ASCs across the country are struggling to maintain margins as operating costs continue to climb, and there appears to be no relief in sight.
Healthcare costs for commercial payers are projected to increase by up to 8.5% in 2026, driven by persistent inflation, rising utilization of behavioral health services, and escalating prescription drug spending, according to a new report from PwC’s Health Research Institute.
Howard Mitz, DO, gastroenterologist and owner of Littleton, N.H.-based North Country Gastroenterology, told Becker’s that reimbursement rates are failing to keep pace with expenses.
Dr. Mitz said the biggest financial strain on his practice stems from “insurance companies not keeping up with the rising costs of everything,” from IV solutions and infusions to staff salaries.
In an annual OR Manager survey, 77% of ASC leaders reported earning $100,000 or more, up from 58% in 2022. Meanwhile, 68% reported total annual compensation of $120,000 or more. Still, these wages may not be sufficient to offset mounting operational pressures. Leaders now oversee an average of 40 employees, compared to 36 in 2022 and 32 in 2019.
Staff salaries across the board are also increasing. A SullivanCotter survey found that compensation for advanced practice providers in medical and surgical specialties rose 2.8% and 2.4%, respectively, from 2024 to 2025. Between 2022 and 2025, median total cash compensation climbed 22.9% for CRNAs and 40.7% for CAAs.
For surgical technologists working in ambulatory settings, mean annual salaries jumped from $57,500 in 2024 to $63,910 in 2025, according to the latest Bureau of Labor Statistics data.
“Staffing is the single most significant expense in an ASC, as in most businesses,” Raghu Reddy, chief administrative officer of MiOrtho Surgery Center in Southfield, Mich., and a member of ASCA’s education, programs and quality committees, told Becker’s.
He noted that reducing hours, adjusting staffing ratios or relying heavily on per diems or agency nurses may temporarily cut costs, but those strategies often result in high turnover and lower-quality patient care. Retaining experienced staff, he said, is essential.
Dr. Reddy recommends investing in employee retention, noting that while the upfront cost may be significant, it “pays dividends in continuity, efficiency and patient satisfaction over the long run.”
The industry is facing additional challenges tied to IV fluid shortages. In September 2024, Hurricane Helene severely damaged a Baxter International plant in Marion, N.C., which produces 60% of the nation’s IV fluids. That disruption continues to affect ASCs nationwide.
With another hurricane season approaching, Erin Fox, PharmD, senior pharmacy director at University of Utah Health, told Becker’s it remains crucial to monitor IV fluid supplies closely, especially as the system has not fully recovered from 2024’s shortages.
Erin Fox, PharmD, senior pharmacy director at University of Utah Health, told Becker’s that with hurricane season approaching, it is important to closely watch IV fluid supplies, especially since the system has yet to fully recover from 2024’s disruptions.
Overall supply costs have soared and are expected to keep rising. Medical supply chain expenses are projected to increase 2.41% in 2026, driven by higher prices for IT services, capital equipment and surgical supplies, according to Vizient’s Summer 2025 Spend Management Outlook.
“The cost of equipment, supplies and implants continues to climb, driven in part by tariffs and broader market pressures,” Dr. Reddy said. “Negotiating competitive pricing is especially difficult for standalone ASCs without the leverage of a hospital or management company partner. Larger independent ASCs may still manage effectively today, but rising costs are inevitable across the board. The real challenge lies in balancing surgeon-specific preferences with supply chain efficiency.”
ASCs are also grappling with rising device costs.
“Rising device costs have placed significant pressure on our ASC, particularly as reimbursement continues to decline,” Pierce Nunley, MD, director of Shreveport-based Spine Institute of Louisiana, told Becker’s. “We cannot simply absorb these increases, so we focus on several strategies: negotiating construct pricing to ensure fair value, standardizing with preferred vendors to streamline costs, and exploring group purchasing organizations to gain volume-based savings. Additionally, we lean heavily on long-standing vendor relationships to find creative solutions. Ultimately, we remain diligent in balancing high-quality patient care with financial sustainability by refusing to accept unchecked cost increases.”
