Regulatory pressures and uncertainty, continued labor shortages, reimbursement issues and cybersecurity risks are a few of the challenges that ASCs are up against.
However, it is not all doom and gloom for the industry, as some positive actions and steps can be taken to turn the current obstacles into growth opportunities.
Ghulam Khilji, director of global operations at RTMC Global HealthCare, recently connected with Becker’s to share what he sees as the most important challenges to tackle in the ASC space today.
Editor’s note: This response has been lightly edited for clarity and length.
Question: What unexpected obstacles are causing headwinds in the ASC industry so far in 2025?
Ghulam Khilji: One of the most disruptive surprises in 2025 has been the reversal or delay of certain favorable policies by CMS. While CMS had previously expanded the number of procedures allowed in ASCs and promoted site-neutral payment models, this year has seen a pullback due to increased lobbying from hospital associations and questions about long-term patient outcomes in outpatient environments. The sudden regulatory ambiguity has left ASC operators unsure about what procedures they will be reimbursed for and whether expansion plans based on previously approved services will remain viable. Furthermore, CMS has introduced new quality reporting requirements mid-cycle, requiring rapid system changes and increased administrative burden. This not only distracts from patient care but also stretches already limited administrative resources, particularly in smaller ASCs that lack the capacity to swiftly adapt to changing requirements.
Another major and largely unexpected headwind has been a sharp escalation in healthcare workforce shortages, especially among surgical nurses, anesthesiologists and administrative support staff. While staffing challenges have been an ongoing issue in healthcare, 2025 has seen a worsening due to the aging workforce, competition from travel nurse agencies, and staff burnout exacerbated by post-pandemic workload surges. ASCs, which operate on thinner margins than hospitals, are finding it increasingly difficult to attract and retain skilled professionals without drastically increasing wages. This problem is compounded in rural and suburban areas, where labor pools are even more limited. Consequently, many ASCs are being forced to reduce operating hours, limit the number of procedures per day, or pay unsustainable overtime rates. The downstream effect is a hit to profitability, staff morale, and patient access, which are all critical benchmarks of ASC success.
In 2025, many ASC operators are reporting increased friction with both private insurers and government payers, primarily due to new prior authorization protocols and claim denials. Payers are tightening their reimbursement policies, often challenging procedure necessity even when documentation is robust. Additionally, delays in processing payments are crippling cash flows for ASCs, particularly independent centers with limited reserves. The growing prevalence of value-based contracts, while well-intentioned, has added to the complexity, as centers struggle to collect complete patient outcome data or meet stringent reporting benchmarks. These issues are particularly pronounced in states where Medicaid expansion has occurred, and new payer systems are still stabilizing their integration with ASC billing platforms. The result is that centers must now devote disproportionate time and resources to revenue cycle management, diverting focus from clinical excellence and patient satisfaction.
While technology adoption in ASCs was expected to be a growth catalyst, 2025 has revealed it as a double-edged sword. Many centers invested in digital health tools, AI-based diagnostic systems and upgraded EHR systems, hoping to enhance patient care and streamline operations. However, unexpected technical integration issues, lack of interoperability with hospital systems and rising costs of implementation have turned these investments into significant operational challenges. Moreover, the increased digital footprint has made ASCs a more frequent target for cyberattacks. Thus, technology, once viewed as a pathway to modernization, can currently be seen as a financial and logistical strain, unless strategically managed and robustly supported.
The ASC industry, historically resilient and adaptive, finds itself at a crossroads in 2025. Unexpected obstacles such as regulatory pullbacks, labor shortages, payer friction and technological upheaval are testing the limits of operational agility. While the industry retains its core strengths, the need for strategic recalibration is clear. ASCs must collaborate more closely with industry associations to advocate for supportive policies, invest in staff retention and development programs, negotiate smarter payer contracts and develop scalable, secure technology solutions. Additionally, forming strategic partnerships with health systems or larger ASC networks may provide the infrastructure and leverage needed to weather these headwinds. With proactive leadership, strong governance, and a continued focus on quality care, the ASC industry can not only overcome these obstacles but emerge stronger, more integrated and better prepared for future disruptions.
