Site-neutral payment reforms have been under close watch by ASC leaders over the last several years as the industry continues to advocate for financial parity with HOPDs.
CMS’ 2026 Hospital Outpatient Prospective Payment System rule advances a major step toward site-neutral payment, aiming to reduce the long-standing Medicare payment gap between hospitals and physician offices.
Hospitals currently receive about 60% higher Medicare payments for similar services due to facility-fee differences — a structure lawmakers say incentivizes hospital acquisition of physician practice. New site-neutrality reforms are expected to lower hospital payments, rather than boost ASC payments to HOPD levels.
“I’ve sat down and met with the senators that are putting [site-neutral payment policies] together, and I will tell you that the goal is not to bring up surgery center payments. The goal is to bring down hospital payments to surgery center levels, and what does that mean at a large scale for purchasing,” Adam Bruggeman, MD, CEO of Texas Spine Center and chair of the AAOS Advocacy Council, said during a keynote session at the Becker’s 22nd Annual Spine, Orthopedic, and Pain Management-Driven ASC + The Future of Spine Conference in Chicago, in June 2025. “We talked about the [group purchasing organizations] and having different segments, but what happens when everyone gets paid the same? How is that going to impact vendors and are they going to dig in?”
Daniel Decker, MD, a urologist and co-founder of Vitality Urology Clinic in Mountain Home, Ark., told Becker’s that site-neutral payments could have a significant impact on the ASC space in his region as the demand for surgical services continues to rise over the next several years.
“There’s going to be a 30% increase in ASC usage. CMS—with value-based care, with site neutrality — is really wanting to push that,” he said. “I’m a big believer in it because the type of surgeries I was trained in in residency, we’re now doing in ASC.”
He added that in the rural retirement community he serves, prostate issues and other urology needs are very common, and would have once required a hospital stay. The widespread use of ASCs for specialty care has greatly improved access to these services, and site neutrality would continue that expansion, he said.
Creating opportunities for further expansion in the ASC space would ideally free-up hospital beds and resources to focus on more high-acuity cases — but achieving this synergy will require collaboration and understanding, Dr. Decker added.
“[It’s] a dynamic of getting hospitals to understand that this is in [their] best interest,” he said. “If they don’t figure[this] out, it’s eventually just going to happen — they’re going to make site neutrality.”
