From shrinking anesthesia reimbursement to aggressive payer tactics, orthopedic groups and ASCs are heading into 2026 under mounting financial pressure.
Columbia Orthopedic Group CEO Andrew Lovewell joined Becker’s to discuss the anesthesia risks, reimbursement battles and growth priorities shaping his outlook for the year ahead.
Editor’s note: This interview was edited lightly for clarity and length.
Question: What anesthesia-related issue do you expect to be the most disruptive in 2026?
Andrew Lovewell: I expect anesthesia to continue as a focal point for ASCs and hospitals alike. Once again, Medicare reduced the ASA conversion factor in 2026. In turn, I would expect the subsidies from every facility in the country to increase, given the Medicare reduction. Our group has in-house anesthesia, but we are not immune to the rising labor cost and the continued limited availability of qualified anesthesia providers. Couple this with payer behavior, and we continue to look down the barrel of a monumental disaster.
Q: What financial priority will take up more of your attention in 2026?
AL: Our financial priorities for 2026 are cost containment, reimbursement contracts, and ensuring that we keep the money that we have already been paid. Every healthcare organization in the country is evaluating its budget and which line items can be contained or shifted towards lower-cost labor, different vendors, or automation/AI tools. Reimbursement contracts are a major focus for all organizations today. The payviders continue to post multi-billion dollar profits year over year while independent groups struggle to maintain their already existing shrinking margin. In addition, we are seeing even more audits, record requests, and denials than we have before. One of the most recent rules that many of us are fighting is the BCBS rule regarding out-of-network (OON) providers and BCBS’s attempts to lower facility reimbursement by 10% due to the use of said OON provider – even when a contract is in place. Using blanket payer policy to trump contractual obligations isn’t new, but the payers are getting more egregious with this tactic.
Q: What are you most excited about in the upcoming year?
AL: Our practice continues to grow and evolve. This year, we will finish a large expansion to our ASC and develop the region’s most comprehensive pain management program. This service line will build upon the legacy that our organization has already created and deliver unparalleled expertise and access. We have already expanded our service offerings this year by adding a rheumatology service as well.
