Image by Elias from PixabayAmbulatory surgery centers (ASCs) are primed for growth, but this rising tide won’t lift all boats. Making the most of what promises to be a positive year for the sector will require disciplined planning, targeted investment, and a clear-eyed view of regulatory and reimbursement risk.
This was the overarching message of a recent ASC News webinar focused on 2026 payment dynamics and growth strategies.
“We’re going to grow, which is great; we just need to figure out how to do the expansion,” Geri Eaves, CEO and administrator at the Bone and Joint Institute Surgery Center in Franklin, Tennessee, said on the webinar.
Data-driven decision-making and the technology that enables it will differentiate high-performing ASCs from the rest, according to Stacy LaLonde, vice president of payer strategy at ASC development and management firm Compass Surgical Partners.
As for opportunities, there are many. But one, in particular, stands out to Compass, which recently named a new CEO.
“We’re probably most excited about the cardiac ablation codes that have been added to the ASC Medicare reimbursement methodology,” she said on the webinar.
Webinar panelists focused on more than operations. Payer negotiations will also be critical to prevent still significant threats from derailing otherwise solid expansion plans. And on a broader level, keeping the momentum going for the ASC sector as a whole will require collective effort.
“We’re already starting to work on 2027,” Kara Newbury, chief advocacy officer at the Ambulatory Surgery Center Association (ASCA), said on the webinar. “We’re doing everything that we can to minimize the burden on our facilities while also trying to stabilize – and eventually enhance or increase – reimbursement.”
The following outlines key insights from the wide-ranging conversation, from shifting regulations to revenue pain points and recommended investment priorities.
Change is coming fast
The 2026 Centers for Medicare and Medicaid Services (CMS) final payment rule for ASCs is a net positive for the sector, Newbury said.
Among other specifics, she cited the 2.6% average payment update across all codes, the addition of nearly 600 procedures to the ASC covered procedure list (CPL) and the removal of burdensome quality reporting measures, such as screening for COVID vaccinations and social drivers of health.
Considering the early stage of the current administration and the late timing of political appointments, “it’s actually impressive how much was done,” Newbury said.
And although not all recent change has been positive for health care generally, “2027 is going to be huge” for ASCs.
Growth will be uneven
One big win for ASCA in 2026 was opening up cardiovascular procedures. However, new codes drive growth only if a center has the capacity, staffing and infrastructure to take them on.
“You’re not going to have an ophthalmic facility say, ‘Hey, I want to add cardiac ablations tomorrow,’” Newbury said.
Even for established specialties, taking advantage of new codes — such as a new batch of orthopedic procedures representing billions in potential revenue — could require significant operational reform.
Consider the Bone and Joint Institute, which is working hard to prepare despite relative lack of capacity concerns.
“We have a very large facility, so we’re luckier than a lot of other surgery centers,” Eaves said.
Even with enough space, the anticipated case increase (particularly spinal procedures) will require “more trays, more instruments” and potentially, operational reform, Eaves said.
“We’re going to have to look at our workflows and how we can bring that growth in and still keep the quality of care as high as possible,” she said.
Data is king
Beyond sufficient infrastructure and staffing, technology providing actionable, data-based insights is “going to be very useful” for growth-minded ASCs, Eaves said.
“Look at what technology can pull out your metrics and show you what you can do better,” she said on the webinar.
With proper analysis, electronic medical record (EMR) data can be useful “from the clinical side to operations to the revenue cycle,” Eaves said.
“If you can bring in technology that will help look at your coding and make sure you are not missing anything and your billing company is not missing anything, that’s definitely going to help your facility,” she added.
“At the end of the day, data drives your ability to have a great conversation with a payer,” LaLonde said. “Always stay on top of how your contracts are performing. Make sure that you’re getting paid the reimbursement that you negotiated.”
Payer negotiations will shape outcomes
Much of the conversation focused on adopting an effective negotiating posture with payers.
“Power has shifted” to some extent, Newbury said, citing price transparency legislation as well as the No Surprises Act, which empowers policies like one Anthem used to penalize the use of out-of-network providers.
Although payers will always find more sophisticated ways to reduce reimbursement, ASCs generally still have the upper hand, LaLonde said.
“The site-of-service shift savings from higher-cost settings to the ASC is still a really strong value proposition,” she explained. “Push on back on payers if they start to want a haircut, especially your higher acuity case types.”
Leveraging hospital partners or management companies can add to an ASC’s negotiating leverage. For example, Eaves credits a management partner for “getting physicians to the table” as educational advocates for the ASC.
“Always talk about quality,” Eaves said. “We love hospitals and we need them, but ambulatory surgery centers exist for a reason, and we do what we do really well. So use your physicians, use your management company — leverage whatever you can to work with payers.”
Panelists honed in on a specific area of potential pushback for ASCs: ensuring negotiated rates capture reimbursement for implants.
“We’re seeing fewer contracts that are allowing implants paid separately, so make sure your rates are being negotiated to capture that implant reimbursement depending on the payer methodology,” LaLonde said.
For an ASC with a lot of implants, due diligence is critical — even if it means a lot of work.
“It’s a huge task for your business office manager or your administrator to make sure that you’re working with your revenue cycle management (RCM) company or your billing or coding company to make sure you’re not missing anything, and then negotiating with payers for your carve outs,” Eaves said.
Looking beyond payers also can be an effective strategy for ASCs.
“If you have a partnership with your vendors, a lot of times you can negotiate pricing with them,” Eaves said. “Help them understand that there is a difference between the hospital and the ambulatory surgery center, that we don’t get paid as much as the hospital, and that our expenses are very impactful to our facilities.”
The panelists also highlighted the advantages of direct-to-employer models for maintaining or growing margins. LaLonde called these arrangements a “physician satisfier” due to the advantages in controlling market share and reimbursement for services beyond surgical procedures (goals that generally align with those of the ASC). However, scrutinizing the facility portion of bundled payments is critical to ensuring adequate reimbursement.
Eaves concurred.
“We’ve had a really good experience with [direct-to-employer arrangements] so far. We just started working with some of that last year, and it’s starting to pick up,” she said. “But keeping an eye on how you’re getting paid and who’s facilitating the process is really important.”
ASCs must speak with one voice
Although 2026 promises to be a winning year, pitfalls remain. For example, site-neutral payment reform may seem positive to some, but ASCA is concerned.
“People think, ‘I’m going to get paid what a hospital outpatient department gets paid,’ but that is not what has been discussed,” Newbury said. “What is being discussed is bringing everyone to the lowest common denominator, … to the physician office rate.”
Even past wins should not be taken for granted, Newbury said. For example, CMS’s continued use of the hospital market basket to update ASC payments (as opposed to the previously used consumer price index, which resulted in historically lower updates) is by no means guaranteed.
“There’s a lot more work to be done to ensure that it’s continued to be used in 2027 and beyond,” Newbury said.
Navigating these and other headwinds will require ASC leaders to engage with ASCA and state associations, educate lawmakers, and otherwise participate directly in advocacy efforts, Newbury concluded.
“We need to make it clear that while we are and can be the lower-cost alternative, we still need enough reimbursement to stay in business,” she said.
