ASCs have become an important lever in the battle against surgical and procedural care gaps in rural areas as hospitals and health systems look to expand services at a lower cost while shifting inpatient volume, when possible.
Here are five notes on the relationship between rural care and ASC growth in 2026:
1. ASCs were much more commonly found in urban areas as opposed to rural ones in 2024. Urban was defined as being in metropolitan statistical areas, according to a MedPAC report released Jan. 15, 2026. Ninety-four percent of ASCs were in urban areas, compared with 6% in rural areas.
2. The number of ASCs per 100,000 Medicare beneficiaries varied widely across states in 2024, according to the report. Here’s a breakdown across five states:
- Vermont represented the minimum number of ASCs per 100,000 Medicare beneficiaries with less than five.
- Illinois represented the 25th percentile of ASC distribution per 100,000 beneficiaries at approximately seven.
- The median number of ASCs per 100,000 beneficiaries was about nine, represented by New Hampshire
- Arkansas fell into the 75th percentile for number of ASCs per 100,000 Medicare beneficiaries at approximately 13.
- Maryland represented the maximum number of ASCs per 100,000 Medicare beneficiaries at over 35.
3. Despite their relatively small presence in the market, rural ASCs may have the benefit of being more connected to their communities and more able to readily respond to large scale shifts in healthcare.
“CMS wants value-based care, but how are you really going to make that happen?” Daniel Decker, MD, a urologist and co-founder of Vitality Plus Urology Clinic in Mountain Home, Ark., told Becker’s. “I think rural ASCs have an advantage there, because we can keep track of this stuff. We’re smaller, and then you grow from there.”
4. ASCend, a management services organization based in Gillette, Wyo., is on a mission to keep rural ASCs independent and locally owned. Founded by CEO Linda Bedwell and COO/CFO Norberto Orellana, ASCend aims to empower physician-led surgery centers in underserved regions.
“Unfortunately, many hospital systems are cutting services, leading to healthcare deserts,” Ms. Bedwell told Becker’s. “ASCs are uniquely positioned to be a solution—providing affordable, sustainable healthcare. On a national level, healthcare costs continue to rise, and ASCs can and should play a key role in controlling those costs. That includes everything from Medicare solvency to the financial burden patients feel. ASCs are essential to achieving a value-based care future.”
5. Certificate-of-need laws are one barrier to further development of ASCs in rural areas. Some of the most rural states in the U.S., including Wyoming and Idaho, have CON laws in place.
Montana repealed its CON law in 2021 and has since seen a 12.5% increase in the number of ASCs, home health agencies and inpatient addiction treatment centers, according to an October report from the Frontier Institute. According to the report, by reducing red tape, Montana has encouraged lower-cost, community-based care models, including outpatient surgery and physician-office-based services. These reforms have expanded access without relying on new taxpayer funding.
