Becker's ASC Review

18 THOUGHT LEADERSHIP What's on the horizon for ASCs? A conversation with ASCA's CEO By Francesca Mathewes O n July 15, CMS released the 2026 proposed payment rule for ASCs, including updates to patent policies and the proposed addition of more than 200 procedures to the ASC Covered Procedures List in 2026. Bill Prentice, CEO of the Ambulatory Surgical Center Association, recently joined Becker's to discuss the policy proposal and where ASCA is concentrating its advocacy efforts for the remainder of 2025. Editor's note: Responses have been lightly edited for clarity and length: Question: What aspects of CMS' recent proposed rule are you most excited about? Bill Prentice: We're very pleased with the decision to expand the ASC-CPL, and to rely on the clinical judgment of physicians rather than some hard and fast list. It's a move in the right direction—to create more flexibility for surgery centers to treat more patients with more procedures. On the quality reporting front, we support the elimination of some measures that we have opposed that we don't believe would help surgery centers provide better care to the patients they serve. We're pleased that they're removing the COVID-19 measure and the social determinants of health measures that were simply surveys but would not really help surgery centers provide better care to patients. Q: And what areas of the proposal fell short for you? BP: On the payment side, the secondary scaler that they use to adjust our weights for budget neutrality continues to artificially depress our reimbursements in a way that's very harmful. Every payment system is siloed when CMS applies budget neutrality adjustments, and because ASCs are in their own silo but don't have their own payment system—they are paid a percentage of the hospital outpatient department rate—they are doubly impacted by that budget neutrality adjustment. As a result, as more volume moves into our setting, some of our most common procedures take a reimbursement hit; for example, the rate for cataracts is projected to be lower for 2026 than in 2025. e overall result of the secondary scaler is that it creates a disincentive for surgery centers to want to take more Medicare patients. Q: Where is ASCA focusing its advocacy now? BP: We're preparing our comments on many elements of this 900-page-plus proposed rule. Right now, we're soliciting input from our members about the proposal and about how various provisions would impact them, so that we can respond appropriately by the mid-September deadline to submit comments. en we'll sit and wait until the final rule comes out on or around November 1 to see how successful we've been in terms of securing changes. As an example, even though CMS has proposed to add a lot of procedures in this proposal to the ASC-CPL, they didn't add some of the cardiac procedures that we and the cardiology community were asking for. We're hoping that we can provide more supporting information to the agency during this comment period, so that they'll add those procedures in the final rule. Q: What procedures specifically are you hoping to see added? BP: We requested that CMS add the cardioversion and transesophageal echocardiogram codes (92960, 93312 and 93318) and electrophysiology studies (93619, 93620, 93624, 93642 and 93724), but CMS did not propose those for addition. We've been working very closely with the cardiology community for the past few years in terms of educating the agency on those types of procedures and how they can be safely performed in the ASC setting on many patients. Q: How can ASCs prepare for this expanded procedure list as far as quality and safety are concerned? BP: It's going to be slow and steady. It's going to be based upon the clinical judgment of the physicians and where they think these procedures can be safely performed, and then it's contingent upon surgery centers to make sure that they are set up to be able to perform those procedures safely. at includes room size, equipment and clinical protocols. All of that has to go hand in hand for this to work. And we're confident that we can do it. It is also important to note, because people see CMS proposing to move almost 300 codes off of the inpatient-only list that can now be performed outpatient, whether in the hospital outpatient department or the surgery center, that doesn't mean that all that volume is going to shi. ose procedures would still be able to be performed as inpatient procedures and be reimbursed at the inpatient payment rate, but if finalized as proposed, surgeons will have the flexibility to choose the right site of service for their patients. For many of those procedures, that volume will initially stay in the hospital, but as clinicians become more comfortable with the procedures, they can begin slowly and steadily moving some of those procedures and performing them outpatient. Q: What other trends are you seeing shaping the ASC industry right now? BP: We still have concerns about access to anesthesia. I think that's a headwind in the ASC community and a problem that we've been trying to work with the anesthesiology community to address. eir reimbursement concerns are being foisted onto surgery centers and hospitals in terms of additional payments and stipends that we really can't sustain. So, that's a problem that we're looking to find ways to address. We're in active communication with the anesthesia community and trying to see if we can find solutions that make sense to us all. is was a problem that, quite honestly, was decades in the making. It's going to take a fair amount of time to address it in a substantive manner. I don't think there's going to be one simple solution. We need to produce more anesthesia providers, which, again, is a longer-term problem to solve. And then the other important element will be finding more efficient ways for surgery centers to use anesthesia so that they can limit the cost. n

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