From changing patient expectations to economic pressures, ASC leaders are warning of underrecognized trends that could catch the industry off guard.
Here are three emerging shifts ASCs may not be ready for:
1. Rising patient technology expectations
ASCs need to keep a sharp eye on patient expectations, particularly when it comes to technology, Kristen Owens, MSN, RN, ASC manager at Morgantown, N.C.-based Carolina Digestive Care, told Becker’s.
“Patients want care that’s easy, affordable and convenient,” Ms. Owens said. “If ASCs don’t offer things like online portals and clear pricing, they may lose patients to places that do.”
As consumers grow accustomed to digital convenience in every area of life, they increasingly expect the same from healthcare. Yet ASCs have historically lagged in adopting technology. Nearly 1 in 4 centers still rely on paper documentation, and two-thirds of those plan to stay paper-based until regulations require a change, according to the Ambulatory Surgery Center Association’s July 2025 survey.
Cost remains the biggest barrier, with 49% of paper-based ASCs citing expense as the main reason for avoiding digitization.
Still, progress is being made. The same survey found that 76% of ASCs now use an EHR, up from 55% in 2021.
2. The economy affecting patient behavior
The economy is increasingly influencing when, and whether, patients schedule elective procedures, according to Rebecca Anne Vitillo, BSN, RN, administrator of Nutley, N.J.-based Meadows Surgery Center.
The share of unemployed Americans with no prior work experience reached 13.4% in July, the highest level since April 1988, according to the Bureau of Labor Statistics. Meanwhile, only 2 in 5 U.S. employees hold a “quality” job — one that meets basic financial needs and offers stability, according to the American Job Quality Study.
“I do not think that enough attention is being given to the effect that the economy is having and will continue to have on patients who decide to schedule elective surgeries,” she said. “The cost of these procedures from the point of surgeons’ costs and anesthesia costs are beginning to have an impact on patient volume.”
When finances tighten, patients often delay nonurgent surgeries, especially those requiring out-of-pocket spending. Ms. Vitillo said many are postponing or canceling elective cases until they feel more financially secure.
“In many instances, case volume is down in ASCs,” she said.
Even small dips in elective volume can have significant operational consequences for centers already grappling with staffing shortages and margin pressure.
This pattern isn’t new. During the 2008 financial crisis, healthcare growth slowed as consumers cut spending and avoided elective care, noted Adam Brown, MD, a practicing emergency physician and founder of ABIG Health, in a 2024 Medpage report. The same dynamic resurfaced during the COVID-19 recession: 22% of Americans avoided medical care, and 29% skipped medications due to financial strain, CNBC reported.
3. The impact of how medical debt affects credit scores
A lesser-known but potentially far-reaching issue for ASCs is the changing link between medical debt and credit reporting, said Sally Wright, CFO of Puyallup, Wash.-based Meridian Surgery Center.
In January, the Consumer Financial Protection Bureau finalized a rule removing medical bills from credit reports. However, in July, a U.S. District Court judge in Texas approved a joint request to vacate the rule, a move that could reinstate medical debt reporting.
Ms. Wright said many ASCs aren’t yet accounting for how these shifting regulations could affect their revenue cycles. Although procedures are often “authorized and medically necessary,” patients can now have unpaid or unresolved medical bills without lowering their credit score, she said.
If unpaid medical debt no longer affects credit standing, patients may feel less urgency to pay bills promptly. That could lead to higher bad-debt rates and slower payment cycles, adding more financial strain to ASCs already managing thin margins.
