Here are 10 developments, policies and trends for ASC leaders to watch in the year ahead:
1. Anesthesia shortages and reimbursement declines
Throughout the last year ASC leaders have consistently identified anesthesia staffing shortages and cost issues as significant disruptions to their operational flow and growth opportunities.
“ASCs require anesthesia services to deliver most of the care they provide. Increasing competition and decreased reimbursement for anesthesia services have made it a significant cost center for many ASCs. Several years ago, that was not the case. The relatively lower reimbursement rates for ASCs, combined with these increasing costs, have made the business model much more challenging,” John Valkenburg, board member of the Ambulatory Surgery Center Association and executive director of Upstate Orthopedics Ambulatory Surgery Center in East Syracuse, N.Y., told Becker’s.
“ASCs are relying on continued growth, particularly of higher-margin procedures, to maintain viability. The anesthesia shortages make that sustained growth even more of a challenge,” he added.
The shortage is being driven by several factors, including a mismatch between the number of outgoing anesthesiologists and new residency slots available.
Nearly 30% of anesthesiologists are projected to leave the practice by 2033, according to a 2023 white paper from Medicus Healthcare Solutions. Currently, the U.S. has a ratio of 1 anesthesiologist for at least 7,700 people, while over 17% of current providers are nearing retirement and over 56% are over 55.
The shortage also extends to certified registered nurse anesthetists, who make up more than 80% of anesthesia providers in rural counties. By 2033, the U.S. is projected to face a shortage of about 12,500 CRNAs, nearly 22% of the current workforce. But demand remains high, with the Bureau of Labor Statistics projecting 38% growth in the field by 2032, making the CRNA one of the fastest-growing healthcare roles.
Reimbursement declines in the specialty have also taken a hefty toll on providers. The average anesthesia reimbursement rate in 2023 was $21.88 per unit, a 5.5% decline from 2019, according to Coronis Health. Similarly, Medicare reimbursement fell from $22.27 per unit in 2019 to $21.12 in 2023, a trend highlighted in a VMG report.
Longer-term trends are equally troubling. Over the past 23 years, inflation-adjusted Medicare reimbursement for select pain management procedures has decreased an average of 2.81% annually, according to the American Association of Physician Leadership.
2. Consolidation efforts by corporate entities, hospitals and health systems
While the ASC industry largely remains fragmented and independent, more ASCs are considering partnership or sell-off options as operational costs and reimbursement declines continue to pressurize margins.
According to a survey released by VMG Health Oct. 9, 59% of independent ASCs would consider a strategic partnership rather than a full sales transaction. Among ASCs open to partnerships, 71% would consider partnering with a health system, 31% with a management company and 29% with a private equity group.
This trend has developed as hospitals and health systems become increasingly interested in ASCs. In a 2024 VMG Health survey of 141 health system executives, including CEOs, CFOs and COOs, outpatient surgery ranked as the top service line for joint venture partnerships, with more than 60% of respondents indicating ASCs were a top interest for their growth.
“As reimbursement rates fail to keep pace with rising practice costs, how can physician practices sustain themselves long-term?” John Donovan, MD, an otolaryngologist at ENT Salem (Ore.), told Becker’s. “Private practices cannot sustain themselves indefinitely given these conditions. There is an absolute limit to physician [work relative value units] production. Once that is reached in any practice, falling payments and general inflation in tandem become an unstoppable tide. This leaves one sustainable option; transition from private practice to an employed model.”
3. Small ASCs with big impact
Despite trends towards more widespread consolidation within the ASC industry, ASC software company HST Pathways released a report in April that suggested the dynamics of ASC performance tilt in favor of leaner, more specialized facilities.
HST Pathway’s survey of 590 ASCs found a stark contrast in revenue performance between small and large ASCs. From 2023 to 2024, ASCs operating with just two operating rooms reported a 22% increase in year-over-year revenue. In contrast, facilities with 15 or more ORs saw their revenue decline by 8%.
“This surge may indicate that smaller ASCs are becoming more efficient or are better positioned to adapt to market demand,” the report said. “These trends suggest a shifting dynamic in ASC performance, with smaller centers thriving while larger ones face headwinds.”
Other ASC leaders are echoing this sentiment, pointing to the operational advantages of smaller, more focused facilities. Benjamin Stein, MD, an orthopedic surgeon and co-founder of Capital Surgical Solutions, told Becker’s in August that size isn’t everything, rather specialization is.
“A lot of the larger surgery centers, many of them are broad, multispecialty centers, which I think is a significant flaw in some respects, because when you’re trying to get ahead, it’s all about routine,” he said “If you look at it from a clinical perspective, catering to the clinical deployment of a single specialty means your staff — your sterilization departments, both operating room and recovery staff, anesthesia staff — will all be much more knowledgeable, efficient and targeted in the care they provide if they can focus on one specialty.”
4. Operational and supply costs
Even as some pandemic-era disruptions have eased, ASC leaders say supply and implant costs remain elevated, particularly in device-heavy specialties.
“We’ve seen big increases since the outset of COVID in supply chain costs,” Jim Freund, managing partner at Physician Transaction Advisors, told Becker’s. “Those are real challenges.”
On the ground, ASC administrators report ongoing pressure on supply pricing, especially in orthopedics and other implant-driven lines. Greg DeConciliis, administrator of Boston Out-Patient Surgical Suites, told Becker’s he doesn’t see much relief.
“On the supply side, implant prices, especially in orthopedics, spiked during COVID-19 and haven’t really come back down. At the same time, there’s a lot of new technology entering the space. Advancements like robotics, AI and newer products are exciting, but they come with added cost. So the expense of doing business and performing procedures has stayed high and, in many cases, continues to rise.”
That leaves ASCs struggling to reconcile expectations for technology from surgeons and patients with economics that don’t always work in a freestanding setting. And these pressures are expected to get worse — medical supply chain costs are projected to increase 2.41% in 2026.
“The tariff issues impacting both cost and procurement of supplies has been challenging to manage,” Andrew Gwinnell, executive director of Truvista Surgery Center in Troy, Mich., told Becker’s. “Governmental policy fluidity creates an environment where we are constantly re-evaluating supply arrangements and P&L forecasts.”
5. Payer cost-containment strategies
From narrow networks to prior authorization expansion and AI-driven denials, payers are intensifying cost-containment efforts.
Sean Gipson, division CEO and president of Hurst, Texas-based Remedy Surgery Center, told Becker’s that“stricter prior authorization requirements, more narrow networks and direct contracting” are dominant disruptors.
Janet Carlson, vice president of ASCs at Louisville, Ky.-based Commonwealth Pain and Spine, emphasized the growing importance of proactive payer relationship management and rate negotiation, both on-cycle and off-cycle.
Jack Dillon, CEO of Anesthesia Practice Consultants, told Becker’s that the biggest shift in his organization’s relationship with payers has been “the acceleration trend of payer aggressively narrowing networks and unilaterally cutting reimbursement, particularly targeting anesthesia services.
“We’re also seeing more frequent delays in contract negotiations, denials for medically necessary care and increased pressure to accept unfavorable in-network rates,” he added. “These moves are often justified under the guise of cost containment, but they threaten practice sustainability and patient access to care.”
6. Staffing and retainment issues
ASCs have struggled to recruit and retain both providers and non-clinical employees as the demand for surgical services outpaces the growth of the healthcare workforce.
“In our experience, the staffing issues primarily surround registered nurses and certified surgical technologists. As an ASC, it’s very difficult to compete with the salaries of hospitals as they skyrocketed during and after COVID-19,” Jane Whinnery, chief operation officer and administrator of Wellbridge Surgical in Indianapolis, Ind., told Becker’s.
This has led leaders to explore tools for increasing retainment outside of compensation.
” We have attempted to keep our salaries competitive, but our true approach to attracting and retaining top talent is to offer an environment that is difficult to achieve in a hospital system. For example, the staff have complete autonomy over their schedule. They self-schedule working around their home life, children, appointments etc., coordinating with their teammates to ensure coverage of the ASCs procedures. We allow flexibility during the day to leave for appointments without burdening them having to get their own shift coverage,” Ms. Whinnery said. “We offer generous packages for PTO and paid holidays with increases for tenure. We’ve tried to create an environment of trust and mutual respect so that there aren’t a lot of rules or bureaucracy that are necessary in hospitals. The entire leadership team works alongside the staff during busy times, demonstrating servant leadership and that we all share in the success of our ASC.”
7. Certificate-of-need laws
Certificate-of-need laws were designed to regulate the development of new healthcare facilities, equipment purchase, and to avoid repeated or unnecessary services from saturating markets.
However, many healthcare leaders have criticized the laws, arguing that they restrict competition and place an unfair burden on newer or smaller healthcare organizations, instead favoring increasingly large and corporate institutions.
Three states saw significant debate or changes to their CON laws in 2025, with more expected in 2026—which could create major shifts in those states’ healthcare markets. Montana repealed its CON law in 2021, and has seen a 12.5% increase in the number of ASCs, home health agencies and inpatient addiction treatment centers as a result. According to an October report by the Frontier Institute, the repeal has lessened the barrier to entry for providers in the state, and has already increased patient access to same-day surgical care, especially in rural areas that previously lacked these facilities.
8. Physician ownership trends
Montana repealed its CON law in 2021, and has seen a 12.5% increase in the number of ASCs, home health agencies and inpatient addiction treatment centers as a result. According to an October report by the Frontier Institute, the repeal has lessened the barrier to entry for providers in the state, and has already increased patient access to same-day surgical care, especially in rural areas that previously lacked these facilities.
“Physician workforce trends certainly have an impact on the ASC landscape. The ASC landscape is being shaped by a growing shift toward physician employment, with more surgeons joining hospital systems, limiting the pool of independent physicians available for ASC partnerships,” Andrew Lovewell, CEO of Columbia (Mo.) Orthopaedic Group, told Becker’s. “However, many physicians are still looking for autonomy and control over surgical outcomes and demanding that ASCs be an option even in hospital employment.”
9. CMS final rules for 2026
CMS published its 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Final Rule Nov. 21. The update included:
- A 2.6% increase to ASC payments via the hospital market basket update. HOPDs will also receive a 2.6% payment increase, and the hospital market basket update will be used again for ASCs next year.
- Finalized plans to phase out the inpatient-only list over the next three years, removing 285 primarily musculoskeletal procedures from the list in 2026. CMS will add 573 codes to the ASC-covered procedure list, including 271 coming off the inpatient-only list.
- Plans to align payment rates for select outpatient services between HOPDs and off-campus facilities to avoid higher copays based on site of service.
- Changes to the ASC Quality Reporting Program: CMS did not adopt two reporting metrics, nor will it require ASCs to use the Hospital Quality Reporting system for ASC data, as was initially proposed. ASCs will not be required to report on COVID-19 vaccinations for healthcare providers, health equity measures or social determinants of health.
- A note regarding a calculation error that negatively impacted cardiac surgeries, reporting that instead of cutting reimbursement by 4.7%, CMS will increase it by 2.4% over 2025 rates.
10. One Big Beautiful Bill Act: President Trump signed OBBBA on July 4 after Congress approved the package July 3. The law includes several healthcare and coverage provisions, including:
- A temporary 2.5% bump in the Medicaid Physician Fee Schedule for “exceptional circumstances” next year
- Restrictions on student loan borrowing limits for professional degrees.
- Tighter eligibility for ACA premium tax credits
- Limits on the ACA special enrollment period unless certain criteria are met
- New restrictions on state-directed payments and hospital provider taxes
- Medicaid work requirements beginning as early as January 2027
- Increased federal oversight of Medicaid provider taxes
- $50 billion over five years for a Rural Health Transformation program
