From shifting state policies around new ASC development to ongoing staffing issues, here are three factors hindering ASC growth in 2025:
Certificate-of-need laws
While certificate-of-need laws vary from state to state, many ASC leaders argue that these regulations hinder growth by subjecting centers to a lengthy and expensive approval process — one often inaccessible to smaller or independent ASCs.
According to L.E.K. Consulting’s “2024 ASC Insights Study,” the compound annual growth rate of Medicare-certified ASCs between 2019 and 2023 was highest — at least 4% — in Arizona, Mississippi and South Carolina. South Carolina is the only state that has repealed its ASC-specific CON law since 2020.
The next-highest growth bracket — 2% to 4% — also aligned with the absence of CON regulation. States in this category included Montana, Wyoming, Utah, Colorado, Kansas, New Mexico, Texas, Louisiana, Indiana and Michigan. None of these states have ASC-specific CON laws in place.
Simon Schwartz, associate director of the Colorado Ambulatory Surgery Center Association and COO of Englewood, Colo.-based Strategic Resources Group Colorado, voiced strong opposition to such regulations.
“CON is not a good thing,” he told Becker’s. “This is my personal belief, not necessarily the association’s stance, but overregulation doesn’t lead to efficiency. Certificates of need — without a very clear understanding of what they are — is a very difficult thing to embrace.”
Rising operational costs
Independent ASCs are especially strained by rising costs for medical supplies, labor and other operational necessities.
The median investment per full-time physician at physician practices rose to $347,240 in April 2025, according to data from Strata Decision Technology. This marks a 4.8% increase since 2024 and a 16.3% increase since 2023.
Administrative and support staffing costs are also increasing.
“I can’t keep a front-desk person at $15 an hour, like medical practices were able to do 10 years ago,” Michael Warne, CEO of Associated Gastroenterologists of Central New York in Camillus, told Becker’s. “No. 1, it’s unethical. I want to pay people what they deserve to be paid. This is very hard work. It’s stressful. People need to be compensated accordingly.”
“That comes, obviously, at a dollar cost,” he continued. “We’re not only healthcare providers — we’re employers, and we’re looking to support the community. It’s just a simple fact of economics. In addition to the rising labor costs: the cost of EMR, the cost of postage, the cost of medical supplies, the cost of rent, the cost of typical utilities keeping the lights and the water running … it’s going up every year.”
Payer pressures drive physicians out of private practice
The ability to negotiate higher payment rates with payers was the top factor influencing physicians to sell their private practices in 2024, according to the American Medical Association’s Physician Practice Benchmark Survey.
About 70.8% of respondents cited better negotiating ability as “important” or “very important” in their decision to sell.
“The biggest shift in our payer relationships over the past year has been the accelerating trend of payers aggressively narrowing networks and unilaterally cutting reimbursement, particularly targeting anesthesia services,” Jack Dillon, CEO of Anesthesia Practice Consultants in Grand Rapids, Mich., told Becker’s. “We’re also seeing more frequent delays in contract negotiations, denials for medically necessary care and increased pressure to accept unfavorable in-network rates. These moves are often justified under the guise of cost containment, but they threaten practice sustainability and patient access to care.”
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