ASCs are facing a slew of challenges this fall as administrators finalize budgets and prepare for the final quarter of the year — among them, new state taxes, payer uncertainty, anesthesia shortages, inflation and growth pressures.
1. New Jersey’s uncapped ASC tax: On June 30, New Jersey Gov. Phil Murphy signed legislation that lowered the state’s ambulatory care facility assessment rate but removed the $350,000 cap. The law also broadened the scope of facilities subject to the assessment. ASC leaders in the state say the change could raise costs for many centers and slow growth.
“This downward financial pressure not only limits growth but also threatens long term sustainability of smaller surgery centers. This ultimately impacts the ASC industry in New Jersey [trying to meet] the evolving needs of patients and communities,” Meg Stagliano, MSN, president of the New Jersey Association of Ambulatory Surgery Centers, told Becker’s.
2. Payer rate uncertainty: ASCs are navigating significant payer-related pressures in 2025. Leaders cite declining reimbursement rates from both Medicare and commercial insurers, which they expect to continue, directly affecting revenue. Ongoing prior authorization hurdles and slow contract negotiations also pose a barrier to financial stability.
3. Anesthesia staffing shortages: Anesthesia reimbursement and workforce shortages remain among the most disruptive forces for ASCs. Leaders in the space identified anesthesia as one of the top challenges for 2025, with concerns about both costs and coverage capacity.
“The lack of anesthesia providers for ASCs in many markets will continue, and anesthesia compensation will continue to rise,” Adam Spiegel, CEO of Irving, Texas-based NorthStar Anesthesia, told Becker’s. “These two dynamics are at odds: fewer providers and more access needed.”
4. Inflation and rising operating costs: Rising supply, labor and equipment costs, coupled with inflation, continue to outpace reimbursement
“Overall costs have risen — and sometimes doubled in certain areas — since 2020, post-COVID-19,” Will Brancamp, ASC administrator at Infirmary Health System, said. “This includes material and supply costs. Additionally, staffing growth in clinical positions has created a supply-and-demand situation with salaries.”
5. Growth pressures in a competitive market: Financial and regulatory shifts — from CMS adding nearly 300 ASC-covered procedures to state-level certificate-of-need reforms — are fueling new growth opportunities. But pursuing expansion through new service lines, partnerships or real estate strategies like sale-leasebacks requires upfront investment, adding to the strain on ASC budgets.
