Here are several factors that are either supporting or hampering growth for ASCs in 2025:
Harmful factors:
1. Stagnating reimbursement rates
Reimbursement rates have not kept pace with inflation and rising operational costs, putting financial pressure on ASCs. While CMS slightly increased ASC reimbursement rates for 2024, many leaders argue that the boost is insufficient to offset soaring labor, supply and facility costs.
“CMS is not afraid to increase our costs by requiring reporting on patient satisfaction through only their chosen vendors. Our costs rose significantly for this,” Tina Heinrich, administrator of Placerville, Calif.-based El Dorado Surgery Center, told Becker’s. “Too bad they are so slow in increasing reimbursement amounts.”
From 2011 to 2024, the number of Medicare-certified ASCs in the U.S. grew from 1,339 to 2,140, according to VMG Health’s “ASCs in 2024: A Year in Review” report. William Prentice, CEO of the Ambulatory Surgical Center Association, told Becker’s that reimbursement policies are one of the central policy concerns for ASCA in 2025, highlighting that declining reimbursement for ASCs is a missed opportunity for savings in the Medicare program.
“Surgery centers use the same staff, services and supplies as hospital outpatient departments, so it only makes sense to apply the same inflation rate for our yearly updates,” he said.
2. Rising operating costs
From supply chain expenses to staffing and real estate, rising costs are squeezing ASCs. Inflation has driven up the prices of surgical supplies, facility maintenance and staff wages.
Between 2013 and 2022, median medical and surgical supply costs per full-time employee in physician-owned multispecialty practices rose by 82%, according to a Medical Group Management Association report.
“Overall costs have risen — and sometimes doubled in certain areas — since 2020, post-COVID-19,” Will Brancamp, ASC administrator at Infirmary Health System, said. “This includes material and supply costs. Additionally, staffing growth in clinical positions has created a supply-and-demand situation with salaries.”
3. Workforce shortages and retention challenges
The healthcare workforce shortage has hit ASCs hard, especially among nursing and anesthesia roles. Rising wage demands and competition from hospitals offering better pay and benefits exacerbate the issue.
“Staffing shortages remain a significant challenge across the healthcare continuum,” Danilo D’Aprile, president-elect of the Arizona ASCA and vice president of business development at Merritt Healthcare, told Becker’s. “ASCs are no exception. The demand for qualified nurses and anesthesiologists is especially pressing.”
The declining number of experienced OR nurses and a limited pipeline of anesthesiologists further strain ASCs.
Helpful factors:
1. Improving block utilization
Given the challenges ASCs face regarding reimbursement rates, organizations must find other ways to boost revenue and maximize efficiency through block utilization.
“The greatest impact on improving revenue in our [endoscopy] center has been getting the schedules completely backfilled when physicians are on vacation,” Pradnya Mitroo, MD, president of Fresno (Calif.) Digestive Health, told Becker’s. “I have created a process where the managers of both of our divisions review [the] three-month schedule for all providers for vacations. It is then offered to each of the physicians in both divisions to fill. Then, three weeks prior, anything that is not filled by then goes back to the physicians to fill up, sometimes their schedules may have changed. This has improved our block utilization significantly and improved revenue.”
Brett Maxfield, CRNA, the director of anesthesia and surgical services at Teton Valley Health Care in Driggs, Idaho, said this improving block utilization can also reduce costs for staffing and anesthesia while boosting revenue.
“Originally, surgeons were allowed to schedule based on estimated surgical times and using a standard block format. We reviewed actual surgical block usage and actual case time based on historical data, and were able to go through and more accurately schedule case times, more accurately and completely use the block time,” he said. “That enabled us to reduce overall staffing and anesthesia costs while maximizing revenue during those productive periods. This has led to a significant net gain in revenue and productivity, and has also had a pleasant side effect of a decreased staff burnout and an increase in available surgical time for additional surgeons to begin operating with us.”
2. Accessing group purchasing organizations
Many ASCs miss opportunities to lower costs by not utilizing specialty-specific group purchasing organizations.
“Many specialty GPO members achieve savings of 12% to 18% over prior contract pricing,” said Robert Nelson, PA-C, former executive director of Island Eye Surgicenter, adding that effective supply chain management is critical to profitability.
Matawan, N.J.-based management services organization Redefine Management leverages its access to a GPO to empower physician groups and ASCs — a strategy its leadership says is key in supporting the financial futures of independent practices in today’s economic climate.
“We don’t just connect physicians with opportunities. We analyze their volume, streamline their operations and design a roadmap that makes their partnerships the most efficient and lucrative,” Shawn Bannon, chief development officer at Redefine told Becker’s.
3. A more targeted approach to anesthesia billing
Scott Mayer, CEO of Rosemont, Ill.-based Ambulatory Anesthesia Care, recently told Becker’s that, with more Medicare-eligible patients entering the patient pool each day, ASCs need to be more precise with their approach to billing and payment practices for these cases.
“One of the things we’re trying to educate the space on is, when you do want to bring the Medicare population in — which we’re happy to service, support and take care of — Are you taking into account that there may need to be some financial stipend or support given to the anesthesia side for that specific patient?” he said.
This differs from the way that many ASCs may be approaching their current anesthesia payment processes as it relates to Medicare patients, specifically, by separating that calculation from a practice’s overall anesthesia billing.
“I feel like people are lumping these bigger, kind of macro situations of, “Oh, we need to pay [for] anesthesia …” when, really, we’re not looking at the root of the problem, which is Medicare reimbursement driven on the anesthesia side, and that utilization needs to be increased as well.”
AAC has been heavily leveraging data analytics and other technologies to bring clarity to these complex billing processes.
“We’ve done a lot to make sure — from EMR, Power BI, from our financial reporting, but also from our operational reporting — to [figure out] how we can get down all the nuances and details as to what could be improved, or where things are standing out,” he said.
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