Most ASC leaders Becker’s spoke with summed up the 2025 payer environment in a single word: challenging.
Four of the five leaders pointed to intensifying prior authorization and referral requirements, rising denials, and shrinking reimbursement, all as supply and operating costs climb.
Question: In one word, how would you describe the payer environment for ASCs in 2025 and why?
Editor’s note: These responses were edited lightly for clarity and length.
Brenda Carter. Administrator of Southwest Idaho ENT (Boise): Challenging. New requirements for referrals and prior-authorizations have further increased the challenge for patients and practices alike before even getting scheduled in an ASC. Couple that with declining reimbursement and increases in costs for medical supplies, the need for strict financial oversight increases year over year.
Janet Carlson, MSN, RN. Vice President of ASC Operations of Advanced Surgical Institute (Louisville, Ky.): Challenging.
Curtis Collins. Chief Operating Officer of Palmetto Surgery Center (Columbia, S.C.): Promising. Executives at the payor level have shifted their focus to cost containment and patient satisfaction resulting in further dialogue and cooperation during contract renegotiations. Our center has made significant progress moving implant surgeries such as Cochlear and Inspire implants to the ASC where we are more than capable of providing these services at a cost savings to the plan and patients. Additionally, I was pleased to see Medicare moving in this direction with a reimbursement increase for Inspire implants for 2026 as well.
Jeffrey Flynn. Administrator and COO of Gramercy Surgery Center (New York City): Challenging, but there are a lot of opportunities as the payers are more focused on changing the site of service to the lower-cost setting.
Bonnie Greenblatt. Director of Ambulatory Surgical Services of Michigan Institute of Urology (Utica): Challenging would be my one word summary for the payer environment this year. Rates continue to decrease, although operational costs continue to rise. Authorizations and denials are ever increasing and complex, creating administrative burden and slowing reimbursement.
