain our greatest differentiators.
While the cost environment is evolving rapidly, we are entering 2026 with a clear strategy, a united team and a commitment to not only meet these challenges but turn them into opportunities for smarter, more resilient operations.
Thomas Jeneby, MD. Plastic Surgeon in San Antonio: We aim to achieve anesthesia independence in 2026 by relying fully on in-house practitioners. We currently supplement our anesthesia team with an outside group. We have three in-house providers, but as volume increases, we must pay inflated prices. Our goal is to eliminate that dependence.
Isaiah Johnson. CEO of Bhatti GI Consultants (Chaska, Minn.): In 2026, we are preparing for continued changes from CMS. Instability within CMS creates tension for revenue cycle and financial planning and analysis teams. Without consistent guidance, it is difficult to prepare for the unknown.
Beth Russell, MSN, RN. Executive Director and Vice President of Surgical Services at Knoxville (Tenn.) Orthopaedic Surgery Center: The single biggest obstacle we’re preparing for in 2026 is navigating the new anesthesia landscape facing ASCs. Shifts in anesthesia contracting and reimbursement have created significant cost pressures, and the challenge is maintaining efficiency and access to care while absorbing these changes.
We are focused on redefining workflows, optimizing scheduling and — most importantly — working with payers to ensure reimbursement structures reflect the true cost of safe, high-quality anesthesia services. Balancing financial sustainability with patient-care excellence will be a critical priority for every ASC in the coming year.
Chuck Schwab, RN. Executive Director for ASC Ventures of Illinois Bone and Joint Institute (Des Plaines): The biggest obstacle for our ASCs heading into 2026 will be effectively managing capacity. As outpatient orthopedics increasingly shifts to ASCs, efficient operations will be essential. Using advanced data analytics and AI to optimize daily operations will be essential.
To succeed, we must improve block utilization, accurately schedule cases and partner with anesthesia and manufacturer vendors to support increased operational capacity.
