From the rise of de novo facilities to the continued decline of reimbursement rates, ASC leaders are constantly retooling their approach based on what the industry throws at them.
Reimbursements and insurance authorizations, especially when it comes to anesthesia services, have been a nagging issue for ASCs.
The workforce has been dramatically changed over the past few years, in particular the lack of qualified surgical technicians.
These five ASC leaders, executives and administrators recently connected with Becker’s to share the ASC industry trends that are top of mind for them in 2026.
Note: Responses were lightly edited for clarity and length.
John Beauchamp. Senior Director of Administration, Revenue Cycle and Data Analytics at GI Associates (Milwaukee): 2026 is off and running. There are so many competing pressures right now. One of the most underestimated pressures on ASCs is the erosion of fair reimbursement for physician and anesthesia services. It’s just not low rates, but a structural misalignment where professional fees are being compressed while ASCs are expected to deliver higher efficiency, access and quality. When physician and anesthesia economics weaken, the ASC model becomes fragile.
Anesthesia, in particular, is becoming more and more of a limiting factor, and that risk is grossly underappreciated. It’s been a real challenge for us to recruit and retain anesthesiologists and CRNAs due to low reimbursement.
Peter Bravos, MD. Chief Medical Officer of Sutter Surgery Center Division (Sacramento, Calif.): One of the biggest challenges ASCs face today is navigating slow and inconsistent authorization processes. Routine procedures often require prior approvals that can take days or even weeks, creating unnecessary delays. These inefficiencies don’t just frustrate clinicians; they directly affect patients. Delayed care can worsen conditions, increase anxiety, and drive up costs. For patients in rural or underserved areas, these barriers may compound, limiting access and widening disparities.
Kathleen Hickman, RN. Administrator and Clinical Director of Dutchess Ambulatory Surgical Center (Poughkeepsie, N.Y.): I believe there will be several disruptors in the upcoming year for the ASC industry. One will be the continuing anesthesia coverage issue with the associated financial implications. This issue is further compounded by the increased cost of supplies and decreased reimbursement. On a positive note, AI will be a valuable tool in specific processes and could perhaps aid in some of the potential disruptors such as streamlining purchasing, analyzing metrics and providing tools for increasing efficiencies.
Carrie Marut. Administrator of Mentor (Ohio) Surgery Center: One workforce issue I thought was temporary that now feels permanent is the decline in certified surgical technicians. It seemed after the COVID-19 pandemic, the industry was falling short of surgical techs but now that we are well out of the pandemic, surgical technicians are still a dime a dozen. It feels like we are fighting against each other to employ certified techs because the market is so bare. One disadvantage of a surgery center is that the students do not come to them for their clinical experience, so it is difficult to hire them when they graduate. When we put out ads for surgical techs to apply, we often get a wide variety of applicants and none of them with any surgical experience. I hope shortly there will be a turn in the market and surgical techs will be plenty to support the hospitals and surgery centers.
Dan Tasset. Founder and Chairman of NueHealth (Leawood, Kan.): There are a number of angles when it comes to the ASC de novo market today.
Number one, we’re seeing internal migration in this country from certain states to other states. That raises the question: is there enough capacity where people are moving to accommodate those needs? When you move a large employer from New York to Texas and bring 40,000 employees, is there enough capacity?
Second, there’s still a large site-of-service shift. The federal government continues to decrease the inpatient-only list, and that causes more demand on the ambulatory chain. So that plays into the de novo factor.
But the single biggest thing is that current facilities — many of them — will not be able to accommodate value-based care because they’re not built and designed correctly. I equate this to QuickTrip — stores tearing down locations that are only 10 years old to build new stores with new designs.
