CMS finalized its 2027 outpatient and ASC payment rule Nov. 4 with a 2.3% payment update for ASCs that meet quality reporting requirements, down from the 2.4% it proposed. The agency also lowered the weight scalar to 0.814 from 0.872 this year, which turns the update into a pay cut for half of the 30 procedures that bring ASCs the most Medicare dollars. At the same time, the rule adds 619 procedures to the ASC covered procedures list.
“Other than the [inpatient-only] list changes, the 2027 final rule disappoints in that it maintains the status quo for surgery center policy,” Ambulatory Surgery Center Association CEO Bill Prentice said.
Becker’s connected with 16 ASC leaders to get their reactions. Most welcomed the added procedures but said the 2.3% update and lower weight scalar fail to keep pace with rising labor, supply and anesthesia costs. Many said a center’s case mix will decide whether 2027 brings a raise or a cut, with eye and GI centers hit hardest and cardiovascular and device-intensive programs best positioned to gain.
The question: What is your reaction to the CMS final 2027 ASC rule? How will it help or hurt your ASC?
Editor’s note: Responses have been lightly edited for clarity and length.
Mitesh Amin, MD, CEO of AlignedCardio (Richmond, Va.): The 2027 CMS final rule is an encouraging step forward for cardiovascular care in the ASC setting. While the overall payment update is 2.3%, the impact varies considerably by procedure. For example, reimbursement for atrial fibrillation ablation is increasing approximately 17%, with meaningful increases for other electrophysiology procedures as well.
We believe these specific adjustments reflect CMS’ growing recognition of the significant costs associated with performing complex cardiovascular procedures, particularly the specialized equipment, technology and disposable supplies required.
Despite these reimbursement increases, there is still work to be done. As more cardiovascular procedures migrate from hospitals to ASCs, we need to continue working closely with device manufacturers and suppliers to develop pricing models that reflect the economics of the ASC setting. Equipment and supply costs that may be sustainable in a hospital environment do not necessarily translate to an ASC.
Ultimately, the opportunity is significant. Appropriately selected patients can receive high-quality cardiovascular care in ASCs, often with greater convenience and at a lower overall cost to the healthcare system. However, realizing that potential requires both appropriate reimbursement and a cost structure that supports the outpatient model.
Overall, we view the rule as a positive development and another step toward accelerating the migration of cardiovascular procedures to the ASC setting.
Terry Bohlke. CEO of Keystone Surgical Partners (Nashville, Tenn.): CMS’ 2027 final payment rule is a tale of two cities. ASCs that do higher-acuity, implant-heavy work are the big winners with hefty payment increases. ASCs focused primarily on high-volume, lower-acuity cases will see slight decreases. Pain injections, cataracts and colonoscopies are some of the highest-volume ASC procedures experiencing slight cuts. Additionally, CMS updates the wage indexes each year, which could ease or worsen the base rate changes, depending on each ASC’s metropolitan statistical area.
But there are bigger stories here, and they have to do with the number of cases moving to ASCs, including the procedures receiving Medicare cuts.
Consider gastroenterology. Gastrointestinal procedures make up the highest-volume service line in the ASC setting, accounting for 28% of Medicare ASC volume. The final rule trims Medicare GI payments by about 1% overall. And to add insult to injury, the 2026 physician-side cut to endoscopy, which averaged about 8%, is a separate hit on the same work.
But case volume tailwinds for GI far outweigh Medicare’s ASC reimbursement cut. The U.S. population continues to age, increasing the demand for colonoscopies. Also, while the age for a screening colonoscopy was dropped from 50 to 45 back in 2021, this change is still in transition, as only 18% of 45- to 49-year-olds are having the procedure compared to 43% of 50- to 54-year-olds. Due to this growing compliance in the lower age group, coupled with the aging population, GI procedures in ASCs are expected to increase 24% over 10 years, even despite some patients electing to use the at-home stool test.
Ophthalmology and pain management have similar volume stories. Baby boomers drive the number of cataract surgeries, and these cases are expected to continue to surge over the next five to 10 years as this population continues to age. Pain management is growing similarly with the aging demographics, and the clinical shift to nonaddictive forms of pain control like transforaminal epidural steroid injections is also increasing demand. An additional offset for pain programs is the 13% Medicare reimbursement increase scheduled for spinal cord stimulation.
The bigger story here is the double-edged sword of surgeries being pushed to ASCs. On one side, by expanding the list and removing procedures from the inpatient-only list, CMS is inviting more surgery into ASCs. There will be debate on CMS’ motives in moving more than 600 procedures off the inpatient-only list and onto the ASC covered procedures list and how many cases these relatively low-volume procedures will bring to ASCs. In my view, every procedure that moves off the inpatient-only list and onto the ASC covered list is a win for physician judgment. It widens the set of settings a surgeon can choose from, based on what is clinically appropriate and safe for the patient. Even when a procedure isn’t high volume, its arrival on the list matters, because the decision about where to operate returns to the surgeon and the patient.
So here’s the second side of the added volume equation. As the ASC covered procedures list expands, centers will see more complex, higher-acuity procedures. Most ASCs have plenty of available operating room time, but they are often tight when it comes to preoperative and recovery space, sterilization capacity and inventory storage.
So the physician autonomy achieved by CMS adding procedures to the ASC list only becomes real if centers have room for the cases. A surgeon can’t choose the ASC for a procedure when the center lacks the space to recover patients, sterilize instruments or store supplies.
The window to prepare is now, and that window is closing fast. ASCs need to examine their opportunities and consider expansion, if possible. Expansion can take a year or more, especially if moving other tenants is required. The system has already decided that more cases are coming to ASCs. The centers that start planning now will be the ones that prosper when the volume arrives.
Peter Bravos, MD. Division Vice President and Chief Medical Officer of Sutter Health Surgery Center Division (Sacramento, Calif.): The final rule pulls in two directions. Adding more than 600 procedures to the ASC covered list is a real opportunity to safely bring higher-acuity cases to appropriate patients. At the same time, a downward adjustment to ASC payment weights means Medicare will pay less in 2027 for many high-volume cases in ophthalmology, GI and pain management, despite the 2.3% update.
We will stay disciplined on efficiency and add new procedures based on clinical appropriateness, surgeon readiness and recovery capacity. Ultimately, a payment system that encourages care in lower-cost settings should also protect, not erode, the economics of the cases ASCs already do well.
Ray Brown. CEO of Lake Lucien Surgery Center (Maitland, Fla.): Both. I guess the job is handed to us to make lemonade from lemons. On the bright side, we can look at the codes such as spinal cord stimulator generator or rotator cuff repair and see if our internal case-costing works in our favor.
Janet Carlson, MSN, RN. CEO and Founder of Vertex Surgical Solutions (Columbia, S.C.): The 2027 CMS final rule presents a classic “double-edged sword” for ASCs. While the addition of 619 procedures to the covered list is a welcome expansion that allows us to offer more specialized care to our patients, the 2.3% update — coupled with the weight scalar adjustments — simply doesn’t keep pace with the rising costs of supplies, labor and clinical technology. As a clinical leader, my concern is that we are being asked to do more with less. We are eager to bring these new procedures into our center, but the financial pressure on common, high-volume cases makes it increasingly difficult to maintain the high-quality, efficient environment that makes ASCs the preferred site of service. We will need to be extremely strategic with our case mix to offset these margin pressures.
While I appreciate CMS continuing to expand the list of procedures eligible for the ASC setting, the reimbursement reality is becoming unsustainable. A 2.3% update does not reflect the inflationary environment we are operating in, and the weight scalar adjustment effectively penalizes us on the very procedures that form the backbone of our center’s volume. For ASCs to continue providing a safe, cost-effective alternative to the hospital setting, the payment structure must reflect the true cost of care. We are excited to grow our service lines, but we need reimbursement models that support, rather than erode, our ability to invest in the clinical staff and equipment necessary to deliver excellent outcomes.
Jacob Corbell. CEO of Midwest Cardiovascular Institute (Naperville, Ill.): We think the final rule is excellent for cardiology ASCs, and we’re super excited about the changes. Adding more approved procedures will open up opportunities for patients to get access to more affordable procedures in a physician-led and physician-owned center.
Sev Hrywnak, MD. Owner and CEO of Advanced Ambulatory Surgical Center (Chicago): If your case mix doesn’t “fit” the new payment math, even with neutral intent, your specific mix of procedures, complexity and payer mix can mean margins compress.
Nate Kalkwarf. Executive Director of Iowa City (Iowa) Ambulatory Surgical Center: Because our case mix is split entirely between ophthalmology and ENT, we don’t perform the device-intensive procedures necessary to offset the 340B weight scalar penalty. Ultimately, we are taking a net reimbursement cut on our core volume precisely when our staffing, anesthesia and supply costs are climbing.
Omar Khokhar, MD. Managing Partner of Illinois GastroHealth (Bloomington): In an era when costs of providing healthcare are increasing steadily, a reduction in reimbursement is the wrong way to go and sends the wrong message. Yes, we have to be fiscally prudent, but reducing reimbursement simply delays access to care, and those patients will end up in the acute setting, which is ultimately more expensive and associated with poorer clinical outcomes.
Zachary Marwil, MD. Managing Director of Endoscopy Center of Long Island (Garden City, N.Y.): CMS finalized an average 2.3% increase in ASC payments overall, but many GI procedures are left out, with endoscopy centers potentially seeing a reduction in reimbursement in 2027. This carve-out matters. These procedures are the backbone of colorectal cancer screening and early detection, and ASCs deliver them at a fraction of hospital costs. Squeezing margins on these services that ASCs perform could force some centers to scale back, leaving patients with longer wait times, higher costs and fewer screening options. A small overall increase will mean little if it comes at the expense of preventive care. Even worse, these reductions could have lasting and devastating consequences for the financial sustainability of ASCs and, more importantly, patients’ access to these vital and lifesaving services.
Branden Nelson, MSN, RN. Ambulatory Services Administrator at Sutter Sierra Surgery Center (Roseville, Calif.): After reviewing and reading about the CMS finalized 2027 outpatient and ASC payment rule, I was disappointed. I feel strongly that ASCs play an important role in healthcare. As industry leaders in this environment, we have shown that we can provide comparable high-quality surgical care in a more affordable setting. For this reason, I think the continued migration of cases from the hospital to the ASCs makes sense for patients, health systems and payers. I support this shift, but the reimbursement methodology needs to support it.
As we take more complex cases in our ASCs, we will incur higher costs for staffing, equipment, implants, supplies and medications to maintain the high quality consumers have come to appreciate about our ASCs. Expanding what we are able to do but reducing reimbursements feels like we’re moving in two different directions.
This change will impact us financially, yes, but my bigger concern is the impact on our patients. We already offer great service and quality at a lower cost than the hospitals, but if reimbursements no longer reasonably support our ability to provide this standard of care, we risk these cases being pushed back into a hospital environment where the overall cost may be higher to both patients and payers.
ASCs should be part of the solution. We just need reasonable reimbursements to move cases into our high-quality, low-cost environment.
Melissa Rice. ASC Administrator at Loyola Ambulatory Surgery Center (Maywood, Ill.): The CMS final 2027 ASC rule is a positive step for many ambulatory surgery centers because it continues to recognize the value of providing high-quality, lower-cost care in the outpatient setting. Expanded procedural opportunities and ongoing alignment with hospital outpatient payment policies can help ASCs demonstrate their value while increasing patient access to care. For our ASC, any additions to the ASC covered procedures list create opportunities to safely perform more cases in a cost-effective environment, which benefits both patients and payers. However, reimbursement updates continue to lag behind rising labor, supply and technology costs, creating ongoing financial pressure for centers. The rule also places greater emphasis on quality reporting and compliance, which can add administrative burden if not supported by meaningful operational improvements. As with most CMS updates, the impact will vary by specialty mix and payer contracts, but overall it supports the continued migration of appropriate procedures to the ASC setting. Moving forward, success will depend on centers closely monitoring operational, quality and financial metrics to ensure they can capitalize on new opportunities while managing increasing costs and regulatory requirements.
Amanda Ryan, DO. Medical Director of the ASC at Current Clinic Carlsbad (N.M.): Our world-class arrhythmia program is a vital resource for Southeast New Mexico but is a device- and labor-intensive program. As a rural cardiovascular ASC in 2027, our biggest hurdle isn’t the CMS base rate, it’s commercial payer alignment. We will leverage Medicare’s explicit push toward the ASC setting to negotiate stronger commercial and Medicare Advantage contracts, ensuring our rural community doesn’t lose access to lifesaving cardiovascular interventions.
Nirav Shah, MD. President of DDA Division and Chief Medical Officer of Clinical Research at US Digestive Health (Wyomissing, Pa.): The 2.3% payment update fails to keep pace with escalating labor, supply, technology and regulatory costs, and the new weight scalar reduces reimbursement for many of the high-volume procedures that are the foundation of ASC operations. CMS continues to encourage the migration of care to the outpatient setting, which we support, but that strategy is difficult to sustain when reimbursement for the procedures we perform every day continues to decline. Ultimately, this rule asks ASCs to deliver more value with fewer resources, creating additional financial pressure on centers that are already operating in a challenging economic environment.
Neil Tanna, MD. Senior Vice President of System Perioperative Services and Strategy at Northwell Health (New Hyde Park, N.Y.): The final 2027 CMS rule presents a dual reality that both accelerates and financially pressures our perioperative growth strategy. While the expansion of the covered procedures supports our goal of shifting complex surgeries away from main operating rooms, the parallel reduction in the weight scalar effectively cuts reimbursement for certain high-volume cases. Ultimately, multispecialty centers with robust orthopedic and device-heavy caseloads are better positioned to weather these compressed margins, forcing us to meticulously balance our clinical case mix to remain sustainable.
Tracy Young, CRNA. Co-Founder and COO of Essential Anesthesia Management (Lafayette, La.): The 2027 ASC rule is a mixed bag. Expanding the ASC covered procedures list by 619 procedures is directionally positive and reflects the continued migration of increasingly complex care into the outpatient setting. But a 2.3% increase does not keep pace with the real cost pressures ASCs are facing, particularly around anesthesia staffing, labor, supplies and technology. The headline sounds positive, and any increase is appreciated, but many high-volume procedures will still face meaningful payment pressure.
From an anesthesia perspective, CMS is asking ASCs to do more complex work while reimbursement remains constrained. That makes efficient workforce models even more important. Certified registered nurse anesthetists are a critical part of that solution because they can safely expand anesthesia capacity, support access and help ASCs take on appropriate higher-acuity cases without recreating a costly hospital staffing model.
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.
