By Bill Prentice
The ambulatory surgery center (ASC) market evolved markedly in 2025. Many centers expanded service lines to add spine, cardiovascular or total joint procedures and adopted technologies, such as robotics, AI, telehealth and advanced electronic health records. To help surgery centers navigate the transitions, the Ambulatory Surgery Center Association’s (ASCA) work became more critical than ever. We helped ASCs shift from simpler outpatient procedures to higher-acuity cases and provided the regulatory and business guidance they needed. We advocated for the ASC community and provided education in the form of virtual courses, benchmarking surveys and our annual in-person conference.
Our advocacy efforts last year covered myriad regulatory, clinical and operational issues.
In February, ASCA sent a letter to the Centers for Medicare & Medicaid Services (CMS) Acting Administrator Stephanie Carlton outlining its top priorities for 2026 rulemaking. We highlighted several policy areas that would allow ASCs to better serve the Medicare population and requested that CMS do the following.
- Continue use of the hospital market basket as the annual update mechanism for ASC payments, as initially established during the first Trump administration. This will ensure better alignment of the ASC and hospital outpatient department (HOPD) payment systems.
- Add procedures to the ASC Covered Procedures List (ASC-CPL) when clinicians provide outcomes data supporting their inclusion.
- Reassess measures added in recent years to the ASC Quality Reporting (ASCQR) Program that only increase the burden on facilities without providing any benefit to patients or healthcare facilities.
In the same month, ASCA co-led a coalition letter written to the U.S. Senate Committee on Health, Education, Labor & Pensions Chairman Bill Cassidy (R-LA) and Ranking Member Bernie Sanders (I-VT) expressing concerns about proposed price transparency legislation and its potential negative impact on surgery centers.
The letter, sent in partnership with the American Society for Gastrointestinal Endoscopy, argued that proposals requiring ASCs to publicly disclose “de-identified maximum and minimum negotiated charges” would be administratively burdensome and fail to provide useful information to patients. ASCA believes that current regulations, including the No Surprises Act, provide an appropriate framework for patients to access accurate cost estimates.
In May, Senators Bill Cassidy, MD, (R-LA), and Richard Blumenthal (D-CT) introduced the Senate version of the Medicare Beneficiary Co-Pay Fairness Act (H.R. 3006/S. 1776). This followed the House introduction in April by Representatives Mike Kelly (R-PA), Robert Menendez Jr. (D-NJ), Troy Balderson (R-OH) and John Larson (D-CT).
ASCA drafted the language and advocated for the introduction of this legislation, which proposes to cap the maximum Medicare copayment for procedures performed in ASCs at the inpatient deductible. If passed, the bill will align ASC copayments with those in HOPDs, preventing beneficiaries from paying more for the same procedure simply because of the care setting.
In June, ASCA submitted comments in response to the Department of Justice (DOJ) Antitrust Division’s RFI on unnecessary laws and regulations that pose high barriers to competition. This RFI was announced in conjunction with the DOJ’s establishment of the Anticompetitive Regulations Task Force “to advocate for the elimination of anticompetitive state and federal laws and regulations that undermine free market competition and harm consumers, workers and businesses.” ASCA’s comment letter emphasized the ease of converting an ASC to an HOPD, while highlighting the barriers in doing the reverse. It also identified CMS payment policy issues that serve as barriers to competition, including the agency’s refusal to add certain codes to the ASC-CPL.
In September, ASCA submitted formal comments in response to CMS’ 2026 proposed payment rule for ASCs and HOPDs. In the comments, ASCA supported CMS’ proposal to broadly expand the list of procedures allowed to be performed in ASCs, and agreed with CMS that clinicians are the stakeholders best suited to determine the appropriate site of service for their patients. ASCA’s comments also reflected ongoing advocacy for continued alignment of inflationary update factors between ASCs and HOPDs and the elimination of the budgetary adjustment that continues to severely depress rates for important Medicare procedures like cataract removals.
With regards to quality reporting, ASCA expressed support for the removal of four measures from the ASCQR Program that held little applicability to meaningful measurement of a surgery center’s operational quality.
Also in September, during National Advocacy Day, ASCA members and staff, representing 30 states, met with 122 members of Congress and their staff to help educate federal legislators about the ASC community and secure further support for the Medicare Beneficiary Co-Pay Fairness Act.
In October, ASCA sent a letter to CMS requesting a delay of the five-year prior authorization demonstration for certain services provided in ASCs that was set to begin on December 15. The demonstration project would impact 10 states: Arizona, California, Florida, Georgia, Maryland, New York, Ohio, Pennsylvania, Tennessee and Texas. In addition to concerns about the demonstration project in general, ASCA does not believe that the Medicare Administrative Contractors (MAC) are equipped to handle the new prior authorization requests, especially given the government shutdown.
Looking Ahead
Last year, ASCA built on its foundational mission and accomplished goals in advocacy, quality, education and growth. As surgery centers take on more complex cases and adapt to evolving healthcare economics, ASCA’s role as the source of best practices, strategies and advocacy becomes ever more important.
Looking ahead, we are positioned to address upcoming challenges, such as more complex procedures migrating to ASCs, tighter labor markets, cost and reimbursement pressures and regulatory shifts. Our continued emphasis on benchmarking, quality, member education and advocacy will be key to helping ASCs thrive.
