Image by Lucas Wendt from PixabayAs the ambulatory surgery center (ASC) industry heads deeper into 2026, many of the most consequential forces shaping its future are not the ones making headlines.
Beyond the familiar debates over reimbursement, procedure migration and consolidation, a sometimes quieter set of dynamics is emerging – issues that are unfolding incrementally, often outside formal rulemaking or earnings calls, but with the potential to materially alter how ASCs operate, compete and grow.
To surface these less-visible risks and opportunities, ASC News asked industry leaders to identify the issues they believe deserve more attention as 2026 unfolds. Their responses highlight early warning signs, emerging inflection points and strategic blind spots that may not yet be front of mind for many operators – but perhaps should be.
Those responses are below, edited for style, length and clarity.
This is the final installment of ASC News’ executive outlook project. You can read Part I (focused on 2026 trends and opportunities) here. You can read Part II (focused on challenges) here.
Danilo D’Aprile; VP Business Development, Merritt Healthcare; President, AASCA
One under-the-radar issue in 2026 is the combined impact of rising physician employment and growing ASC market consolidation. More surgeons, especially younger ones, are entering hospital or large-group employment, which naturally shifts referral patterns and reduces their influence over where cases are performed. At the same time, large PE-backed ASC platforms and health systems are expanding their regional presence and building more coordinated outpatient strategies.
Together, these trends would reshape who controls outpatient surgical volume and which centers have the leverage to grow. Independent ASCs may find it increasingly challenging to compete for surgeons, negotiate with payers, or maintain specialty depth because of shifting market dynamics.
Jessica M. Rodriguez, MBA, CASC, ASCA Board Member and Executive Director of OAM Surgery Center at MidTowne in Grand Rapids, Michigan
Site neutrality. While “site neutrality” sounds favorable for ASCs in theory, certain versions of these policies could unintentionally reduce reimbursement, narrow patient choice, or shift inappropriate cases into the ASC setting.
My concern is that early state legislation – especially if it passes quietly – could set precedents that reshape the ASC landscape before the industry fully understands the implications.
Travis Messina, CEO, Regent Surgical
ASCs have historically resisted technology, but that resistance is creating opportunities for transformation. ASCA reports that only 76% of ASCs use an EHR today, meaning nearly one in four still rely on paper, and two-thirds of those plan to remain analog until regulations force a change.
That tells us the industry still has significant leaps to make, and the opportunity goes far beyond EHR adoption. Task automation and streamlined communication can improve efficiency, strengthen relationships with patients and payers, and better demonstrate outcomes. Technology is no longer optional; it is essential for growth and will be one of the defining trends in the year ahead.
Waleed Nasr, Co-Founder and CEO, Medely
An area I think we could pay more attention to in 2026 is how we are utilizing workforce data. This information is often an untapped resource across all health care facilities, including ASCs, and that’s a significant competitive disadvantage.
Most facilities still manage their scheduling through spreadsheets and then lack visibility into key metrics like shift fulfillment rates, time-to-fill, cost per shift, and other data that is not easily surfaceable using manual input techniques. Without access to this information, administrators can’t easily identify patterns in coverage gaps, optimize staff allocation based on procedure types, or make informed decisions about when to use full-time staff versus flexible options.
Financial pressures are only intensifying, but ASC leaders who invest in analytics and centralized reporting will be better able to control costs and maintain their standard of care.
DJ Hill, Former CEO and Current Board Chair, Compass Surgical Partners
One issue that isn’t getting enough attention is how quickly commercial site-of-service policies are changing – and the downstream impact that will have on physician-owned ASCs. Payer policies are pushing lower-acuity case types out of hospital settings, sometimes faster than providers or health systems are prepared for.
Without the appropriate site of care available that is equipped to handle these cases, hospitals will either lose these patients or be forced to take a negative margin on these cases in an environment where margins are already razor-thin. ASCs can’t be created overnight, and, without the appropriate planning, hospitals can quickly find themselves in a challenging situation.
Lisa Austin, Senior Advisor, Avanza Strategies
While not new, we continue to see private equity, changing ownership models, and consolidation playing a part in our ASC businesses. This may have an impact on independent surgeons and practices. This may also impact throughput, standardization, and payor contracting power.
Keith Smith, Medical Director, Surgery Center of Oklahoma
The failure of the big insurance model has not hit the radar of many physicians or facilities but has begun to manifest as delays and denials of care are becoming more common. The purchase of care outside of the cartel-like system will become more commonplace and represents a great opportunity for those willing to display pricing and therefore cater to this increasing population of victimized patients.
Steve Hockert, Chief Development Officer, Solara Surgical Partners
I think we’ll see a major focus on the patient experience — not just satisfaction scores, but the full journey from scheduling to recovery.
As more procedures shift outpatient, patients are becoming more discerning consumers. ASCs that streamline access, remove friction and communicate clearly will stand out. It’s a quiet differentiator now, but it’s going to become a competitive edge.
Chris Schriever, Co-Founder and CEO, ASCdata
We see the under-the-radar issue playing a big role in 2026 as the cumulative impact of development and operational delays caused by regulatory choke points, which disproportionately affect smaller, independent centers.
While CMS continues to expand the list of covered procedures, the physical supply of new ASCs is being slowed by prolonged, unpredictable delays in state Certificate of Need (CON) processes and final federal certification for a Medicare Provider Number. This creates a costly delay in opening as well as cash-flow interruptions for new facilities.
Simultaneously, the slow creep of prior authorization requirements, aggressive commercial payer denials, and lengthy credentialing backlogs creates a tasking structural leak in the revenue cycle for existing centers.
This quiet bureaucratic logjam threatens to turn a major market opportunity into an access bottleneck.
