For many ASCs, implants have become a difficult expense to manage, often requiring large upfront payments while reimbursement remains inconsistent.
“Implants and surgical supplies are the most consistently misaligned ASC expense,” Peter Bravos, MD, chief medical officer of Sutter Health’s Surgery Center Division, told Becker’s. “They often require an immediate, high-cost purchase, while payer reimbursement is delayed and frequently reduced, bundled or denied. Costs also vary by patient and surgeon, coverage rules are inconsistent and documentation issues may further reduce final payment.”
Dr. Bravos said vendor models such as consignment and rep-managed inventory can further widen the gap between when ASCs incur costs and when they are reimbursed.
“While other expenses present their own challenges and can fluctuate relative to payment, none combine the same level of upfront cost, cash exposure and reimbursement uncertainty as implants and supplies,” he said.
According to a December 2025 report from ASC supply purchasing company Advantien, implants are regularly among the highest cost expense items for ASCs and can sometimes exceed the total reimbursement for a procedure.
Mike Boblitz, CEO of Athens (Ga.) Orthopedic Clinic, said rebate-driven pricing has contributed to higher implant costs for years.
“Implant costs have been inflated for years in exchange with ‘rebates’ that reward ASCs for utilizing higher cost products,” he told Becker’s. “New payer proposals include increasing facility rates in exchange for ASCs eliminating the inflated rebate-driven prices. This can create a net positive to private orthopedic practices that operate ASCs via aggressive negotiations with vendors that are hungry to capture market share — at prices below current market rates. A great approach to help reverse the rapidly rising cost of healthcare for employers.”
Sean Gipson, division CEO and president of Dallas-based Remedy Surgery Center, said the cost of surgical implants, disposable instruments, medications and personal protective equipment has steadily increased since the start of the COVID-19 pandemic, with many prices never returning to pre-pandemic levels.
“ASCs, which lack the bulk purchasing power of large hospital systems, are particularly vulnerable,” he said. “Many are forced to overstock key supplies to avoid backorders, further straining their cash flow and storage capacity. We’re seeing 15% to 30% increases on some of our core supplies, year over year. Perhaps the most significant pain point is the widening gap between operating costs and reimbursement.”
Carmel Galster, RN, administrator of Wausau (Wis.) Surgery Center, said implants remain one of the clearest examples of costs outpacing reimbursement. She pointed to the Inspire procedure, which requires a unique implant that costs more than the full Medicare reimbursement in her region.
The reimbursement landscape can be especially difficult for orthopedic implants. According to the Advantien report, payers use a wide range of reimbursement models, requiring ASC administrators and revenue cycle leaders to closely track the details of each payer contract.
Advantien said ASCs may be able to address that issue through strategies such as kitting, which can increase the billed implant cost by including a disposable item. The report also recommends that ASCs calculate detailed case costs for all procedures to determine whether reimbursement justifies performing the case in the ASC. If it does not, leaders may need to renegotiate reimbursement with payers or reconsider whether the case is financially viable in the outpatient setting.
At the same time, manufacturers may offer rebates or volume-based discounts to encourage loyalty and increase market share. According to Advantien, strategically managing those vendor relationships can play a key role in ASC profitability.
Lindsay Lauderdale, senior director of development at San Antonio-based Huebner Ambulatory, said rising implant costs have increased the expense of performing cases without a corresponding increase in reimbursement.
“To mitigate these circumstances, we’ve had to be more diligent in reviewing reimbursement allowables and selecting cases we allow to be performed at the center, strengthen our vendor negotiations, while optimizing our supply chain management to preserve both clinical quality and financial sustainability,” she said. “While patient care and outcomes remain at our forefront, these cost pressures require ongoing evaluation of case mix, supply utilization and operational efficiencies.”
Mahesh Mulumudi, MD, co-founder and CEO of Lynnwood, Wash.-based CardioNow, said ASCs can also reduce pressure by tailoring device selection more carefully.
“Often, we assume a one-size-fits-all approach for all patients, which is not the most resourceful or cost-effective strategy,” he said. “Tailoring device selection to individual patient needs can help mitigate expenses.”
There’s also a Medicare policy affecting coinsurance payments for certain procedures, particularly those involving implants, may be disincentivizing patients from using ASCs and creating barriers to lower-cost care settings.
A Medicare policy affecting coinsurance payments for certain procedures, particularly those involving implants, may be discouraging patients from using ASCs and creating barriers to lower-cost care settings.
For many procedures, Medicare beneficiaries pay 20% coinsurance, but in hospital outpatient departments that amount is capped at $1,736 in 2026. Hospitals are then made whole by Medicare for any remaining amount after the cap is reached, Kara Newbury, chief advocacy officer for the Ambulatory Surgery Center Association, told Becker’s.
The policy is most likely to affect higher-cost procedures, particularly in cardiology, orthopedics and cases involving devices or implants, she said. For example, CMS’ procedure price lookup tool shows a total knee replacement costs $10,552 in an ASC versus $14,275 in a hospital outpatient department, yet patients pay $142 more in the ASC because the coinsurance cap does not apply.
