Payment

Ambulatory surgery centers (ASCs) continue to expand their footprint in Medicare while delivering care at significantly lower cost than hospital outpatient departments (HOPDs). That’s according to a recent status report from the Medicare Payment Advisory Commission (MedPAC). The report offers a high-level overview of ASC utilization, spending, quality and geographic distribution under fee-for-service Medicare. MedPAC is an independent congressional advisory body that analyzes Medicare … [Read more...]

As 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 … [Read more...]

Ambulatory 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 … [Read more...]

Improper payments in Medicare and Medicaid – overpayments, underpayments, or payments where insufficient information was provided to determine whether a payment was “proper” – remain on the downswing. Specifically, the estimated improper payment rate for fee-for-service Medicare in Fiscal Year 2025 was 6.55%, or $28.8 billion, according to the U.S. Centers for Medicare & Medicaid Services (CMS). That’s down from 7.66%, or $31.7 billion, for Fiscal Year 2024. Contextually, the Medicare … [Read more...]

The shift of musculoskeletal procedures from inpatient to outpatient alone is potentially a multi-billion-dollar opportunity for ambulatory surgery centers (ASCs). That’s according to a recent analysis from Trilliant Health, a health care data and analytics company. “With the removal of the [IPO] list, we're tracking the potential for accelerated migration to the outpatient setting, which has the potential to increase care value somewhat broadly, but also has very real implications for … [Read more...]

If 2026 is shaping up to be a defining year for the ambulatory surgery center (ASC) business model, it is also one that will test its limits. Rising labor costs, payer complexity, anesthesia shortages and margin pressure are operational realities that executives are confronting daily. The shift of higher-acuity cases into outpatient settings continues, but the economic and workforce infrastructure needed to support that growth has not always kept pace. For many operators, the challenge is … [Read more...]

From seismic policy shifts to blockbuster deals and the accelerating migration of higher-acuity care into the outpatient setting, 2025 was a defining year for the ambulatory surgery center (ASC) industry. ASC News readers gravitated toward stories that captured an industry in transition – one balancing rapid growth and innovation with mounting regulatory action, reimbursement pressures, and questions about scale, ownership and independence. Clinical evolution was another important theme. … [Read more...]

The U.S. Centers for Medicare & Medicaid Services (CMS) finalized plans to phase out the Medicare Inpatient-Only (IPO) List in November while also covering more procedures in the ambulatory surgery center (ASC) setting. But some voices in the post-acute care space continue to express concern with the changes. As CMS accelerates the shift of more procedures into outpatient settings, skilled nursing leaders are warning that downstream Medicare policy has not kept pace, renewing calls to … [Read more...]

The ambulatory surgery center (ASC) industry is entering 2026 with plenty of momentum, fueled by a shifting regulatory landscape plus rising demand from patients and payers alike. But there are sizable hurdles ASC operators will need to clear as they move forward. To help set the scene, Ambulatory Surgery Center News connected with 12 ASC leaders and market experts, asking them about the trends, challenges and opportunities likely to define 2026 most. Those who participated in this … [Read more...]

One of the largest health insurers in the nation is pushing a new out-of-network policy that could prove seriously challenging for ambulatory surgery centers (ASCs). Starting Jan. 1, 2026, Anthem will penalize hospitals, surgery centers and other facilities whenever those facilities use out-of-network providers for patients covered under Anthem commercial plans. In other words, the insurer is putting financial pressure on facilities to use only in-network resources, except in certain … [Read more...]