Bill takes aim at ASC, HOPD payment gap

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A bill introduced in Congress on March 20 would tie ASC annual payment updates directly to the hospital outpatient department fee schedule increase factor. 

Currently, ASC payment updates and HOPD payment updates follow different formulas, a gap that historically has resulted in lower annual increases for ASCs. Starting in 2027, the bill would give ASCs the same update rate as HOPDs.

The legislation also would prohibit CMS from applying a budget neutrality adjustment specifically to ASCs, a mechanism that previously had offset payment increases to keep aggregate spending flat. Additionally, when CMS calculates budget neutrality adjustments for the hospital outpatient system going forward, it would be required to factor in ASC expenditures jointly, rather than treating them as separate buckets.

The Outpatient Surgery Access Act of 2026 was introduced by Rep. Beth Van Duyne, R-Texas. It has been referred to committee and has not yet passed.

At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.

Register to Attend Webinar

Is ambulatory care healthcare’s big margin engine? 4 leaders weigh in

Wednesday, July 29
1:00 PM - 2:00 PM CDT

Presenters: Joe Ganley, athenahealthJeffrey Flynn, CASC, Gramercy Surgery CenterBryan Tsao, Access Center, Loma Linda University HealthJason Zepeda, Northridge Hospital Medical Center, CommonSpirit HealthGreg DeConciliis, PA-C, CASC, Boston Out­Patient Surgical Suites

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