ASC Market Brief: Policy, People, and the Path to 2026

Ep. 126: ASC Market Brief: Policy, People, and the Path to 2026

Here’s what to expect on this week’s episode. 🎙️

As Q3 wraps, this episode spotlights the signals that matter for ASC leaders heading into the busiest quarter of the year. We track policy direction, the continued shift of cases to outpatient settings, and how employer data transparency is accelerating site-of-care redirection. We scan market momentum and partnerships, revisit anesthesia coverage and how centers are adapting, and share pragmatic AI wins that tighten schedules and improve RCM.

Skim the quarter’s major ASC trends in under 20 minutes to guide Q4 execution and set up 2026 planning.

Episode Transcript

Alex Larralde: Hi everyone, and welcome back to this week in Surgery Centers. It’s the last day of Q3 and we’re going to do something a little different today. I’m going to share with you some of the market trends, the big news and announcements we heard over the summer and let you in on a couple of things that we’re tracking so that you can do the same at your center.

We’re going to cover policy updates, market structure, workforce dynamics, and of course a little note on technology as we gear up for fourth quarter and 2026 planning. What we’re not doing today? No product talk. No deep policy analysis. Just enough signal to inform planning. Two anchor points set the tone. In mid-July, the Centers for Medicare and Medicaid Services released the proposed Calendar Year 2026 Outpatient Prospective Payment System and Ambulatory Surgery Center Payment System rule. It continues the long shift toward outpatient care and previews what a late year final rule will likely look like. And a quick heads up for operations. On October 1st, or tomorrow, if you’re watching this podcast upon release, the ICD-10-CM codes and guidelines switch to fiscal year 2026. It’s a routine turnover, certainly not today’s headline, but worth noting because early weeks can bring some preventable denials if teams are not aligned.

So, let’s get into it and talk about the trend of case migration to the outpatient setting. Over the past few years, we’ve seen a steady shift of procedures into ambulatory surgery centers, and this quarter that momentum is of course being reinforced from two directions, policy and purchasers.

The CMS proposed 2026 update continues to normalize outpatient care, while employers with better claims transparency are pushing care to high-value sites. That combination sets the stage for where volume goes next.

So first, let’s talk about policy. As I mentioned, this summer’s proposed 2026 payment update for ASCs is incremental, but directionally consistent payment policies and the supporting addenda, shape which services, ancillaries, and indicators fit well in the ASC setting, the public comment window proceeds a late year final rule that will ultimately govern 2026.

Then on September 8th, just a few weeks ago, the National Alliance of Healthcare Purchaser Coalitions released new findings from its Pulse of the Purchaser Survey of over 324 employers. It found that employers with full claims data rights were markedly more likely to use higher value purchasing strategies like site-of-care redirection and direct contracting than employers without complete data access.

The report also highlights persistent pressure from hospital and pharmacy costs with purchasers leaning on data transparency to counter trends. Here’s a quick real-world example. A self-funded employer runs a simple comparison on a routine ortho scope, the all-in episode cost at a hospital outpatient department is higher while the ASC comes in lower with similar outcomes. When the employer actually has full claims access, their third-party administrator can steer members to the ASC with a benefit design nudge, maybe a lower copay, simpler scheduling, no fanfare, just a quiet shift in cases. Multiply that by a handful of common procedures and you will start to feel the volume move.

Now, none of this is a sudden pivot. It’s the next chapter in a multi-year arc, more procedures moving to lower cost, high-quality sites reinforced each year by CMS rule-making and employers getting smarter with claims data.

Within that arc, cardiovascular stands out. The 2026 proposed rule from CMS includes adding cardiac catheter ablation to the ASC covered procedures list, something professional societies have been pushing for, and it also revisits the criteria for what can be added to the list more broadly. We’ll know what actually makes the cut when the final rule lands later this year.

Meanwhile, summer trade coverage shows a practical shift, more cardiovascular work, finding its way to ASCs and office-based labs and some operators planning hybrid facilities that can flex between settings. If ablation is finalized for ASCs, expect payer policies to follow over time, which is typically what accelerates real specialty and service line build outs.

It’s not at all clear for every cardiac procedure, but the direction is favorable. If 2026 policy tracks as proposed, it could open the door wider for heart-rhythm cases in the ASC setting.

So now let’s shift over to the market and what moves we’re seeing there. United Surgical Partners International or USPI, part of Tenet Healthcare, reported continued momentum this summer. Same store revenue was up more than 7% in the first half of 2025, helped by integration of around 50 centers acquired last year, and a strong development pipeline. Tenet also raised its 2025 outlook in late July, reinforcing the growth thesis in ambulatory surgery.

Ascension’s agreement to acquire AMSURG adds another major system buyer to the ASC platform landscape. The June announcement cites over 250 centers across 34 states with reporting pegging the deal value at $3.9 billion dollars. That’s a scale move with obvious implication for referrals, contracting leverage, and recruiting in multiple regions.

Zooming out, hospital and health system ownership of surgery centers has surged. The latest Hospital Leadership ASC survey from Avanza Strategies shows 82% of hospitals or health systems owned at least one ASC in 2024. A number that’s up from 48% in 2023 and 41% in 2019. Among those that own ASCs, 57% now own two or more, and 90% plan to increase ASC investments or affiliations. Ownership models remain mixed, but the center of gravity is shared control. Around 75% structure their ASCs as joint ventures, and 67% prefer to hold a majority stake.

As larger platforms and health systems expand, you feel it close to home. Referral patterns start to shift; payer negotiations get recalibrated and recruiting dynamics move with them. The hinge is ultimately physician alignment. You can see it in how many operators now emphasize health system partnerships. SCA Health is one example, which tells you that joint venture models are shaping access in a lot of markets.

So, what might that look like where you are? When a health system takes a majority stake in a joint venture center, employed physicians often get priority access and day-to-day operations tighten up, credentialing, quality reporting, even the software stack.

Where a platform like USPI Tenet grows alongside a big system buyer, referral gravity usually follows physician alignment first and payer rates second. And independents still have a clear lane. Faster access, predictable block time and transparent outcomes. In competitive areas. They keep their edge by leaning into subspecialty depth, or by centering well-known surgeon experience…

Which is a nice segue into our next topic, something that’s top of mind for everyone, which is staffing, the issue that’s never fully eased, especially in anesthesia.

Over roughly the past decade, anesthesia reimbursement has gone down while pay for anesthesia professionals has gone up. That squeeze is why it’s getting harder in some places to secure steady anesthesia coverage. To keep rooms running, many centers are now using stipends or guarantees in their agreements. It’s not anyone’s first choice, it’s just what the math often requires right now.

And at the same time, demand is not falling. We have an aging population, steady surgical volume, and limits on how fast new anesthesiologists and CRNAs can be trained. Put those together and you have a very tight labor market at the very moment revenue pressure is mounting. And that’s a tough combination.

You can see this tension in everyday operations. As we’ve discussed on the podcast, ASCs have some different ways to set up coverage. Traditional contracts with anesthesia groups, in-house teams employed by the center or health system, certified registered nurse anesthetist only models in states that allow it, or a hybrid of all of these approaches, there isn’t one right model for everyone. Centers have to choose what fits their state rules, case mix and budget.

What these models do have in common though, is the goal: reliable coverage, so you can start on time, and finish on time. Here’s the practical takeaway. For an ASC, the most persuasive thing that you can show an anesthesia provider is time you can count on. First case on time starts prove that you’re organized, and accurate turnover times prove that your schedule is realistic.

When those two things are strong, it’s easier to staff rooms, easier to discuss performance terms, and easier to avoid last minute scrambling that burns money and goodwill. Whether you contract with an outside group or employ clinicians directly, predictable days are what keep people willing to cover your rooms.

There’s also a policy backdrop worth noting. We’ve seen payers test new ideas to control costs. Some proposals haven’t gone forward, but they remind us that payment rules can change, and anesthesia is often in the spotlight when payers are looking for savings. Even when a proposal is withdrawn, the conversation usually comes back in a different form.

So where does that leave ambulatory surgery centers today? Professional payments are under pressure, compensation for clinicians has climbed, and that gap makes coverage harder to sustain without new terms. The workforce is tight. Demand for anesthesia services is steady, and training pipelines take time to expand. Nothing in the last quarter suggests that these themes are fading.

If anything, recent news has underlined the same two points. Reimbursement pressure and workforce supply are still the biggest anesthesia challenges, and until both of those change, the centers that do best are the ones that make their days as predictable as possible because predictability is what keeps anesthesia coverage in the building.

Onto the topic I know everyone can’t get enough of. Artificial intelligence, but let’s break down how it’s actually helping ASCs today across both the office and the OR.

Every ASC leader we talk to is fighting some combination of the same three pressures. Rising costs, a relentless administrative burden, and the constant challenge of a lean team. You’re asked to do more with less, and it can feel like you’re fighting fires all day, every day.

But what if you had a new kind of teammate, one that could handle the tedious, repetitive work without complaint? That’s the promise of AI in the ASC space. And now while major hospital systems are spending millions on headline-grabbing robotics and predictive diagnostics, the AI trend in surgery centers is more measured, more practical, and frankly, more immediately useful.

It’s not about being a rocket scientist, it’s about becoming a smarter, more efficient operator. The fastest gains are not necessarily in the operating room, but in the front office and business office where the little wins add up to a significant competitive advantage.

Think about your schedule. It’s the engine of your ASC, but it’s a fragile one. A single late start or a surprise add-on can derail an entire day. AI tools are now acting as a copilot for your schedule. They analyze historical data from your center, which surgeons run long, which procedures are faster than you might think, and they use that data to create a more realistic and therefore more reliable daily schedule. They can even flag patients who are statistically more likely to no-show, giving your team a chance to fill that slot proactively. The result, fewer surprises, less wasted time, and a smoother flow for patients and staff.

Published in the Journal of the American Medical Association Surgery, in a randomized trial of 683 surgical patients, a machine learning model predicted case length more accurately than standard estimates and reduced patient wait times with no increase in turnover time. The author’s takeaway was simple. Using machine learning every day to predict case duration can help optimize and tighten your schedule.

Let’s talk about the business office, the place where AI makes the quickest, clearest difference. A denied claim drains margin and time. So, think of AI as a steady, extra set of hands for your RCM team. Upfront, it runs eligibility and prior authorization checks and gives you a simple list of what’s missing before the patient even arrives. That alone cuts a lot of day of cancellations and paperwork.

On the backend, it reads the operative note to suggest codes, with a human reviewing, of course, scrubs claims for common errors before they go out and groups denial by root cause, so the right fixes happen fast. The result is straightforward. More first pass approvals and less time spent chasing dollars after the fact.

On the clinical side, AI is all about freeing up your highly skilled staff from the mundane. An ambient documentation tool, for example, can listen in on a patient conversation and draft a quick history and physical or a post-anesthesia note.

AI can also help with inventory management, suggesting reorder times based on usage and even prompting staff to capture implant lot numbers before the patient leaves, making recalls and audits cleaner. And it can even help you with something as simple as updating a preference card, ensuring your team has the right tools every time.

So, what’s the takeaway. For ASCs, AI isn’t a silver bullet, and you don’t need to be the first to adopt every shiny new tool that comes out in the market. The smart move is to take incremental, safe steps.

Find a pilot program that addresses a specific pain point, whether it’s scheduling chaos, or denied claims, and start there. Always keep a human in the loop for anything clinical, and make sure any tool that handles PHI offers a Business Associate Agreement. The fastest gains will come from improving your processes, not from a single piece of technology.

By using AI as an assistant, you can save time, reduce stress, and elevate your team to the work that truly matters, which is caring for patients.

To wrap things up, taking a step back, the signals from this quarter line up and they point in the same direction toward ASC growth.

On the policy front, the proposed 2026 update keeps the shift to outpatient on track. We’ll get the details in the final rule later this year.

For purchasers, employers are leaning harder on claims transparency. Where they have full data rights, you see more site-of-care redirection and more interest in ASC partnerships.

Looking at platforms, major operators and health systems continue to expand on the ASC side. Capital, development, and integration work are all pointed at outpatient growth.

Looking at the workforce, anesthesia is still the practical bottleneck. Coverage models are evolving under reimbursement pressure, and the centers that run predictable days are the ones most likely to keep coverage.

And finally, on the AI front, interest is up, adoption is measured. The near-term wins are practical and focused on improving business efficiency and streamlining your processes.

And as we look ahead to the next month, there are a number of state conferences and of course the Becker’s ASC conference in Chicago, October 16th through 18th. So, lots of places to compare notes in person with your colleagues. I encourage you to get out there, meet some folks, make some new friends, bring your team along and find a couple of new ideas that you can start implementing right away.

And with that, we wrap up today’s episode of This Week in Surgery Centers. I hope today was helpful for you as you gear up for an always busy Q4. We have some incredible guest conversations lined up over the next few months, so be sure to check back often for new episodes and we’ll see you again next time.