ASCs are facing a convergence of forces — from artificial intelligence and payer pressure to anesthesia shortages and shifting physician employment models — that could fundamentally reshape how they operate.
Twenty-eight ASC leaders joined Becker’s to discuss the emerging disruptors they believe will most significantly alter the ASC landscape over the next several years.
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Editor’s note: Responses have been lightly edited for clarity and length.
Question: What emerging disruptor do you believe will most significantly alter the ASC landscape over the next few years?
Peter Bravos, MD. Chief Medical Officer of Sutter Health Surgery Center Division (Sacramento, Calif.): Artificial intelligence will fundamentally reshape how ASCs deliver care and manage operations. As its capabilities continue to advance, AI will improve communication, identify meaningful patterns and automate routine functions such as scheduling, staffing, documentation and coding, reducing administrative burden across the care team. AI will also generate predictive insights that strengthen quality and safety while supporting the expansion of more complex outpatient services without adding unnecessary cost or complexity. The result will be a simpler, more efficient experience for both clinicians and patients.
Charlene Cioe. CNO of Summit Center for Surgery (Oakbrook Terrace, Ill.): AI stands out as the most transformative disruptor overall for these reasons:
- Clinical decision support that enhances preoperative planning and intraoperative precision, particularly when integrated with robotic systems.
- Predictive analytics to forecast patient risks, reduce complications and optimize throughput.
- Back-office automation (billing, claims denial management, scheduling) that directly improves revenue cycle performance and mitigates staffing shortages. Because ASCs have relatively consistent workflows and measurable KPIs, they are an ideal environment for AI to demonstrate rapid and measurable impact, which accelerates adoption
- AI assists other innovators, such as Robotics, which helps guide instruments, improves motion control, and supports outpatient procedures
- May help decrease readmissions
- As we move forward with increasingly complex procedures in the ASC setting, such as complex joint, spine and CV procedures, technology-driven solutions maintain high safety outcomes while lowering costs.
The only issue I see is that I can’t always rely on/trust AI, must rely on human factors. Must always check AI to ensure a positive outcome for the patient.
Bottom line: AI and advanced analytics will be the most significant disruptor in the ASC world over the next several years.
Deena Edwards, RN. Administrator of The Surgery Center of Southwest Ohio (Moraine): I believe the cost of anesthesia is the thing that is making it difficult for ASCs to remain profitable. Anesthesia reimbursements by Medicare and commercial payors have continued to decline while the cost for anesthesia have risen. This has saddled surgery centers with stipends to secure anesthesia coverage. Those stipends are very expensive and have forced many centers to change models of care, often to models that are not as safe for the patient.
Megan Friedman, DO. Chair and Medical Director, Pacific Coast Anesthesia (Los Angeles): The biggest disruptor will be the shift from static, block-based operations to data-driven, demand-matched ASC models.
ASCs are already highly efficient, but as higher-acuity cases migrate into the outpatient setting under payer pressure, they will be forced to manage hospital-level complexity with ASC-level margins. That will require real-time analytics, predictive scheduling and flexible staffing — particularly for anesthesia — rather than fixed surgeon blocks and legacy coverage models. The ASCs that succeed will be those that can operationalize data to dynamically align throughput, staffing, and reimbursement, without sacrificing clinician sustainability or patient access.
George Hanna, MD. President, Director of Pain Management and Chief Transformation Officer at VIP Medical Group’s Vein Clinic and Pain Treatment Center (New York City): The most significant disruptor to the ASC landscape over the next several years will be payer-driven cost-containment strategies that are increasingly reshaping access, economics, and growth for independent ASCs.
Large national insurers are deploying a more aggressive and sophisticated playbook that goes well beyond traditional utilization management. This includes network design strategies that disadvantage independent ASCs, expanded and increasingly opaque prior authorization requirements, AI-driven claims adjudication and denials, delayed or friction-based payment practices, and heightened post-payment audit activity. In parallel, some payers are using administrative and contracting pressure to discourage ASCs from remaining open to out-of-network care, even when such care is clinically appropriate and fully compliant with federal law.
The downstream impact is structural. These payer behaviors influence where cases can be performed, which facilities can scale, and which ownership models remain viable. They also risk accelerating consolidation toward hospital-owned or payer-aligned facilities, often undermining the cost and efficiency advantages ASCs are designed to deliver. How ASCs, physicians, policymakers, and regulators respond to these dynamics will play a defining role in shaping the next phase of the ASC market.
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.
Sev Hrywnak, MD, Owner and CEO of Advanced Ambulatory Surgical Center (Elmwood Park, Ill.):
1. Value-based care and alternative payments:
- Shifts in reimbursement models: Payers and employers increasingly favor high-quality, low-cost, patient-centric care outside the hospital setting.
- Bundled payments and shared savings: ASCs that demonstrate efficient, lower-risk outcomes can capture more of the total episode of care value.
- Impact: Incentives to invest in perioperative pathways, enhanced recovery programs, and post-acute care coordination. Risk if payers tighten metrics or recourse is limited for failure to meet benchmarks.
2. Consolidation and market competition
- Vertical integration: Hospitals, surgery groups and analytics/tech platforms seeking to consolidate can create larger networks that compete with standalone ASCs.
- Acquisition and partnerships: Private equity interest and strategic partnerships with specialty groups can rapidly scale ASC footprint.
- Impact: More standardized pricing and procurement, but potential price pressure on independent ASCs and evolving contract terms with payers.
Narasimhan Jagannathan, MD. Division Chief of Anesthesiology at the Phoenix (Ariz.) Children’s Hospital: Workforce constraints, particularly anesthesia and nursing shortages will be the defining disruptor, with physician leaders increasingly relying on data-driven (using AI) preoperative screening, scheduling and staffing decisions to maintain safety, throughput, reimbursement and ASC viability.
Les Jebson. Administrator of Prisma Health’s Orthopedics & Sports Medicine Institute (Columbia, S.C.): The emerging disruptor poised to most significantly alter the ASC landscape over the next few years (2026–2030) is the convergence of artificial intelligence and advanced, automated technologies for operational and clinical efficiency. While high-acuity procedure migration is a major trend, the ability to manage that complexity profitably hinges on AI-driven administrative and clinical automation. This will come in the form of highly complex algorithms that integrate the revenue cycle, predictive scheduling and supply chain optimization.
Benjamin Levy III, MD. Gastroenterologist at University of Chicago Medicine: Over the next few years, I believe that artificial intelligence is going to have a major impact on Gastroenterology care at ASCs and at hospitals nationwide. Computer aided detection technology systems that help detect polyps hopefully will become even better at finding significant polyps that are small, flat or difficult to see due to the prep quality. Hopefully AI will help us to identify even more sessile serrated adenomas. In addition, real time dictation systems during endoscopy like Argus’ Endosoft will hopefully be adopted by more practices. This amazing new technology allows Gastroenterologists to describe polyps during procedures via ambient listening and speeds up the process of writing accurate procedure reports. In the future, hopefully AI will help gastroenterologists identify Barrett’s esophagus and gastric cancer during EGDs. In addition, it would be great for AI technology to help ASCs fill in last minute cancellations through scheduling software. There are also great opportunities for AI to help ASCs with revenue cycle management work.
Thomas Jeneby, MD, CEO of Palm Tree Surgicenters, Chrysalis Cosmetic Surgicenter and Maximus Plastic Surgicenter (San Antonio, Texas): I would say patient tracking through the entire phase of the patient journey — waiting room to preoperative care, preop to operating room, in room to cut time, surgery end to exit, exit to PACU, PACU to home. This is important for many reasons. You can show differences between teams with A/B testing. You can create incentive programs and see when staff needs to flex. I believe OR data will get more automated and precise.
Omar Khokar, MD. Managing Partner of Illinois GastroHealth: I’m looking at increasing efficiency. In particular, AI models predicting peri-procedural risk and identification of patients safe for ASC vs. hospital
Earl Kilbride, MD. Orthopedic Surgeon at Austin (Texas) Orthopedic Institute: The biggest disruptor in my mind to the ASC landscape is the big healthcare system. Costs are lower when competition exists. While partnering with a system may be an optimal relationship on all fronts (contracts, benefits, labor costs, etc.), if the ASC and the providers are entirely “owned” by the system, patients may feel the effects as their independence shrinks because they are forced to stay in the system.
Scott Kulstad, CEO of St. Paul (Minn.) Eye Clinic: One of the most significant emerging disruptors to the ASC landscape over the next several years will be the accelerating push toward in-office procedures, whether driven by payer mandates or emerging innovative payment models. While marketed as “site-neutral” or “cost-saving,” these shifts pose a real threat to ASCs for several reasons.
First, payer‑driven migration of procedures into the office setting — often tied to pre‑authorization requirements, coverage determinations or unilateral payment policy changes — undermines the ability of ASCs to maintain predictable case volumes. As payers tighten reimbursement or designate certain procedures as “office‑only,” ASCs lose both revenue and scheduling efficiency, even when the ASC remains the safest and most appropriate setting for many patients, which has the effect of destabilizing the ASC environment.
Second, new alternative payment models are increasingly structured to reward lower-cost sites of care, pushing physicians to move procedures into the office even when upfront capital investment, staffing needs and patient‑safety considerations are more appropriately aligned with an ASC environment. These models frequently fail to account for the true cost of delivering high‑quality surgical care or the broader administrative and compliance burden placed on practices.
Finally, the rapid expansion of in-office procedure expectations disproportionately affects subspecialty‑driven ASCs where technology, equipment and clinical complexity often exceed what can reasonably or safely be delivered in a routine clinic setting. If this trend continues unchecked, we risk a model where cost containment overrides patient safety and where ASCs, designed to deliver efficient, high‑quality outpatient surgery, are marginalized in favor of payment policies.
For these reasons, the shift toward in‑office procedural care may reshape—and potentially destabilize — the ASC landscape more than any other disruptor in the next several years in the absence of thoughtful policy debate that ensures patients’ have access to high quality, safe, equitable care.
Jessica Lam, PhD. Practice Manager of Pacific Coast Anesthesia (Los Angeles): The most significant disruptor will be the increasing financial and operational complexity of running ASCs as payer pressure intensifies while volumes continue to rise.
From a practice management standpoint, ASCs can no longer rely on growth alone to sustain margins. Success will depend on tighter revenue cycle management, more precise labor cost control, and the ability to scale operations without increasing overhead at the same rate.
We are already seeing that small inefficiencies — in scheduling, staffing, supply utilization or denial management — now have an outsized impact on profitability. The ASCs that thrive will be those that build infrastructure around analytics, standardization and disciplined financial operations, rather than relying on informal or surgeon-driven processes.
Andrew Lovewell. CEO of Columbia (Mo.) Orthopedic Group: The biggest disruptor in the ASC space over the next few years will be payer control and the site-of-service shift. As payers increasingly dictate site-of-service and reimbursement models, ASCs will be forced to pursue cases they may not have considered in the past. Removing the inpatient-only list is fine, but if the reimbursement for those services isn’t sufficient to cover the costs, this is a moot point. Additionally, as the payers dictate care, physicians lose autonomy, and patients get lost in the shuffle. ASCs that are closely aligned with practices must think about ways to strengthen partnerships even more through internal management, hr service agreements, or any other ways to combine forces and gain economies of scale. ASCs will need to be extremely cautious during this next evolution of care, as costs and payer pressures will continue to rise at breakneck speeds.
Paul Lynch, MD. Founder and CEO of US Pain Care (Scottsdale, Ariz.): This answer is probably obvious to most people, but the emergence of artificial intelligence — particularly when paired with advanced robotics — will be the most significant disruptor of the ASC landscape over the coming years and decades. In the near term, artificial intelligence will fundamentally change how ASCs document care and interact with patients. Pre-operative visits, patient intake, clinical documentation, coding, billing and denial management will increasingly be handled by AI-driven systems. I believe 25%–50% of current administrative and support staff costs could be eliminated or redeployed within the next five years as these technologies mature and integrate into routine operations.
Over a longer horizon, robotics — while historically lagging behind AI in capability — has reached an inflection point. Recent advances suggest that within a decade, many procedures may be performed by a combination of artificial intelligence and robotic systems, with physicians providing oversight, judgment and accountability rather than manual execution alone. Physician leadership will remain paramount, but the delivery of surgical care is clearly entering a new era — one that will dramatically reshape efficiency, cost structure and access within ASCs.
Lee Mathew, Administrator, USPI SurgCenter of Greater Dallas: The most significant emerging disruptor for orthopedic ASCs is the shift toward value-based care and bundled payment models, which reward cost efficiency, quality outcomes and coordinated care. ASCs that can standardize pathways, leverage data and demonstrate superior outcomes will gain a competitive advantage with payers and employers.
Justin Marburger. Regional Surgical Director of Maximus Plastic Surgery Center and Chrysalis Cosmetic Surgery Center (San Antonio, Texas): Artificial intelligence will be the most significant disruptor of the ASC landscape — not as a distant concept, but as an immediate operational force. Like many healthcare leaders, I was initially skeptical of AI and its role in clinical environments. That skepticism has shifted as its capabilities have evolved at an exponential pace. Today, AI represents a pivotal and monumental leap forward that ASCs must embrace thoughtfully and proactively.
In the near term, AI’s greatest impact will be operational rather than clinical. AI-driven platforms are already transforming how ASCs manage compliance, staffing, scheduling, supply chain forecasting, policy development and survey readiness. These tools reduce administrative burden, surface risk earlier, and allow leaders to make faster, more informed decisions using real-time data instead of retrospective reports.
From a daily workflow perspective, AI has the potential to function as a continuous operational partner — supporting leaders with regulatory interpretation, assisting in policy and procedure development, identifying staffing inefficiencies and reinforcing best practices across departments. This allows ASC leadership teams to shift focus away from manual processes and toward strategic growth, staff engagement and patient experience.
The ASCs that will thrive over the next several years will not be those that adopt AI indiscriminately, but those that integrate it responsibly — using it to augment human expertise rather than replace it. When aligned with strong governance and clinical judgment, AI can enhance consistency, reduce burnout and elevate the overall performance of surgery centers. The future of ASCs will belong to organizations willing to evolve alongside this technology, not resist it.
Mark Mayo, CASC, Administrator of Associated Surgical Center (Round Lake, Ill.): Cost of care will continue to be a major issue facing ASCs. We have consumers on one hand concerned about their own overall economic condition, let alone how much it will cost them to have a necessary surgical procedure. We must make sure our surgeons, and their referring PCPs, make their patients aware of the lower cost option of having the same procedure performed at an ASC rather than at the hospital.
On the other hand, we ASCs face increased costs that are not appropriately reimbursed by payers, including Medicare. I am sure others will bring up the reality, and the higher cost implications, of securing anesthesia services, hiring staff and increasing cost of medical supplies, especially implants.
Medicare, for example, has provided an effective 2.6% increase for 2026 in reimbursement which does not even equal the overall 2.7% CPI for 2025, let alone the medical care cost index increase last year of 3.2%.
ASCs have traditionally been paid much less than HOPDs for performing the same surgical case, sometimes with the same surgeon, the same supplies & medications, the same quality staff. Hospitals have the ability to shift costs and bill patients for other aspects of their care while ASCs have one much lower flat fee for the same procedure.
As great as our care for patients is, and as much as managed care and Medicare save by having cases performed at the lower-cost ASC setting, they may be squeezing the golden goose too much by not meeting our actual cost increases with these low payment adjustments.
Louise McCarthy, RN. Executive Director of Nursing and Administrator of Clearwater Endoscopy Center (Clearwater, Fla.): As a small, independent GI ASC in Florida, I see three emerging disruptors that will most significantly alter the ASC landscape over the next few years.
First is artificial intelligence. While AI has the potential to improve scheduling efficiency, revenue cycle performance and clinical documentation, the cost of integration and ongoing maintenance presents a real challenge for independent centers that must balance innovation with tight operating margins. Staying current will increasingly require strategic adoption rather than broad implementation.
Second is insurance reimbursement pressure. We are experiencing a continued shrinking of margins driven by rising operational costs — staffing, supplies, compliance and technology — while reimbursement rates decline or remain flat. This imbalance threatens the sustainability of smaller, physician-led ASCs and may accelerate consolidation.
Third is anesthesia workforce disruption. As an ASC that relies exclusively on board-certified physician anesthesiologists, the rising cost and shortage of anesthesia physicians is forcing many centers to re-evaluate their care models. This challenge is further compounded in Florida by the evolving scope of practice for CRNAs, which introduces both operational and regulatory considerations that will directly impact staffing, cost structures, and care delivery models.
Together, these forces are reshaping how independent ASCs operate, invest and plan for the future.
Hari Nathan, MD, PhD. Associate Professor of Surgery at the University of Michigan (Ann Arbor): Expansion of the CMS Ambulatory Surgical Center Covered Procedures List is in the news, but this is an incremental change. Site-neutral payments, if they are implemented, will be a true disruptor by removing financial incentives to do outpatient procedures in the hospital setting. Site-neutral payments will also remove some incentives for facilities to seek HOPD status through affiliation with hospitals.
John Prunskis, MD. Medical Director and Principal of DxTx Pain and Spine (Chicago). The emerging disruptors that are going to impact the ASC Landscape is the use of artificial intelligence to make sure that all prior authorizations, medical clearances laboratory data, instructions etc. have taken place to eliminate cancellations the day of or day before the procedure.
Also the development of insurance products recognizing the savings that ambulatory surgery centers present so that they are utilized more.
Syed Shah, MD. Medical Director of Stony Brook (N.Y.) Ambulatory Surgery Center: The future growth of surgery will be driven predominantly by the ambulatory setting. We are already witnessing a significant shift in surgical cases that were traditionally performed in inpatient hospitals now moving to ASCs. This transition is accelerating as advances in technology, anesthesia and perioperative care continue to make outpatient surgery safer and more efficient.
One of the most significant disruptors we foresee in the near future is staffing — particularly anesthesia staffing. There is already a well-documented shortage of anesthesia professionals, and this workforce gap will make it increasingly difficult to keep pace with the rapid growth in surgical volume. Without proactive intervention, staffing constraints may become a limiting factor in the expansion of ambulatory surgical services.
To meet future demand, we must act now to expand the pipeline of anesthesia professionals by increasing the number of anesthesia trainees and investing in long-term workforce development strategies.
Marjorie Reiter. Administrator of the SurgCenter of the Potomac (Bethesda, Md.): There are so many potential disruptors over the next five years and I’m sure there will be many not even on the horizon yet! If I take a global view, I would think there are two — one financial and one technological. The financial I’m focused on is the uncertainty of the ACA subsidies and reimbursement in general. With the potential long-term impact of the subsidies going away, we will be right back where we started before the ACA was passed with overcrowded ERs and people using them for primary care and/or sicker because they can’t afford healthcare, etc I had hoped we’d left that nightmare behind us, but not so. I have no idea how people are going to be able to afford their insurance and those on ACA tend to be the neediest regarding their healthcare issues.
As far as technology, AI is certainly an issue as is the development of new technology that we don’t even know about. This has taken up lots of the oxygen in this space, so I won’t further belabor it, only to note that new technology is expensive and if the reimbursement rates are going down, affordability becomes an issue. However, the lack of human research capital will likely be a significant disruptor with all the changes at CDC, NIH, etc. and the research dollars going away. Therefore, the elections of 2026 and particularly 2028 will likely be incredibly significant disruptors!
Tammy Smittle, RN. CEO of Stonegate Surgery Center (Austin, Texas): The most consequential disruptor shaping the ASC landscape over the next several years will be the accelerating shift from independent surgeons to employed physician models, particularly health system and large multispecialty group employment. This trend fundamentally alters the economic, governance, referral and growth dynamics on which traditional ASCs have historically relied. Unlike technology or payment reform — which tend to optimize existing models — surgeon employment changes the model itself.
Jessica Sorsby. Vice President of Operations and Compliance at DxTx Pain and Spine (Chicago): We are excited to see the expansion of ASC procedures allowed by Medicare with the addition of 573 new procedure codes to the ASC-CPL in 2026! In 2010, ASCs had just 3,482 approved codes with Medicare. CMS no longer publishes the count of approved codes, but 2026’s addition of 573 procedure codes in one year alone was record breaking showing that Medicare is making major shifts and investment in the ASC space. This exciting shift of procedures to ASCs can create a major disruptor as the shift draws increasing interest of physicians and organizations alike who want to enter the space that can reshape everything from the referral flows to payer contracting negotiating power to state regulatory items. States that have CON requirements may have more difficulty getting CON approval; states that do not have CON requirements may have trouble getting payer contracts as the network increases. Current ASCs need to maximize what they have now before the influx — including optimize your payer contracts and expand service lines including CON approved specialties now.
Alan Wagner, MD, President and Founder of Wagner Kapoor Institute (Virginia Beach, Va.): Real-time to near-real time decision-making support and guidance on behalf all levels of the ASC process — supply chain lean process (just in time sourcing, as well as prediction of need), support staffing models, anesthesia requirements and risk assessment so that acuity and risk management becomes almost bespoke, surgical team resource allocation including operative times for better scheduling are just all the tips of the iceberg!
