Seven ASC leaders joined Becker’s to discuss the financial threats they are most concerned about in 2026, from staffing costs to the changing payer landscape.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What financial threat keeps you up at night heading into 2026? Why?
Beth Hoy. Administrator of New Tampa Surgery Center (Wesley Chapel, Fla.): Staffing costs keep climbing, stipends are growing and reimbursements keep shrinking. The gap gets wider every year, and there is no easy fix. It is the one area where the financial pressure feels relentless, and it absolutely keeps me up at night heading into 2026.
Les Jebson. Administrator of the Orthopedics and Sports Medicine Network at Prisma Health (Greenville, S.C.): Shifting payer landscape – continued push for pricing. Rising operational costs – equipment and personnel, a dynamic regulatory and policy climate.
Joe Peluso. Administrator of Aestique Surgery Center (Greensburg, Pa.): ASCs are facing a significant dilemma centered around balancing quality patient care revenue with actual expenses. Leadership is crucial in having the courage to choose to make difficult decisions. ASCs are navigating a pivotal moment facing rising expenses led by providing quality anesthesia services, improving the scheduling and staffing efficiency model (filling blocks, on time starts, patient selection, and room turnover) that can help to address the additional increasing financial challenges, such as staffing shortages, costs of supplies and drugs, and the need to increase staff salaries with less or stagnant reimbursement from payers.
ASCs have traditionally accommodated surgeons’ scheduling requests to help attract their book of business. Today, because of scheduling inefficiencies, economic challenges, less available and more costly anesthesia coverage, and the need to provide safe, quality care services with declining reimbursement, ASC models need to evolve to address structure, patient expectations, and value. Improving scheduling and staffing inefficiencies is one of the few initiatives ASCs can manage to address the efficacy conundrum while facing cultural and structural resistance.
In lieu of model changes, several ASCs are relying on providing financial subsidies, stipends, bonuses and increased contractual payments to ensure patient care services are available, making the current ASC business model difficult to sustain. Increasingly, ASCs are being asked to subsidize services to cover the gap between the revenue services generated and the cost of providing them.
There will be ASC winners that are willing to change the current model and partner with their providers to make financial efficiency a priority, delivering cutting-edge solutions that enhance patient outcomes and financial operational success. ASCs that do not embrace change will be paying higher costs for services due to inefficiencies in the day-to-day operations of the ASC. There will be ASC losers giving off their profits to subsidize inefficiencies in providing services by clinging to the current model.
Vijay Sudheendra, MD. President of Narragansett Bay Anesthesia (Providence, R.I.): Anesthesia costs and coverage are a top concern for ASCs in 2026, with 67% of surveyed leaders citing anesthesia as a significant financial challenge. There is a growing mismatch between what payers reimburse for anesthesia services and the actual cost of recruiting and retaining high-quality providers, especially in markets with high demand and limited supply.
Many centers are now paying inflated stipends or relying heavily on expensive contract groups, which erodes margins on high‑value cases like spine, total joints and complex GI. Leaders are actively collaborating with anesthesia to renegotiate payer contracts and redesign workflows to improve efficiency and maximize anesthesia time per case.
This cost-reimbursement gap is not a one‑time problem; it’s a structural, ongoing pressure that affects every strategic decision. It forces tough choices: whether to accept more volume at thin margins, how aggressively to pursue new procedures, how much to invest in staff retention and technology, and whether to consider a joint venture or sale to a larger platform for better scale and contracting leverage.
Benita Tapia, RN. Administrator and Director of Nursing for 90210 Surgery Medical Center (Beverly Hills, Calif.): Overhead costs continue to be a significant concern. Staffing, in particular, remains challenging, as hospitals often pay nurses and technicians substantially higher rates for performing the same procedures that are done in an ASC. Despite this, hospitals typically receive nearly double the reimbursement that ASCs are paid for identical services.
At the same time, the cost of supplies and equipment continues to rise. These financial pressures make it increasingly difficult for facilities to maintain high-quality, value-based care while controlling expenses.
Ashley Tenbusch, BSN, RN. Clinical Director of Waverly Lake Surgery Center (Albany, Ore.): Staff benefit package. From salaries to cost of medical coverage. The benefits we provide our independent ASC staff are climbing astronomically, and I wonder at what point we will be unable tot offer the package we do (to compete with the local hospitals). Will there come a time when we have been priced out?
Melissa Waibel. CEO of Guam Surgicenter: There are multiple financial threats that keep me concerned. The ever-increasing prices for supplies, devices, implants and shipping cost which continue to outpace any increases provided via government or private insurance reimbursement. The continuing trend for surgeons to be hospital employees without the ability to utilize the surgery center has a big impact when located in remote locations. The high cost of anesthesia, which requires subsidies through the surgery center. The last threat is patients not having the financial ability to have surgery. More patients are postponing surgery as they need the dollars just to meet their basic needs. I am still hopeful that before the end of 2026, some of these concerns will improve.
