Health systems, investors and industry analysts are increasingly pointing to a common theme when it comes to ASCs: relative to hospitals and health insurers, their financial profile looks comparatively steady, even as broader reimbursement and cost pressures persist across healthcare.
The comparison looks more favorable for ASCs than for other parts of the industry heading into 2026. Moody’s rated health insurers’ 2026 outlook negative, citing sustained medical cost pressure and disruption from ACA subsidy changes and Medicaid cuts. Nonprofit hospitals are faring somewhat better, S&P Global Ratings has kept a stable sector view, but Fitch Ratings projected only modest margin gains for 2026 as systems brace for Medicaid reductions.
Commercial payers are increasingly denying cases based on site of service, pushing health systems to redirect lower-acuity surgical volume into the outpatient setting. Building or acquiring an ASC costs a fraction of adding capacity to an inpatient facility, Mark Langston, chief development officer of Raleigh, N.C.-based Compass Surgical Partners, told Becker’s, giving health systems a lower-cost path to capture that volume without new bricks-and-mortar investment.
That dynamic is shaping how health systems approach their own margins. About 60% of health system executives surveyed in 2024 said they were considering outpatient surgery joint ventures, according to VMG Health.
The population driving demand for outpatient surgery is also expanding. The U.S. ASC market is valued at more than $36 billion and is projected to exceed $144 billion by 2032, driven in part by 18 million more people turning 65 and older over the past decade. Private equity’s position in the sector has held steady, even amid higher interest rates.
CMS has also been widening the number of procedures ASCs are allowed to bill Medicare for. More than 200 procedures were added to the ASC-covered procedures list for 2026, including cardiac electrophysiology ablation, and the agency proposed separate payment for advanced wound care supplies. Expanding the covered-procedures list gives ASCs a wider base of Medicare-eligible cases without new facility investment, reinforcing the site-of-service migration already underway.
Reimbursement trends present a more mixed picture, though the overall direction has stayed positive for ASCs. CMS approved a 2.6% ASC payment increase for 2026 tied to the hospital market basket update. The ASC conversion factor of $56.322 nonetheless remains well below the hospital outpatient department’s $91.415, a gap the Ambulatory Surgical Center Association continues to press CMS to narrow, and rising device and implant costs are outpacing reimbursement growth in several specialties.
Anesthesia reimbursement has moved in the other direction. UnitedHealthcare cut independent CRNA payment 15% for claims billed under the QZ modifier starting Oct. 1, 2025, following an 8.2% federal reduction from 2019 to 2024 and another 2.83% cut in 2025.
Even with those headwinds, ASC leaders are largely forecasting stability rather than decline. A VMG Health survey of 97 ASC leaders conducted in September 2025 found 38% expect positive financial performance in 2026, 49% expect performance similar to 2025 and 13% expect a decline. Respondents also signaled growth plans: 67% said they plan to add surgeons, 58% said they plan to expand service lines and 31% said they plan significant capital equipment purchases, according to the survey.
Some industry advocates argue site-neutral payment policy, under which hospitals and ASCs would be paid the same rate for the same procedure, could further strengthen ASCs’ financial position by shifting additional volume out of hospital outpatient departments.
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.
