As technological advancements, patient preferences and payer incentives continue to make ASCs a more widely accessible and popular setting for surgical procedures, leaders must take note of and balance a number of impending opportunities and developments.
Jeanine Watson, MSN, RN, senior manager of the ambulatory surgery division of the Association of periOperative Registered Nurses, recently joined Becker’s to share her thoughts on where the industry is headed next.
Continued procedure migration
CMS added 573 procedures to the Covered Procedures List for ASCs in November 2025, including many in cardiology, spine and orthopedics. The addition of these procedures was the result of years of advocacy from both ASC and specialty leaders who demonstrated the safety of these procedures in the outpatient setting.
“ASCs are performing procedures with increased complexity,” Ms. Watson said. “They are performing spine cases now, total joint cases and minimally invasive cardiac procedures. I believe those are all going to continue to move to the ASC model.”
The continued shift of procedures to the outpatient setting will not only benefit ASCs, but could optimize inpatient treatment as well.
“I believe that in the not-so-distant future, the inpatient world will really be reserved for those who don’t meet medical criteria for same day surgery,” she said. “I think hospitals will be reserved for — trauma, transplants, major heart procedures and those with risk of significant blood loss, complications or requiring inpatient post-operative care.”
This vision is shared by some health system and hospital leadership leaders. Samuel Bauer, MD, a maternal fetal medicine specialist and chief medical officer of Corewell Health William Beaumont University Hospital in Royal Oak, Mich., told Becker’s that outpatient care will play a critical role in preparing for anticipated increases in patient volumes in the coming years while also improving patient experience.
“It’s a yin and yang for sure. William Beaumont University Hospital is a very large surgical hospital, so you want to be doing lots of surgery in the hospital,” he said. “But we’re moving a lot of this work that was traditionally all done in the hospital to the outpatient [setting], ASCs and other areas. There’s additional capacity, but you need the revenue so that you can continue to get another robot or to add another line of subspecialty surgery.”
More staffing issues
“Unfortunately, on staffing, we’ve been talking about it for 20 years and I think we’re going to talk about it for 20 more,” Ms. Watson said. ASC leaders have consistently cited staffing issues as a chief concern, ranging from anesthesia providers to front desk staff and physicians.
“In our experience, the staffing issues primarily surround registered nurses and certified surgical technologists,” Jane Whinnery, COO and administrator of Wellbridge Surgical in Indianapolis, told Becker’s. “As an ASC, it’s very difficult to compete with the salaries of hospitals as they skyrocketed during and after COVID-19. We have attempted to keep our salaries competitive, but our true approach to attracting and retaining top talent is to offer an environment that is difficult to achieve in a hospital system.”
ASCs have gotten creative in their approach to staffing issues, offering non-monetary benefits such as self-scheduling, ownership opportunities and leadership development.
Sixty-one percent of ASC leaders said recruiting new surgeons is their biggest physician-related risk for 2026, according to a VMG Health survey. This concern is echoed across the physician market. In an August Medscape report, 63% of physicians said they see a shortage of qualified applicants in their local market, compared to 23% who do not and 13% who are unsure.
John Petroni, managing owner of Las Vegas-based Silver State Surgery Centers, told Becker’s that addressing these concerns “has required the ownership team to focus on strategic planning, open communication and a commitment to fostering relationships with potential physician partners who are willing to embrace the ASC model they worked so hard to build.”
Technology shifts
According to the Ambulatory Surgery Center Association’s July 2025 survey, 76% of ASCs now use an EHR, up from 55% in 2021. Yet nearly 1 in 4 ASCs still rely on paper, and two-thirds of those plan to remain paper-based until regulations force a change. Cost is the top barrier, with 49% citing expense as the reason for staying analog.
“I think the biggest challenge for ASC moving forward is that most are still on paper and charting,” Ms. Watson said. “Now, they might scan it in and store it somewhere, and call that a hybrid electronic method, so you can go back in and see the scanned paperwork that has been done,” but their systems nonetheless remain largely unintegrated.
For the first time since 2021, ASCA’s survey found data collection ranked as the most valuable EHR benefit, cited by 87% of users. Data is increasingly seen as a tool to improve efficiency, strengthen payer negotiations and demonstrate outcomes.
“You’ll be able to pull data accurately and efficiently,” she said. “If you’re trying to pull data manually, you’re never going to keep up with it. It just evolves too quickly. Manual data collection is prone to errors, and this data is often used to determine the quality-reporting outcome measures for CMS.”
