Gastroenterology has experienced a complex mix of momentum and headwinds throughout 2025. Demand for GI services remains high, procedure volumes continue to shift into lower-cost outpatient settings and new partnerships are reshaping practice economics. But rising operating expenses, reimbursement pressure and staffing shortages present significant challenges ahead for 2026.
Here are some of the developments currently shaping GI practices:
Good news
1. Procedure migration continues to accelerate: GI remains one of the biggest beneficiaries of the shift of care into outpatient settings. A March 13 MedPAC report found gastrointestinal procedures account for 28.3% of all Medicare ASC volume, making GI one of the dominant service lines driving ASC growth.
According to the report, colonoscopy with lesion removal (7.7%), upper GI endoscopy with biopsy (7.4%) and colonoscopy with biopsy (6.7%) were among the most frequently billed ASC procedures in 2023. Additional colorectal cancer screening services, diagnostic colonoscopies and upper endoscopies also appeared in the top 20 most commonly billed services, further underscoring how heavily ASCs rely on GI volume.
This concentration of high-demand procedures illustrates why GI groups continue to invest in anesthesia support, capital equipment modernization and expanded care pathways. With CMS and commercial payers broadening coverage and refining site-of-service rules, GI migration into ASCs is expected to accelerate through 2026.
2. Stronger private equity and partnership activity: Private equity’s role in gastroenterology is evolving. Overall deal volume has slowed sharply, from 26 transactions in 2022 to 13 in 2023, a trend that has continued this year.
But the deals happening now are larger, more strategic and under greater regulatory scrutiny. Major platforms such as GI Alliance, Gastro Health and United Digestive continue to anchor the market, while early 2025 saw Optum’s SCA Health make a major move by acquiring U.S. Digestive Health Management, a 250-provider platform with 24 ASCs.
Nearly 1 in 10 U.S. gastroenterologists now works within a PE-backed group, reflecting a decade-long consolidation trend that has shrunk small, independent practices and fueled the growth of mega-groups. Cardinal Health’s $2.8 billion majority acquisition of GI Alliance in late 2024 has also reshaped the landscape by signaling new corporate entrants into GI.
Financial pressure is another key driver. Reimbursement for colonoscopy with biopsy has fallen nearly 40% over 15 years, pushing more independent groups toward partnership. Meanwhile, states such as Oregon and Pennsylvania have advanced oversight legislation in 2025, tightening review of healthcare PE deals.
3. Technology and therapeutics breakthroughs: AI is rapidly advancing within gastroenterology, with new research and clinical adoption accelerating in 2025. Studies presented at Digestive Disease Week in Chicago and online found that AI tools, including ChatGPT, provided more empathetic and higher-quality responses to patient questions about GI cancers compared to physicians. The American Gastroenterological Association also released new guidelines noting AI can enhance polyp detection during colonoscopy, though its long-term impact on colorectal cancer prevention remains uncertain.
Clinicians are increasingly incorporating AI into daily workflows. GI practices have begun using AI for administrative support, patient pre-screenings, referral triage and real-time lesion detection during colonoscopy. Leaders said AI tools are already improving intake, scheduling and diagnostic accuracy.
Larger groups are also investing in AI-driven patient engagement. Chicago-based GI Partners of Illinois reported significant improvements in diagnostics, workflow efficiency and digital communication as the organization expands its AI partnerships and technology strategy.
Bad news
1. CMS’ physician fee schedule remains a significant concern: Gastroenterologists are facing mounting financial strain as reimbursement continues to fall. A study in The American Journal of Gastroenterology found that from 2007 to 2022, unadjusted GI reimbursement declined 7%, while inflation-adjusted rates dropped 33%, underscoring the widening gap between payments and rising operating costs. The situation may worsen: a recently passed U.S. House of Representatives funding bill paves the way for a 2.8% Medicare physician pay cut.
Surinder Devgun, MD, managing partner of Rochester (N.Y.) Gastroenterology Associates, told Becker’s in March that shrinking reimbursement leaves small practices with limited paths forward. As costs rise and income stagnates, physicians may be forced to take pay cuts, leave clinical practice or join larger entities for financial stability. He noted his group has responded by expanding alternative revenue streams, such as advanced practitioners, infusions, vaccinations and independent labs, while working to demonstrate value to secure stronger contracts.
2. Rising operational costs and wage inflation: ASCs, including GI practices, are struggling to maintain margins as expenses accelerate across staffing, supplies and pharmaceuticals. PricewaterhouseCoopers’s Health Research Institute projects commercial healthcare costs could rise up to 8.5% in 2026, while gastroenterologist Howard Mitz, DO, and owner of Littleton, N.H.-based North Country Gastroenterology told Becker’s reimbursement is “not keeping up with the rising costs of everything,” from IV solutions to staff salaries.
Labor pressures are a major driver. ASC leaders now oversee an average of 40 employees, and wages continue to rise. CRNA compensation is up 22.9% since 2022, CAA compensation is up 40.7% and surgical technologist salaries have climbed to $63,910 per year in 2025. Leaders note cutting staff to save money often increases turnover and harms care quality, making retention essential.
Supply challenges add further strain. IV fluid shortages persist after Hurricane Helene damaged a Baxter plant producing 60% of U.S. fluids in 2024, and Vizient projects supply chain costs will rise another 2.41% in 2026. Rising device and implant prices are forcing ASCs to negotiate harder with vendors, standardize products and explore group purchasing to maintain financial stability.
3. Persistent staffing shortages — especially anesthesia: Anesthesia remains one of the most significant pressures on GI-focused ASCs as workforce shortages deepen and demand continues to rise.
GI leaders told Becker’s in March that shortages of both CRNAs and anesthesiologists are already limiting patient access, while reimbursement for anesthesia services is not keeping pace with rising operational costs. Several leaders also noted that wage inflation and workforce gaps are straining ASC efficiency, making collaborative staffing models and clear CRNA scope-of-practice agreements increasingly important.
Others have pointed to broader systemic challenges, including potential changes tied to site-neutrality legislation and growing anesthesia needs following the expansion of colorectal cancer screening guidelines from age 50 to 45, a shift that added an estimated 19 million individuals to the screening pool.
Leaders also emphasized the national shortage of anesthesia providers is being driven by rising procedural volume, aging clinicians and widespread reliance on propofol in GI endoscopy. Some have called for increased federal funding for graduate medical education to expand residency slots and help address long-term shortages.
