Site-neutral payment reform is poised to reshape outpatient care economics, and industry leaders told Becker’s the policy could accelerate the migration of procedures away from hospital outpatient departments, while introducing new financial and access risks.
Many view the shift as a long-awaited step toward aligning reimbursement across care settings and expanding lower-cost surgical options. Others caution that sustained payment pressure could strain margins and disrupt access, particularly in vulnerable markets.
Procedure migration and shifting incentives
Leaders broadly expect site-neutral payments to push more procedures into ASCs, where care is typically delivered more efficiently and at a lower cost.
“It will likely accelerate the migration of appropriate procedures into ASCs,” Peter Bravos, MD, chief medical officer of Sutter Surgery Center Division in Sacramento, Calif., told Becker’s, noting that care tends to move toward the most patient-friendly and cost-effective setting.
That shift may gain additional momentum as regulatory changes take hold. George Galvan, MD, neurosurgeon and CEO of Texas Neurological Spine in San Antonio, said site neutrality, combined with the phasing out of cases from the CMS inpatient-only list, will further drive cases out of hospitals and into ASCs and office-based settings.
As reimbursement differences narrow, hospitals may also rethink their growth strategies. Dr. Galvan said site neutrality could slow physician practice acquisitions, which have historically been used to capture higher hospital-based reimbursement, and instead encourage more ASC joint ventures.
Leveling the playing field — or lowering reimbursement
For some, site-neutral payments represent a long-awaited correction to pricing disparities between hospitals and independent physician groups.
“These policies help level the playing field between hospital systems and independent physician groups,” Paul Lynch, MD, founder and CEO of US Pain Care in Scottsdale, Ariz., said, adding that closer alignment in payer negotiations could strengthen reimbursement for physician-led care over time.
J. Eric Haas, MD, CMO of the American Academy of Value-Based Care in Tampa, Fla., framed the shift more broadly as a move toward delivering care in the most appropriate setting.
“The right site of care for the right patient for the right reasons leads to better outcomes at lower costs,” he said.
Still, not all leaders agree the policy achieves true parity.
“The reimbursement bar has been lowered once again,” Dr. Galvan said, arguing that payments have trended downward rather than settling between hospital and ASC rates.
Financial pressure and sustainability risks
Even as volume shifts toward ASCs, leaders say the long-term financial impact remains uncertain.
“Policymakers should be careful that site neutrality does not simply compress reimbursement across all settings,” Dr. Bravos said. “That could challenge the financial sustainability of certain ASC service lines.”
Others see broader structural implications. Jeffrey Carlson, MD, president of Orthopaedic & Spine Center in Newport News, Va., suggested the policy may contribute to ongoing consolidation pressures. “This imbalance seems to be the objective: a not-so-subtle way of pressuring physicians into consolidation,” he said.
At the same time, increased alignment between hospitals and ASCs could reshape access dynamics in ways that are not yet fully understood.
Regional impact and access concerns
The effects of site-neutral payments are also expected to vary by geography, particularly in rural and underserved areas. Daniel Decker, MD, a urologist and co-founder of Vitality Plus Urology Clinic in Mountain Home, Ark., said the policy could support expansion of care in rural markets, where access challenges are often driven by distance and limited infrastructure. “Rural ASCs are well-positioned to improve healthcare in underserved populations,” he said.
However, others warn of potential unintended consequences in high-need regions. Suhail Nath, director of finance at UofL Health—University Hospital in Louisville, Ky., said site-neutral payments could contribute to hospital closures, particularly in rural areas, ultimately limiting access to care.
A changing outpatient landscape
Despite differing views on long-term effects, leaders agree site-neutral payments will alter the competitive dynamics between ASCs and hospitals. Given their lower cost structures, ASCs are positioned to gain share in many markets, according to Mark Soberman, MD, adjunct instructor of healthcare management at Shenandoah University in Winchester, Va.
“ASCs will have an advantage over HOPDs,” he said.
As the policy evolves, the central challenge will be balancing cost reduction with financial sustainability and patient access, a tension that will shape the next phase of outpatient care.
