Rural ASCs and independent physician practices are navigating a split picture in 2026. New federal dollars, a federal shortage designation push and emerging payment reform are creating fresh opportunities for surgical access outside hospital walls.
At the same time, clinic closures, a tightening Medicare landscape and unresolved scope-of-practice fights are putting some of those same communities at risk.
Here’s a look at five recent developments helping rural surgical access, and five working against it.
Good news
1. A federal shortage designation for general surgeons
A bipartisan group of senators led by Sen. Brian Schatz, a Democrat from Hawaii, introduced the Ensuring Access to General Surgery Act of 2026 June 24, which would create the first formal federal shortage designation for general surgeons and direct the Health Resources and Services Administration to map gaps in surgical care access nationwide. Supporters, including the American College of Surgeons, say the designation could support recruitment and retention efforts in underserved areas where delays in surgical care carry direct consequences for patients.
2. A Kansas hospital’s $2.5 million robotics grant
Clay Center, Kan.-based Clay County Medical Center received a $2.5 million state grant through the Kansas Rural Health Transformation Program to purchase a da Vinci 5 surgical robot, June 1. The platform will support minimally invasive procedures in general surgery, gynecology and urology, bringing a level of surgical technology to the rural community that was previously out of reach. As more states receive their RHTP funding, the space could see an uptick in similar investments.
3. Momentum for physician-owned rural hospitals
CMS included a request for information on physician-owned hospital participation in its proposed 2027 inpatient payment rule, and Congress is weighing HR 2191, the Physician Led and Rural Access to Quality Care Act, which would let physicians own rural hospitals located more than 35 miles from a main campus or critical access hospital.5. The bill would also lift longstanding limits on expanding existing physician-owned facilities.
4. New MSOs built to keep rural ASCs independent
ASCend, a management services organization based in Gillette, Wyo., launched with a mission to keep rural ASCs independent and physician-led rather than absorbed into larger systems, Becker’s reported May 7. Co-founder Linda Bedwell said rural ASCs are “uniquely positioned” to solve emerging healthcare deserts as hospital systems cut services.
5. Site-neutral payment reform seen as a rural opening
ASC physician leaders say the 2026 site-neutral payment rule could specifically benefit rural communities. Daniel Decker, MD, a urologist and co-founder of Vitality Plus Urology Clinic in Mountain Home, Ark., told Becker’s that rural ASCs are “well-positioned to immediately improve healthcare in underserved populations” because the policy addresses the geographic and logistical barriers rural patients face.
Bad news
1. A Georgia rule threatens to shutter rural clinics
The Georgia Composite Medical Board recently issued a position statement reinterpreting a 2006 state law in a way advanced practice registered nurses warn will force clinic closures statewide. The guidance is prompting physicians to terminate protocol agreements with APRN-owned clinics, which nurses are legally required to hold to practice in Georgia, threatening primary care and psychiatric access in rural communities.
2. Rural physicians are leaving Medicare
Independent physicians, the partner base that sustains most physician-owned ASCs, are opting out of Medicare or closing practices entirely at a rising rate. Payer-operated practices are increasingly filling the resulting gap rather than other independent physicians, narrowing the pool of potential ASC partners in rural areas.
3. More physician practice closures
Four physician practices closed or announced imminent closures in a single week this spring, including a 36-year independent orthopedic practice in Fairmont, Minn., and an Ascension-affiliated clinic in Pawhuska, Okla., raising fresh access concerns in both communities.
4. Funding strings tied to certificate-of-need repeal
The Trump administration has tied states’ RHTP awards to adopting certain policies, including certificate-of-need repeal. The pressure has triggered legislative fights, including in Tennessee, where lawmakers delayed a CON reform vote until the Federal Trade Commission intervened, adding uncertainty to rural ASC expansion plans.
5. Hundreds of rural hospitals still at risk of closure
More than 750 rural hospitals are at risk of closure due to financial problems, with more than 40% of those facing immediate risk, according to the Center for Healthcare Quality and Payment Reform’s most recent analysis. The continued instability strains the hospital partnerships and referral pipelines that many rural ASCs and physician practices depend on.
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.