Image by StockSnap from PixabayA bipartisan House bill introduced March 25 would permanently extend a more favorable Medicare inflation update for ambulatory surgery centers (ASCs).
It would also block another type of payment adjustment that the industry argues could hold ASC reimbursement down.
The legislation – the Outpatient Surgery Access Act of 2026 – was introduced by Reps. Beth Van Duyne (R-Texas) and John Larson (D-Conn). If enacted, it would align annual payment updates for ASCs with hospital outpatient departments (HOPDs) beginning in 2027 and eliminate an ASC-specific budget-neutrality adjustment.
It would also require the U.S. Centers for Medicare & Medicaid Services (CMS) to take ASC spending into account when calculating certain outpatient payment adjustments.
“Outdated Medicare policies are limiting access to high-quality and lower-cost care,” Rep. Van Duyne said in a statement. “Our health care system should reward high-quality, lower-cost care, not stand in its way, like current rules fail to treat outpatient surgical centers fairly.”
For ASC operators, the bill arrives at a key moment.
CMS has been using the hospital market basket as the inflationary update factor for ASC payments on a temporary basis since 2019, following years of advocacy from the Ambulatory Surgery Center Association (ASCA). That policy is scheduled to expire at the end of 2026, creating uncertainty around how Medicare reimbursement for surgery centers will be updated after that.
Often in the health care advocacy world, such expirations are referred to as a fiscal or financial cliff.
Supporters of the recently introduced legislation argue that making the hospital market basket permanent would better reflect the real costs of operating an ASC than the Consumer Price Index for All Urban Consumers, or CPI-U, which CMS has historically used to update ASC rates.
While CPI-U tracks changes in prices for household consumer goods, the hospital market basket is designed to capture health care-specific cost pressures such as wages, equipment and malpractice insurance.
“Ambulatory Surgical Centers provide preventive services and essential procedures to thousands of patients across the State of Connecticut every year,” Rep. Larson said in a statement. “I’m proud to join with my colleague, Rep. Beth Van Duyne, on this common-sense, bipartisan bill to protect outpatient care for Connecticut residents and Americans across the country.”
ASCA is a key supporter of the bill.
“Surgery centers perform millions of essential elective procedures for Medicare beneficiaries every year,” ASCA CEO Bill Prentice said in a statement. “Ensuring an accurate and stable payment system is key to protecting patient access to low-cost, high-quality surgery centers.”
Prentice thanked Reps. Larson and Van Duyne for introducing the “important bill.”
The budget-neutrality aspect of the legislation shouldn’t be overlooked.
The bill text says the U.S. Department of Health and Human Services (HHS) secretary may not apply an ASC-specific adjustment designed to hold aggregate spending at the same level it otherwise would have been.
In other words, if CMS advances a payment adjustment that would increase ASC rates but raise overall spending, it can’t layer on another adjustment to pull payments back down.
The legislation would also direct CMS to include ASC expenditures when determining outpatient payment adjustments for 2027 and later years.
The bill’s prospects remain uncertain, as is often the case with Medicare payment legislation early in the congressional process.
Don’t forget about the M&A implications
Beyond Medicare policy, the bill also matters from an M&A and investment perspective.
As surgery centers continue to attract interest from strategic buyers, health systems and private equity-backed platforms, payment visibility can play an outsized role in how investors evaluate risk.
In short, ASC deals are typically underwritten on assumptions about future procedure growth, payer mix and margin performance. When a key Medicare update is temporary or set to expire, that can introduce uncertainty into those models – and spook overly cautious investors.
