For two rulemaking cycles running, CMS updated it’s policies to expand the number of procedures available in the outpatient setting – but all ASCs may not be seizing opportunities for service line expansion evenly.
But two months of reporting from Becker’s ASC Review suggests the expansion is not landing evenly — it’s sorting ASCs into centers built to capture it and centers at risk of being left behind.
CMS finalized hundreds of codes for expansion of the ASC Covered Procedures List for 2026 and has proposed adding 618 more for 2027, continuing a phaseout of the inpatient-only list that began this year.
NueHealth CEO Dan Tasset has spent three decades watching the ASC industry fight for authority, and he told Becker’s that this moment is the same fight on a shorter timeline. He points to CMS’ Ambulatory Specialty Model, which already ranks roughly 8,600 physicians on cost and outcomes, as evidence that data — not just procedure access — will decide who succeeds.
“The best way to define accountability is that you have to stand behind your product and service,” Tasset said. “You have to guarantee not only the clinical results, but the patient satisfaction, patient experience and the cost.”
About 76% of ASCs now use an electronic health record, up from 55% in 2021 — but roughly 1 in 4 centers still run on paper, and Tasset does not think that gap is survivable much longer.
“If a surgery center is not moving seriously in this direction right now, they are going to be left out,” Tasset said. “I’m not talking about being at risk. They’re just going to be left out of the delivery system.”
The same rulemaking cycle expanding what ASCs can bill for is tightening what many of them get paid for doing it. Alex Taira, who tracks Medicare payment policy for the Ambulatory Surgery Center Association, said CMS’s proposed 2027 Physician Fee Schedule would cut the conversion factor for physicians outside qualifying alternative payment models by 1.68%.
“Congress has intervened to increase physician payments several times in recent years, but the conversion factor has declined in five of the past six years, so this is not an aberration,” she said.
That pressure isn’t distributed evenly across specialties. CMS’s 2027 proposed rule would raise overall ASC payment 2.4% while cutting reimbursement for four of the highest-volume spine and pain procedures performed in ASCs — including a $40.39 cut to facet joint destruction by radiofrequency ablation — even as it adds 618 codes to the covered list. Pain- and spine-heavy centers are absorbing targeted cuts inside a rule described industrywide as a net gain.
Larger, better-capitalized operators are positioned to absorb that volatility in ways independent centers are not. CMS’s parallel proposal to recalibrate 340B drug payments and expand site-neutral reimbursement for hospital outpatient departments is expected to push more volume toward ASCs, and Dallas-based Tenet Healthcare, which owns United Surgical Partners International, has built its growth strategy around exactly that migration — USPI is projecting 5% same-facility revenue growth and a 39% EBITDA margin for 2026. Tenet CEO Saumya Sutaria, MD, said the 340B changes specifically “could be material” to the company’s finances.
Not every operator reads the rule as good news. Paul Lynch, MD, founder and CEO of US Pain Care, said it still stops short of leveling the field for independent centers competing against hospital systems: “Our ASC was built on the premise that the same surgery can be done by the same surgeons more efficiently, less expensively and with better access at an ASC than at the hospital,” Dr. Lynch said. “If they truly wanted to improve access and affordability, the site-neutral payments would raise ASC rates to HOPD rates.”
Geography compounds the divide. About 720 rural hospitals — roughly one-third of the national total — are at risk of closing, yet just 6% of ASCs are located in rural markets versus 94% in urban ones. The CMS shift is opening access in the opposite kind of market from where hospitals are disappearing.
Linda Bedwell, CEO of ASCend, a surgery center in Gillette, Wyo., said the mismatch doesn’t erase the opportunity: “ASCs are uniquely positioned to be a solution — providing affordable, sustainable healthcare. That includes everything from Medicare solvency to the financial burden patients feel. ASCs are essential to achieving a value-based care future.”
Staffing adds another constraint on top of geography: 83% of orthopedic and spine ASC leaders cite credentialing delays as their top challenge, and the orthopedic surgeon workforce is projected to shrink 4.3% through 2037 even as demand climbs 6.4%. Even centers with the capital and the market to expand are competing for a shrinking pool of surgeons to perform the procedures CMS is sending their way.
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.
