Federal payment updates, insurer reimbursement cuts and a wave of acquisitions are reshaping the ASC landscape heading into 2026.
Here are 10 major policy moves and market developments from 2025:
In the 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center final rule, published Nov. 21, CMS increased ASC payment rates 2.6% using the hospital market basket update. Hospital outpatient departments that meet quality reporting requirements will also receive a 2.6% increase.
CMS said it plans to apply the hospital market basket update to ASCs again next year while monitoring its impact. For 2026, the ASC conversion factor will be $56.322, compared to $91.415 for HOPDs.
CMS to phase out inpatient-only list, add 547 ASC codes
CMS finalized a three-year phaseout of the inpatient-only list. For 2026, the agency will remove 285 primarily musculoskeletal procedures from the list.
CMS will also add 547 codes to the ASC covered procedure list, many requested by the Ambulatory Surgery Center Association. The additions include 276 services currently paid in HOPDs and 271 procedures moving off the inpatient-only list.
UnitedHealthcare cuts CRNA pay amid growing anesthesia strain
A new UnitedHealthcare policy took effect Oct. 1 cutting reimbursements to certified registered nurse anesthetists by 15% when they practice independently. The July 1 update applies to claims billed with the QZ modifier; CRNAs will now receive 85% of the allowable.
The change comes as ASCs report growing difficulty securing anesthesia coverage, driven by declining reimbursement, rising stipend demands and deepening provider shortages.
Trump rollback of competition order could accelerate consolidation
President Donald Trump revoked Executive Order 14036 on Aug. 13, ending a Biden-era directive that called for heightened scrutiny of consolidation across industries, including healthcare. Existing antitrust laws remain in place.
ASC and physician leaders say the repeal could reduce regulatory friction for mergers and partnerships, potentially speeding consolidation and shifting negotiating leverage.
Jason Sansone, MD, president of Orthopedic & Spine Centers of Wisconsin in Madison, told Becker’s the shift could accelerate consolidation among orthopedic and spine practices.
“The revocation of Executive Order 14036 is expected to ease regulatory oversight of mergers and partnerships, creating a more favorable environment for consolidation,” Dr. Sansone told Becker’s. “For spine and orthopedic groups, such as OSCW, this will likely accelerate activity as practices pursue opportunities to grow, align with hospitals or health systems and strengthen their negotiating position with insurers and suppliers.”
SCA Health acquires U.S. Digestive
SCA Health, an Optum subsidiary and one of the nation’s largest ASC chains, acquired Exton, Pa.-based U.S. Digestive Health Management in early 2025 from a private equity owner. The GI platform includes more than 250 providers across 40 sites and 24 ASCs in Pennsylvania and Delaware. U.S. Digestive Health was formed in 2019 through the consolidation of three regional gastroenterology practices.
“One Big Beautiful Bill” becomes law
President Trump signed the One Big Beautiful Bill Act 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
- 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
On June 17, St. Louis-based Ascension announced an agreement to acquire Nashville-based AmSurg. The deal, reportedly valued at $3.9 billion and expected to close in late 2025 or early 2026, would expand Ascension’s ASC footprint from 58 centers to more than 300 in 34 states.
For AmSurg, joining Ascension means doubling down on its partnerships with physicians.
“While the journey is never finished, I am confident we have significantly strengthened our capabilities,” AmSurg CEO Jeff Snodgrass told Becker’s. “The Ascension acquisition provides an opportunity to continue building on this work. Our operating and partnership model has always been built on what we term the ‘collaborative model’ — the acquisition will not change that.”
Surgery Partners rejects Bain’s bid
Brentwood, Tenn.-based Surgery Partners rejected a takeover proposal from Bain Capital in June, saying the offer undervalued the company’s outlook and growth potential. Bain, which holds about 39% of Surgery Partners, valued the bid at $3.2 billion.
Bain has backed Surgery Partners since 2017, supporting acquisitions and de novo development. The bid’s rejection comes amid ongoing physician concerns about private equity’s expanding role in ASCs and its implications for independence and competition.
New survey shows highest hospital interest in ASCs yet
Hospital and health system ownership of ASCs has nearly doubled in five years, according to Avanza’s Intelligence Hospital Leadership ASC Survey. In 2024, 82% of hospitals and health systems reported owning at least one ASC, up from 41% in 2019 and 48% in 2023.
Interest is also rising: 90% said they plan to continue investing in ASCs in 2024, up from 70% in 2023. The survey concluded hospital ownership is becoming standard and that delaying investment is no longer viable.
In March, Matt Stone was named president of Dallas-based United Surgical Partners International, the largest ASC operator. USPI holds an 8.1% market share and has interests in 518 ASCs (375 consolidated) and 25 surgical hospitals (seven consolidated) across 37 states.
Mr. Stone previously served as group CEO for Central, South and West Texas for Tenet Healthcare and has held CEO roles at Northeast Baptist Hospital and Resolute Health Hospital.
