With site-neutral payment reform poised to reshape the economics of outpatient care, many ASC leaders told Becker’s that the policy could accelerate the shift of procedures away from hospital outpatient departments. While some view the move as a long-overdue step toward leveling the playing field and expanding lower-cost surgical settings, others caution that sustained reimbursement pressure could create new financial challenges and unintended access issues.
Here’s how ASC leaders envision site-neutral payments impacting centers in their regions:
Editor’s note: Responses have been lightly edited for clarity and length.
Question: Do you foresee site-neutral payments impacting ASCs in your region? If so, how?
Peter Bravos, MD. Chief Medical Officer of Sutter Surgery Center Division (Sacramento, Calif.): It will likely accelerate the migration of appropriate procedures into ASCs. When reimbursement differences narrow, care naturally shifts toward the most efficient and patient-friendly setting, and ASCs consistently deliver strong outcomes at a lower total cost of care.
That said, policymakers should be careful that site neutrality does not simply compress reimbursement across all settings. Sustained payment pressure could challenge the financial sustainability of certain ASC service lines, ultimately undermining the efficiencies the policy aims to reward.
Jeffrey Carlson, MD. President of Orthopaedic & Spine Center (Newport News, Va.): Site-neutral payments have been threatened for many years. As we have seen reimbursements declining for surgeons while hospital rates continue to go up, I think they’re a way to lower hospital payments. This imbalance seems to be the objective: a not-so-subtle way of pressuring physicians into consolidation.
With the list of inpatient-only procedures going away and HOPD [hospital outpatient department] rates declining, I expect hospitals will be pressured into considering more partnerships with ASCs to maintain profitability. This alignment will restrict access. Our ASC was built on the premise that the same surgery can be done by the same surgeons more efficiently, less expensively and with better access at an ASC than at the hospital. If they truly wanted to improve access and affordability, the site-neutral payments would raise ASC rates to HOPD rates.
Daniel Decker, MD. Urologist and Co-founder of Vitality Plus Urology Clinic (Mountain Home, Ark.): The alignment of thought and momentum towards payment reform across the country continues to grow. Roughly 93% of CMS-certified ASCs are in urban markets. As a surgeon-owner of a rare rural multi-specialty ASC, site-neutrality is crucial for our continued expansion of innovative patient-first care at a lower cost but with superior outcomes.
That is, rural ASCs are well-positioned to immediately improve healthcare in underserved populations because of significant geographical and logistical constraints that site-neutrality will address.
George Galvan, MD. Neurosurgeon and Co-founder and CEO of Texas Neurological Spine (San Antonio): Site neutrality, coupled with the phasing out of cases from the CMS inpatient-only list, will drive a migration of hospital cases to ASCs and in-office settings. In Texas, this shift will likely slow the acquisition of physician practices; hospitals previously used these acquisitions to capture higher hospital-based reimbursements, an advantage that site neutrality eliminates.
On the flip side, hospitals now have more incentive to partner with physicians in ASC joint ventures. The challenge is that instead of finding a middle ground between higher HOPD rates and lower ASC payments, site neutrality has swung reimbursement toward the lower of the two. In essence, the reimbursement bar has been lowered once again.
J. Eric Haas, MD. Chief Medical Officer of the American Academy of Value-Based Care (Tampa, Fla.): Site-neutral payments will significantly benefit ASCs at large by reducing reimbursement gaps with HOPDs, driving increased procedure volume to lower-cost, independent and/or physician-owned settings. This shift, accelerated by CMS’s 2026 rule, aims to equalize payments for similar procedures, potentially boosting ASC revenue while increasing competition.
The AAVBC supports the concept of the right site of care for the right patient for the right reasons, leading to better patient outcomes at lower costs.
Paul Lynch, MD. Founder and CEO of US Pain Care (Scottsdale, Ariz.): U.S. Pain Care operates across multiple markets, including Arizona, California and Nevada, and we expect site-neutral payment initiatives to affect many of our regions over the next five years.
Overall, we believe site-neutral payment policies are positive for physician practices and ASCs. By reducing hospitals’ ability to acquire practices and charge significantly higher facility fees for the same services, these policies help level the playing field between hospital systems and independent physician groups.
Over time, site-neutral payments should better align physicians and hospitals in payer negotiations, which may lead to stronger reimbursement for physician practices if services are valued similarly across care settings. Combined with broader discussions around easing restrictions on physician ownership of hospitals, this could create a more balanced competitive landscape for physician-led care.
Suhail Nath. Director of Finance at UofL Health – University Hospital (Louisville, Ky.): Site-neutral payments in Kentucky, which has high rates of chronic disease and mortality, could worsen health outcomes by increasing hospital closures, particularly in rural areas. This would limit access to the appropriate level of care.
Mark Soberman, MD. Adjunct Instructor of Healthcare Management at Shenandoah University (Winchester, Va.): I can’t say specifically by region, but site-neutral payments will certainly change the dynamic. Given their lower cost structure, ASCs will have an advantage over HOPDs.
