Gastroenterology ASCs and centers are keeping busy across the country as procedure demand rises, but many are still watching margin erode from a failure to capture the full value of the procedures they’re already performing.
Leaders told Becker’s the opportunities are largely untapped and waiting on decisions most administrators haven’t yet made.
The IDR lever
One overlooked lever involves independent dispute resolution, and whether a center is even positioned to benefit from it.
Vijay Bachani, president and chief growth officer of New York Bariatric Group in Roslyn Heights, N.Y., said network status has become a gating factor that too few ASC leaders treat as a growth strategy.
“With the popularity of independent dispute resolution, there is an opportunity to get more cases if the ASC is in network with the payers,” Mr. Bachani said. “That’s one of the key components for IDR — the case has to be performed at an in-network facility.”
In January, CMS released IDR data from the first and second quarters of 2025, which showed that providers, facilities and air ambulances won 88% of disputes in the first half of 2025. Of all the payment determinations, nearly 88% of offers exceeded the qualifying payment amount.
For centers that have remained out of network, that limitation can close off a growing category of volume entirely. Getting contracted isn’t just a billing decision. Increasingly, it’s a case-acquisition one.
Direct employer contracting
While GI ASCs debate payer strategy, a different opportunity has gone largely unexplored: going directly to employers whose workers need care.
Greg Schooler, COO of Cincinnati GI, told Becker’s his organization has built direct relationships with large, nationally headquartered companies with a workforce presence in the region, offering bundled pricing that covers the facility fee, professional fee, pathology and anesthesia.
“Direct contracting with employers has been mostly overlooked by independent ASCs,” Mr. Schooler said. “Our services are extremely cost competitive compared to local hospitals, our care is more conveniently delivered, and the employer gets immediate and direct feedback from their employee about the quality of care they experienced.”
Colonoscopy screenings cost 32% more in a hospital than in an ASC and 50% more in a physician’s office, according to a 2023 analysis from Blue Cross Blue Shield Association.
Device variation
GI devices and accessories vary widely across physicians, often without a clinical rationale to match the cost difference.Nirav Shah, MD, president of the DDA Division and CMO of clinical research for U.S. Digestive Health in Wyomissing, Pa., said the pattern is pervasive and correctable.
“Many ASCs still operate with fragmented analytics and wide variation in the devices and accessories gastroenterologists use — this is often driven by preference rather than value,” Dr. Shah said. Standardizing those devices, paired with quality and outcomes data, can reduce cost and improve consistency while keeping physicians engaged.
Dr. Shah also flagged scheduling as a parallel drain. Underutilized block time, late starts and fragmented room sequencing extend the day and inflate labor costs without adding volume. Actively managing block policies and consolidating cases into fewer rooms can materially reduce overtime and agency labor, he said.
The screening gap
Perhaps the largest untapped opportunity, leaders say, is a volume problem measured in tens of millions of unscreened Americans.
Benjamin Levy III, MD, a gastroenterologist at University of Chicago Medicine, said the updated USPSTF guidelines lowering the screening age to 45 created a patient pipeline the system has barely begun to address. Approximately 21 million new patients now require screening, and early-onset colorectal cancer recently became the leading cause of cancer death in patients under 50.
A 2026 study in the Journal of the National Cancer Institute found only 22.5% of adults ages 45 to 49 had initiated colorectal cancer testing since the guideline update, and only 67% of all eligible Americans are up-to-date on screening.
“Most colorectal cancers are preventable through colonoscopies by removing polyps before they can turn into a cancer,” Dr. Levy said.
He called for expanded gastroenterologist training, more GI procedure rooms at ASCs and broader patient education through initiatives like the American College of Gastroenterology’s awareness campaigns. For GI centers, closing even a fraction of that screening gap translates directly to sustainable case volume growth.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.