ASC leaders across the country say their peers are forfeiting significant revenue and negotiating leverage by failing to adapt to a payer landscape that is growing more complex, more competitive and, in some cases, more predatory.
Here are four specific payer opportunities ASC leaders believe the industry is most urgently overlooking:
1. Accepting inadequate contracts
For many ASCs, the instinct is to stay in-network, keep payers happy and avoid conflict. George Hanna, MD, president and chief transformation officer at VIP Medical Group’s Vein Clinic and Pain Treatment Center in New York City, says that instinct is costing centers dearly.
“Many ASCs still operate defensively within inadequate in-network contracts, despite clear evidence that commercial payers are systematically under-reimbursing procedures relative to cost, while simultaneously inflating patient cost-sharing and misrepresenting true market rates,” Dr. Hanna told Becker’s.
He describes a pattern that goes beyond tight margins. Payers have been actively penalizing ASCs that partner with out-of-network physicians through contract terminations, reimbursement reductions and administrative barriers designed to limit independent competition.
“These tactics are less about cost control and more about preserving payer leverage,” Dr. Hanna said.
A Blue Health Intelligence analysis revealed procedures performed in HOPDs can cost up to 58% more than in ASCs or physician offices. For example, colonoscopies cost 32% more in hospital settings compared to ASCs.
Dr. Hanna advises ASCs to shift from passive participants to strategic operators, using site-of-care cost advantages, price transparency data and legal tools like the No Surprises Act to push back and demand appropriate reimbursement.
For example, using the independent dispute resolution process could be a way to be active participants.
“With the popularity of independent dispute resolution, there is an opportunity to get more cases if the ASC is in-network with the payers,” Vijay Bachani, president and chief growth officer of Roslyn Heights-based New York Bariatric Group, told Becker’s. “That’s one of the key components for IDR as case has to be performed at an in-network facility.”
2. The bundled payment opportunity
While health systems and large physician groups have begun experimenting with episode-based payment models, most ASCs remain firmly planted in fragmented, fee-for-service structures. According to Jacob Rodman, CEO of Raleigh (N.C.) Surgical, this is limiting both ASCs’ financial performance and their long-term payer relationships.
“There’s a significant opportunity to align surgeons, anesthesia, implants and post-acute care under a single episode-based structure that drives both cost efficiency and measurable outcomes,” Mr. Rodman said. “Most centers are still operating in fragmented, fee-for-service silos, which limits their ability to control total cost of care and demonstrate value to payers.”
ASCs that move early to build bundles, with aligned incentives, standardized clinical pathways and outcomes data, will be far better positioned in payer negotiations and network inclusion decisions, Mr. Rodman said.
3. Direct employer contracting
The direct-to-employer contracting movement has gained traction among health systems and large physician groups, but independent ASCs have been slower to pursue it.
Greg Schooler, COO of Cincinnati GI, told Becker’s his center has built a successful direct contracting program with large national employers that have employees in their service area.
“We can offer bundled pricing including the facility fee, professional fee, pathology and anesthesia,” Mr. Schooler said. “Our services are extremely cost competitive compared to the local hospitals, our care is more conveniently delivered, and the employer gets immediate and direct feedback from their employee about the quality of care they experienced.”
ASCs offer lower cost, higher convenience and measurable quality. The barrier for most ASCs is knowing how to find, approach and structure agreements with employers directly.
4. Surgeon transparency
Not all of the opportunity gap is with payers, some of it is inside the PR.
Tammy Smittle, RN, CEO of Stonegate Surgery Center in Austin, Texas, says ASCs are forfeiting significant revenue because surgeons often lack visibility into the financial implications of their own clinical decisions, specifically, how implant costs and contracted reimbursement rates interact to determine whether a case is profitable.
“ASCs are leaving significant revenue unrealized by failing to educate physicians on the specifics of their payer contracts,” she said. “When surgeons are equipped with clear visibility into reimbursement structures and implant costs, they are far more likely to align case selection and clinical decisions with financial sustainability.”
The fix is less about restricting physician autonomy than about equipping surgeons with information they’re often simply not given. And once they have it, Ms. Smittle said, the competitive instinct that defines most surgeons kicks in.
“Given their inherently competitive nature, they are highly motivated to avoid unprofitable procedures once that information is transparent,” she said.
According to a December 2025 report from ASC supply purchasing company Advantien, implants are regularly among the highest cost expense items for ASCs and can sometimes exceed the total reimbursement for a procedure.
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.