Image by StartupStockPhotos from PixabayThe ambulatory surgery center (ASC) industry enters 2026 with undeniable momentum – and a growing sense that the “easy” part of the outpatient shift is over.
More procedures are moving out of hospitals, yes. And it’s true that payers, employers and patients all continue to favor lower-cost (and more convenient) sites of care. What’s more, regulators are expanding what ASCs can do, and investors still view the sector as one of health care’s few durable growth stories.
But the operating environment underneath this growth is becoming more complex. Higher-acuity cases bring, well, higher expectations and system requirements. Site-of-service policies are evolving faster than reimbursement frameworks. Artificial intelligence is moving from experimentation to infrastructure. Workforce pressures – particularly around anesthesia, nursing and administration – are intensifying.
In short, 2026 looks less like a continuation of the last few years and more like an inflection point. Some audacious writers might even go so far as to say 2026 will be a redefining year for the ASC market.
ASC News explores the trends that we believe will play key roles in the year ahead below.
Accelerated migration of higher-acuity procedures to ASCs
The shift of complex care into ambulatory settings will accelerate again in 2026, with cardiovascular, spine and advanced orthopedic procedures leading the way.
Years of data, technology improvements and regulatory change have fueled this trend and will continue to drive it forward.
The U.S. Centers for Medicare & Medicaid Services (CMS) made sure of this when the agency opted to phase out the Medicare Inpatient-Only List and expand the ASC Covered-Procedures List for 2026. But commercial payers are pushing site-of-service optimization more aggressively, too.
And surgeons are increasingly comfortable performing complex cases outside the hospital.
“In 2026, the biggest driver will be the continued shift of high-acuity procedures into the ASC setting,” Steve Hockert, chief development officer for Solara Surgical Partners, previously told ASC News. “Payers, employers and patients all want value, and ASCs are uniquely positioned to deliver that without sacrificing quality.”
It’s likely not surprising to anybody reading this that cardiology remains one of the most closely watched frontiers. CMS’ approval of cardiac ablation codes for ASCs, for example, is already reshaping development pipelines, capital plans and partnership strategies.
“CMS’ approval marks a meaningful step toward expanding access to arrhythmia care, where fewer than 5% of eligible patients currently receive ablation,” Michael Bodner, company group chair of electrophysiology and neurovascular at Johnson & Johnson MedTech, recently told ASC News. “The decision reinforces the strong body of clinical evidence that cardiac ablations can be performed safely by highly trained electrophysiologists in well-equipped ASCs.”
Orthopedics and spine are following a similar trajectory.
The opportunity is significant, but so is the risk. Higher-acuity care demands surgeon willingness, specialized staffing, capital investment, throughput discipline and payer alignment. Typically, it requires much more physical space as well.
“We’re going to see more orthopedic, cardiovascular and spine migration than ever before,” Hockert continued. “The groups that can combine clinical excellence with operational discipline will have a major advantage.”
The site-neutrality double-edged sword will cut both ways
Few policy concepts generate as much confusion – or misplaced optimism – as site-neutral payment. One week, ASC News might chat with an industry leader who sees it mostly as a positive. The next week, it might be positioned as a major headwind.
In theory, site neutrality should benefit ASCs by narrowing the reimbursement gap between hospital outpatient departments (HOPDs) and lower-cost ASCs. But the devil is in the details, and site neutrality can turn into a double-edged sword, with procedures also shifting from surgery centers to office-based settings.
“People think, ‘I’m going to get paid what a hospital outpatient department gets paid,’ but that is not what has been discussed,” Kara Newbury, chief advocacy officer at the Ambulatory Surgery Center Association (ASCA), said during an ASC News webinar. “What is being discussed is bringing everyone to the lowest common denominator.”
If site neutrality moves forward and, in turn, pulls ASC reimbursement down toward physician office rates (or moves procedures into those settings), the impact could be destabilizing.
Additionally, some ASC leaders worry early state-level site-neutral experiments could quietly set precedents before the industry fully understands the implications. Either way, ASC News sees 2026 as a year when site neutrality shifts from abstract policy debate to concrete financial risk or reward.
It’s important to note that not everyone is concerned with site neutrality.
“Based on detailed reviews of all the frameworks we are tracking, we believe none individually or collectively will have a material impact on the company’s net revenue or earnings,” Surgery Partners (Nasdaq: SGRY) CEO Eric Evans said during a 2025 earnings call. “More specifically, there are very few procedures performed in our facilities that should be done in a lower-cost site as contemplated in any of the current frameworks.”
Site neutrality was actually in the spotlight as recently as Feb. 9, when Ezekiel J. Emanuel and Merjan L. Ozisik highlighted the topic in a STAT op-ed piece. In short, they positioned CMS as the “shining star” of the Trump administration, partly because of the agency’s efforts around site neutrality.
“Another positive change – long advocated for by think tanks and the Congressional Medicare Payment Advisory Committee (MedPAC) – is the expansion of so-called site neutral payments,” they wrote. “The government pays substantially different amounts for the same services depending on whether the care is delivered in a hospital or at an ambulatory care facility. For example, an average hip replacement done in a hospital is nearly $3,500 more than the same hip replacement done in an ambulatory surgical center. This is among the most expensive flaws in health care.”
Estimates suggest shifting care from hospitals to lower cost settings could save $100 billion a year without compromising quality, they continued.
“Importantly, equalizing payment across sites through expanded site-neutral payment policies could yield savings of similar magnitude,” Emanuel and Ozisik emphasized.
ASC expansion will outpace payer readiness and create a reimbursement hangover
ASCs are expanding faster than the reimbursement systems that support them.
New service lines, higher-acuity cases and more complex episodes of care are coming online quickly. Payer contracts, credentialing processes and payment methodologies are not keeping pace.
“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, said during a recent ASC News webinar.
The disconnect creates what some operators describe as a reimbursement hangover: cases are added, capital is deployed and staffing ramps up, only for payment delays, underpayments or contract mismatches to then surface.
“We’re already starting to work on 2027,” Newbury said during the same discussion. “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.”
ASC News will actually explore this issue in more depth with Nimble Solutions during an upcoming webinar focused on expansion strategy, payer readiness and revenue cycle alignment.
ASC News – and many others – sees this as a critical issue for 2026.
“ASCs that can prove efficiency, clinical appropriateness and predictable outcomes will capture volume,” Tim Fuchs, chief growth officer for nimble solutions, told ASC News. “Those that can’t meet the administrative/data driven lift will see case denials or leakage back to hospitals. RCM performance becomes a growth limiter or growth engine.”
Regulatory review and prior authorization will pressure ASCs
Regulatory friction is no longer limited to headline-grabbing rulemaking.
In 2026, ASCs will face quieter but more persistent pressure from prior authorization requirements, payer documentation escalation and new oversight models such as CMS’ WISeR initiative.
The risk is less about outright denials and more about delay: care slowed, payments stretched and administrative burden shifted onto already-lean teams. For high-throughput centers, even modest disruptions can ripple across schedules, staffing and cash flow.
“[CMS is] requiring authorizations for a subset of procedures to see if, basically, these procedures are actually needed,” Stacy LaLonde, vice president of payer strategy at Compass Surgical Partners, previously told ASC News. “It’s all around the fraud, waste and abuse initiatives that this new administration is taking on.”
Prior authorization patterns with private insurers aren’t slowing down either, the latest data suggest.
Proof point: Nearly 53 million prior-auth requests were submitted to Medicare Advantage (MA) insurers on behalf of MA enrollees in 2024, according to a Kaiser Family Foundation analysis.
AI will become table stakes and have a larger OR footprint
Artificial intelligence is moving from pilot projects to core infrastructure inside ASCs.
What began as administrative automation – documentation, scheduling, inventory tracking – is expanding deeper into the operating room and across the full episode of care.
“Surgery is entering an AI era, but it only works if the underlying systems are rebuilt so clinical knowledge and data can be analyzed and learned from, at scale,” Oliver Keown, founder and CEO of Oath Surgical, said in a statement when announcing the company’s recent partnership with NVIDIA.
Oath’s AI-native ASC model illustrates where the sector may be headed via real-time video and audio analysis in the OR, automated operative notes, tighter links between intraoperative data and long-term outcomes.
“We’re not just layering software on top of the old system; we’re creating a new one that supports the safe delivery of complex surgery outside the hospital,” Keown previously told ASC News.
Investor interest reinforces the trend as well. Companies such as Apella, which raised $80 million to expand ambient AI and computer vision tools in surgical environments, are betting that automation will unlock capacity without adding staff or square footage.
ASC News anticipates covering many more exciting AI developments in 2026.
“ASCs run lean and small inefficiencies add up quickly,” Marc McComas, vice president of regional operations for Solara Surgical Partners, previously told ASC News. “We started looking at AI to streamline scheduling, optimize room usage and identify patterns that could improve both patient flow and clinical safety. It wasn’t about chasing new technology – it was about solving persistent pain points that affect efficiency and patient experience.”
More states will target anesthesia caps
Here’s the big, bold prediction on 2026 trends from ASC News: Anesthesia will be one of the most acute pressure points for ASCs. Just kidding! We know you already had this on your 2026 bingo card.
But let’s talk about caps, specifically. Payers in several states are attempting to cap anesthesia time or reimbursement, arguing the measures are necessary to control costs. ASC leaders counter that such caps fail to reflect clinical complexity and staffing realities, especially as higher-acuity cases migrate outpatient.
The result is a growing patchwork of state-level responses. Some states are moving to block anesthesia time limits, while others are allowing payer policies to advance, creating uneven operating conditions across markets.
For ASCs already subsidizing anesthesia coverage to keep ORs running, the stakes are high. Limits that look modest on paper can quickly translate into canceled cases, strained physician relationships and margin erosion.
As of early 2026, only a few U.S. states have enacted laws that ban anesthesia time-based caps entirely, including Illinois and Maryland. Washington may soon join their ranks.
This issue will likely become more magnified as the year moves on.
Health system titans will continue to invest in their ambulatory strategy
This ASC News prediction about a trend that will define 2026 is probably a softball, too: Health systems won’t retreat from ASCs, but instead double down.
Ascension’s acquisition of AMSURG, HCA Healthcare’s (NYSE: HCA) ongoing divestment of hospital assets in favor of outpatient growth and Tenet Healthcare’s (NYSE: THC) continued expansion through USPI all point in the same direction of ambulatory care being a core strategy vs. ancillary business.
Health systems see ASCs as a way to protect market share, retain physicians and manage cost pressure in an increasingly outpatient-centric environment. Many are centralizing ambulatory oversight at the executive level and treating ASC networks as enterprise infrastructure.
“Health systems are investing in care models that can scale, and most respondents are investing in high-growth or underserved markets,” an October 2025 report from the Center for Connected Medicine (CCM) at UPMC Enterprises and KLAS Research explained. “Common areas of focus are multispecialty clinics, ambulatory surgery centers and virtual care platforms. This shift beyond hospital walls not only benefits patients but also supports staffing and resource challenges.”
The competitive landscape in 2026 will increasingly pit scaled ambulatory platforms against independent centers — with capital, data and contracting leverage often deciding outcomes.
There will be more targeted (or niche) ASC partnerships
The next wave of ASC partnerships will be narrower and more specialized, ASC News believes.
Rather than broad, generalist joint ventures, operators and investors are forming alliances around specific service lines, patient populations or operating models. Pediatric ASCs are a prime example.
Regent Surgical’s joint venture with Patches Kids Care to develop pediatric-focused ASCs highlights the trend.
“The recovery process for a child is different than the recovery process for an adult,” Regent CEO Travis Messina previously told ASC News. “They don’t know what it’s like to come out of anesthesia, they’re confused, and they can’t find the right words to describe the feeling they’re experiencing. Having an experience that’s dedicated solely to children, with post-op or post-anesthesia care recovery nurses who know how to handle children and comfort them, as well as their parents, enhances the overall experience.”
In this same space, in August, Great Hill Partners acquired a majority interest in Blue Cloud Pediatric Surgery Centers from TPG’s The Rise Fund. That’s another development that supports this trend.
Pediatric ASCs, cardiovascular-only centers and specialty-driven networks allow partners to align capital, staffing and protocols more precisely, reducing risk while deepening expertise.
ASC News expects to be covering the pediatric ASC space, in particular, more frequently in 2026.
Health care uncertainty and rising costs will hit ASCs
Finally, the macro environment is becoming less forgiving.
ACA subsidies are unlikely to expand. Medicaid funding faces pressure. Congress remains dysfunctional. For many patients, elective care is becoming harder to afford.
ASCs are not immune. Centers heavily reliant on elective volume may feel the impact first as patients delay procedures or drop coverage altogether.
What to revisit what ASC News said about the trends that would define 2025? Revisit our trends piece here(and let us know how we did).
