ASCs faced a mix of momentum and pressure throughout 2025. Procedure migration accelerated, technological innovation improved efficiency and new partnerships reshaped ASC growth strategies.
Yet rising operating costs, payer friction and staffing shortages, especially in anesthesia, continue to challenge profitability heading into 2026.
Here are some of the developments currently shaping the ASC landscape:
Good news
1. High-acuity procedures are rapidly shifting into ASCs: An industry report found orthopedics, cardiology and advanced spine are the biggest drivers of ASC growth as technology improves and patients seek lower-cost care.
Brentwood, Tenn.-based Surgery Partners reported a 50% jump in total joint volume, while Dallas-based Tenet’s USPI centers saw 23% growth in orthopedics.
Nashville, Tenn.-based HCA Healthcare also noted rising outpatient cardiac surgery volumes. At the same time, minimally invasive advances are moving lower-acuity procedures such as cataracts and minor hand surgeries into office-based settings, reshaping where care is delivered across the continuum.
2. Technology is transforming ASC anesthesia, improving efficiency, safety and care coordination: Technology emerged as a major accelerator for ASC anesthesia in 2025. AI-driven tools are improving preoperative chart review, case triage and scheduling accuracy, reducing same-day cancellations and streamlining workflows for surgeons and anesthesia teams.
Digital dashboards, automated documentation and smart infusion systems are cutting administrative burden, while advanced regional techniques, enhanced recovery pathways and closed-loop sedation are enabling more complex procedures to be safely performed on the same day. Tele-anesthesia and remote evaluation platforms are further expanding access and personalizing care across outpatient settings.
3. Surgeons are increasingly moving toward ASC partnerships as outpatient volume accelerates: The ASC market is expanding rapidly as more procedures shift from hospitals to outpatient settings, a trend driven by lower costs, minimally invasive technologies and improved anesthesia and pain management protocols.
John Peloza, MD, of Chesterfield, Mo.-based Peloza Spine told Becker’s in May that 65% of surgical procedures have already moved into ASCs, while CMS’ removal of procedures from the inpatient-only list is accelerating migration in orthopedics, spine and cardiovascular care.
As cases move outpatient, more surgeons are pursuing ASC partnerships and joint ventures with health systems to gain workflow efficiency, better patient experience and stronger control over staffing, implants and quality standards. Although consolidation continues, physician autonomy remains a central factor shaping ASC participation and ownership.
Bad news
1. Stagnating reimbursement rates continue to squeeze ASC margins: Reimbursement has not kept pace with inflation or rising operating costs, creating mounting financial strain for ASCs. While CMS provided a modest increase for 2024, ASC leaders say the adjustment is far too small to offset sharp growth in labor, supply and facility expenses.
“Our costs rose significantly,” said Tina Heinrich, administrator of Placerville, Calif.-based El Dorado Surgery Center, noting CMS’ slow response on payment updates.
Industry data shows Medicare-certified ASCs grew from 1,339 in 2011 to 2,140 in 2024, but leaders argue that reimbursement policy remains a major barrier to long-term sustainability.
2. Operating costs and wage inflation are rising sharply: ASCs continue to face significant cost pressures as inflation drives up expenses across staffing, supplies and facility operations.
Medical and surgical supply costs rose 82% per full-time employee between 2013 and 2022, and leaders say the trend has only accelerated post-pandemic.
“Overall costs have risen — and sometimes doubled in certain areas — since 2020,” said Will Brancamp, ASC administrator at Mobile, Ala.-based Infirmary Health System, citing material, supply and salary increases driven by strained clinical workforce demand.
3. Persistent anesthesia shortages continue to limit ASC capacity: Anesthesia is at a critical inflection point as rising outpatient surgical volume collides with a shrinking workforce.
Nearly 30% of anesthesiologists are projected to leave practice by 2033, and many CRNAs are nearing retirement, creating growing gaps in coverage, just as ASC case complexity increases.
Leaders say these shortages are pushing anesthesia models to their limits, driving heavier reliance on CRNAs and anesthesiologist-assistant teams, higher labor costs and mounting burnout.
Reimbursement pressure, including proposals to cap CRNA payments at 85% of the physician fee schedule, is compounding financial strain for ASC-based groups already operating on thin margins.
