ASCs remain one of the most efficient sites of care, but growth in 2026 is far from guaranteed. From reimbursement pressure and rising labor costs to anesthesia shortages, payer behavior and patient affordability challenges, ASC leaders shared with Becker’s what they see as the biggest risk to continued expansion in the year ahead.
Question: What is the biggest risk to ASC growth in 2026?
Editor’s note: Responses have been lightly edited for clarity and length.
Kim Brown, BSN, RN. CEO at Corewell Health Orthopedic Surgery Center – Grand Rapids (Mich.): I think the biggest risk to ASC growth in 2026 is the convergence of decreased reimbursement by payers with the rising costs of staff and supplies.
Matt Cavanagh. Principal at CliftonLarsonAllen (Maumee, Ohio): A worsening shortage of anesthesiologists and CRNAs paired with declining anesthesia reimbursement is the No. 1 risk to ASCs. Without reliable, sustainable anesthesia coverage, OR time and ability to migrate cases to the ASC, makes anesthesia the choke point for ASC growth.
Suzi Cunningham, Administrator of Advanced Ambulatory Surgery Center (Redlands, Calif.): Reimbursement. … ASCs will not survive if we are not paid more. The insurance companies expect us to perform surgeries for less than it costs for us to do them. It isn’t sustainable.
Scott Fraser. Founder and Managing Partner of Fraser Healthcare (Malvern, Pa.): While there are tremendous tailwinds for ASC growth in 2026, such as new CMS coverage for higher-acuity procedures like pulse field ablation, the biggest risk is the combined challenge of healthcare wage inflation and the shortage of providers, specifically anesthesiologists and CRNAs. Both of these issues continue to increase operating costs and limit ASC capacity and profitability.
Andrew Lovewell. CEO of Columbia (Mo.) Orthopaedic Group: ASCs are still one of the most efficient sites of care, but the margin pressure is real. Inflation-driven labor costs, anesthesia availability, implant pricing and technology investments are rising faster than both Medicare and Commercial reimbursement in the ASC arena.
Couple margin pressures with payer behavior (narrow networks, prior authorization creep, post service audits) and the risk compounds. Growth without disciplined case mix management, payer contracting strategy and physician alignment can actually erode profitability.
The ASCs that win in 2026 will be the ones that treat growth as a strategic discipline, not a volume grab. All of us have to focus on tightening operational execution, being selective about service line expansion and maintaining leverage with payers and hospital partners.
Patrick Magallanes. President and CEO of Steindler Orthopedics (North Liberty, Iowa:) The biggest risk to Steindler’s ASC growth in 2026 is the widening affordability gap for patients. Rising healthcare costs, higher deductibles and increased out-of-pocket responsibility are shifting financial risk from payers to patients, particularly for elective procedures that can be delayed or deferred. Even when insurance coverage exists, many patients are effectively self-pay at the time of surgery, increasing cancellations, slowing collections and compressing margins.
At the same time, payer contracting behavior, especially efforts by large national insurers to impose standardized reimbursement rates that do not reflect local market economics, threatens ASC viability. When payers refuse to negotiate, patients are steered away from ASCs and into higher-cost hospital settings, undermining site-of-service optimization and driving up costs for employers, patients and the healthcare system without improving quality or outcomes.
Marykay Pulito, BSN, RN. Director of Operations, Wisconsin ASC Division at Advocate Aurora Health (Milwaukee): I believe there are a few things, including cost of supplies and equipment, anesthesia shortages (including salaries and declining reimbursements), staffing shortages and cost of wages and overall payor reimbursement rates.
Chuck Schwab, RN. Executive Director for ASC Ventures of Illinois Bone and Joint Institute (Des Plaines): The biggest risk to volume growth in 2026 will be a capacity issue. With CMS increasing the number of CPT codes allowed in ASCs, the demand for more OR time is evident.
Like most privately-owned ASCs, we can adjust our block scheduling as needed to meet our surgeon demand. Demand has now outpaced our current capacity. We will need to get creative with alternative scheduling, which may include staying open longer or adding weekend hours. We need to use data analytics more extensively to schedule efficiently and accommodate the expected influx of cases. Without finding an effective way to manage growth, we are at risk for physician-owner dissatisfaction and for ASC-appropriate surgeries to be scheduled at non-preferred institutions.
