Orthopedic ASCs are scaling quickly as more procedures shift outpatient but the definition of “value” is changing under pressure. With payer reimbursement tightening and operating costs rising, leaders say success increasingly depends on smarter payer alignment, tighter management of supply chains and throughput, and stable anesthesia coverage.
All the while, emerging policy changes such as site-neutral payment are slated to further reshape outpatient economics, accelerating migration while forcing new approaches to partnership and strategy.
Here are five developments informing how orthopedic ASCs define value amid payer cuts and rising costs:
1. Payer-ASC partnerships emerge as a key value strategy and path to stronger reimbursement: Orthopedic leaders say payer partnerships are increasingly shaping how outpatient care is delivered and financed. Brett Shore, MD, an orthopedic surgeon with Marina Del Rey, Calif.-based DISC Sports and Spine Center, said surgery centers and insurers are forming strategic alliances to reduce healthcare costs for patients and payers while maximizing value.
He added that these partnerships can support efficient, high-quality care at lower cost and may also improve reimbursement for physicians and anesthesiologists, which he called “a really promising development” for the ambulatory surgery model. However, Dr. Shore noted Medicare remains a wildcard for ASCs, with reimbursement varying widely by procedure and creating tough decisions about how to incorporate Medicare into outpatient strategy.
2. Cost discipline shifts from “cutting” to throughput and supply chain control: ASC leaders say the best way to stay ahead of rising operational costs is by improving efficiency and controlling supply spend.
Peter Bravos, MD, chief medical officer at Sacramento, Calif.-based Sutter Health Surgery Division, emphasized boosting throughput and reliability by optimizing block utilization, aligning anesthesia coverage with demand and reducing late starts. Others pointed to implants, disposables and pharmaceuticals as the fastest-rising expenses, making physician alignment, standardization and case-level cost data essential for reducing variation and negotiating pricing.
3. Anesthesia shortages force orthopedic ASCs to prove value through coverage stability: Anesthesia workforce shortages are driving up costs and disrupting ASC operations, putting pressure on margins and growth.
With fewer anesthesiologists and CRNAs available, ASCs are paying higher wages, relying more on locum and temporary providers, and in some cases delaying or canceling procedures when coverage falls short.
“The biggest challenge we face with anesthesia is the nationwide shortage of anesthesia staff,” Tina Driggers, administrator of DSC Day Surgery Center in Winter Haven, Fla., told Becker’s. “This leads to room closure and cancelling of cases which in turn ends up with economic stresses to the surgery center.”
4. Site-neutral payment could reset the value equation for orthopedic ASCs: Site-neutral payment is emerging as one of the most consequential Medicare reforms for musculoskeletal care, with major implications for orthopedic ASC economics and strategy.
CMS’ proposed 2026 site-neutral payment approach would narrow reimbursement disparities across sites of care, with leaders expecting hospital payments to fall rather than ASC rates to rise, forcing new dynamics in purchasing, partnerships and supply chain leverage. As site-neutral policies expand, orthopedic leaders warn the shift could disrupt employed physician models, accelerate consolidation and reshape outpatient migration.
“Enacting site-neutral payments has the potential to completely upend orthopedic practices,” Adam Bruggeman, MD, spine surgeon and CEO at Texas Spine Care Center (San Antonio), told Becker’s, adding that “many employed physicians may see a dramatic decline in revenue during the transition.”
5. Orthopedics is poised to lead outpatient growth by improving outcomes while lowering total cost: Orthopedic procedures are continuing to shift into ASCs as minimally invasive techniques and improved perioperative tools make more cases feasible outside the hospital. Dr. Shore told Becker’s orthopedics “lends itself nicely to outpatient care,” and as approaches like minimally invasive surgery and blood-loss reduction tools such as tranexamic acid become more widespread, the specialty is positioned to be a “leader and a pioneer” in moving more procedures into the ambulatory setting. He added that the shift can improve patient outcomes while reducing healthcare costs tied to inpatient stays.
