As some hospitals push procedures into lower-cost outpatient settings, ASC operators are expanding aggressively and regulators are opening the door to more complex surgeries.
At the same time, the industry faces mounting challenges, from rising operational costs and staffing shortages to shifting patient payment patterns that are forcing leaders to rethink revenue strategies. Together, these dynamics are redefining the role ASCs will play in the next era of surgical care.
Here are five trends to keep an eye on:
1. High-acuity procedures are gaining popularity in ASCs: Orthopedics, cardiology and advanced spine procedures are among the biggest drivers of ASC growth as technology improves and patients increasingly seek lower-cost outpatient care.
Brentwood, Tenn.-based Surgery Partners reported a 50% jump in total joint volume, while Tenet’s USPI centers saw 23% growth in orthopedics. Nashville, Tenn.-based HCA Healthcare also reported rising outpatient cardiac surgery volumes. At the same time, minimally invasive advances are pushing lower-acuity procedures such as cataracts and minor hand surgeries into office-based settings, reshaping where surgical care is delivered across the continuum.
2. The largest ASC operators are rapidly scaling: The nation’s five largest ASC companies, United Surgical Partners International, AmSurg, Surgery Partners, HCA Surgery Ventures and SCA Health, made major strategic moves in 2025 through acquisitions, new centers and consolidation.
USPI added eight ASCs and raised its earnings outlook, while St. Louis-based Ascension moved to acquire AmSurg. Optum-owned SCA Health also expanded its footprint with the acquisition of U.S. Digestive Health Management, adding 24 ASCs and more than 40 GI practice sites.
3. CMS policy changes are accelerating outpatient migration: Federal policy is reinforcing the shift toward ambulatory surgery. In the CY 2026 OPPS and ASC final rule, CMS added 289 procedures to the ASC Covered Procedures List and removed 271 from the Inpatient Only list, rendering 560 new procedures eligible for ASC reimbursement.
The additions include cardiac ablation, lumbar spinal fusion and vascular procedures — reflecting advances in anesthesia, monitoring and procedural efficiency that enable more complex care to move safely into outpatient settings.
4. Lagging reimbursement and rising costs are squeezing faciltiy margins: Inflation and rising operational costs have outstripped reimbursements. While CMS modestly increased ASC payment rates, the adjustments fall short of offsetting higher labor, supply and facility expenses, operators said.
Compounding the problem, inflation drives up costs across staffing and surgical supplies, with median medical and surgical supply costs per full-time employee rising 82% between 2013 and 2022.
5. Patient payment patterns and revenue cycle dynamics are shifting: ASCs are seeing significant changes in how cases are paid, with partial payments becoming more common. According to HST Pathways’ State of the Industry Report, partial payments rose from 41.2% in 2023 to 56.2% in 2024, while full payments declined from 25.8% to 17%.
The shift is prompting many ASCs to adopt new revenue cycle management strategies, including collecting payments before the date of service and expanding patient payment plans.
