The gap between what ASCs are paid and what hospital outpatient departments receive for identical procedures has become one of the defining financial pressures in outpatient surgery.
Here are five numbers that capture the scope of the problem.
$56.322 vs. $91.415
The 2026 ASC conversion factor is $56.322, compared with $91.415 for HOPDs, which means ASCs are reimbursed at roughly 62 cents for every dollar HOPDs receive for the same procedure. The disparity has widened from roughly 85% parity a decade ago and shows no sign of closing under the current payment framework.
62%
ASCs now receive approximately 62% of HOPD rates for the same procedures, down from roughly 85% a decade ago, according to ASCA analysis cited in Becker’s. The gap is a structural product of how CMS updates each payment system differently year after year.
58%
Procedures performed in hospital outpatient departments can cost up to 58% more than the same procedures performed in an ASC or physician office, according to a Blue Health Intelligence analysis. Colonoscopies specifically cost 32% more in hospital settings compared to ASCs.
$1,711 vs. $2,748
The national average Medicare payment for a cataract extraction at an ASC is $1,711. The same procedure at a HOPD averages $2,748, meaning a $1,037 premium for an identical surgery in a higher-cost setting.
70% vs. 9%
From 2001 to 2023, Medicare payments to hospitals increased by 70%, while physician payments grew by only 9%, according to the American Medical Association. Adjusted for inflation, Medicare physician pay actually declined by 26% over that period.
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.