Becker's ASC Review

8 ASC MANAGEMENT 5 concerning trends ASC leaders are flagging By Francesca Mathewes W hile there has been plenty of encouraging news in recent weeks for ASCs related to reimbursement rates, prior authorization reform and certificate-of-need regulations, a number of issues still weigh heavy on the minds of ASC leaders and physicians. Here are five trends that ASC leaders have expressed concerns over to Becker's. CMS' recent pay boost 'still falls short' While CMS' recently proposed rules for 2026 included a 3.6% increase to the physician fee schedule, some believe the boost is still an inadequate amount to close the gap between reimbursement rates and the cost of operations for ASCs. "While it's encouraging to be recognized and receive increased compensation from CMS for our services, this gesture still overlooks the long-term value physicians bring to the entire healthcare system," Jonathan Kamerlink, MD, an anesthesiologist at Boca Raton-based Florida Spine Associates, told Becker's. "A persistent gap remains between delivering high-value care and receiving fair compensation. In reality, these two things should not be mutually exclusive. I urge my fellow physicians to continue advocating for both exceptional patient care and equitable reimbursement for our work." Payer issues hindering robotics growth While technology for robotic surgery has become more accessible and affordable and widespread in the last decade, Shirin Towfigh, MD, a hernia and laparoscopic surgery specialist at Beverly Hills (Calif.) Hernia Center, told Becker's that the financial equation behind acquiring surgical robots still presents a significant barrier for many ASC leaders and physicians. "e problem is the other arm of the finances here, which is insurance has not kicked in. ere are three tiers of payment by insurance for the same exact operation. If it's done in the main hospital, you get a large amount of money for it," she said. "If the same operation is performed at a hospital-based outpatient surgery center, you get a lesser amount and the least amount is paid to a freestanding surgical center. So it makes no sense financially to do a robotic operation which is expensive in an environment such as a freestanding outpatient surgery center that gives you the lowest reimbursement for that operation. So even though industry has kicked in to help on their side, insurance really has not done their job of allowing that to be a feasible financial situation. So that's a major roadblock right now." Care delivery issues While long wait times and delays in care are nothing new to healthcare, they are something that motivated Mahesh Mulumudi, MD, a cardiologist and CEO of Lynwood, Wash.-based CardioNow, to leave his employed position and start an independent cardiology practice. "e biggest challenge and [one of the] biggest things that I've seen change in the healthcare landscape in the last 20 years is that care delivery is not smooth anymore," he said. "It's not what it used to be. In my opinion, patients could get in to see the providers promptly, get the tests that they need to be done promptly and then get the procedures. at's a classic world that I used to live in, and that's gone." Certified-registered nurse anesthetist staffing Discussion around anesthesia staffing issues oen surrounds physician anesthesiologists, CRNA coverage is also a significant issue as ASCs, especially those in rural areas, are more reliant than ever on CRNAs to cover their anesthesia needs. "Our biggest challenge came in April 2025 when we lost our CRNA coverage for our ophthalmic ASC. We have had solid CRNA coverage for 20 years, and our CRNA was ready to retire. She provided plenty of notice, but we tried for one year to find a replacement without success," Debbie Ehlers, RN, administrator and director of nursing at e Eye Center in Yakima, Wash., told Becker's. "We advertised in all of the usual places, word of mouth, locally, state organizations, etc. Finally, we made the decision to move to RN sedation. In Washington State, according to the Nursing Care Quality Assurance Commission, it is 'within the role and scope of practice for the registered nurse to administer procedural sedation and to manage patients who are receiving and recovering from procedural sedation.' Our RNs are very experienced, with all at least 20 years of nursing experience. All are BLS and ACLS trained, as well as are both surgeons. All participated in the AORN course on sedation and passed the class. Prior to her retirement, our CRNA also provided additional sedation training addressing the unique needs of the ophthalmic surgical patient. A sedation competency form was developed and is utilized. Aer four months of RN sedation, our surgeons as well as our RN staff have determined that patients are receiving safe and quality care with compassion at our facility." One Big Beautiful Bill and its impact on Medicaid President Donald Trump signed the One Big Beautiful Bill Act July 4, aer the Republican-led Congress agreed upon its contents July 3. e bill contained numerous healthcare policy changes, including major adjustments to state Medicaid programs. "We are watching closely how the H.R.1 bill is likely to impact our center and others like ours. We live in an area of California that has a large population of patients that depend on Medi-Cal services," Suzi Cunningham, administrator of Advanced Ambulatory Surgery Center in Redlands, Calif., told Becker's. "ere is concern that if these patients lose coverage, they will stop seeking out care. Or those that seek care, will be unable to afford their patient responsibility, or will be uninsured. Ultimately, it is too soon to tell." "We remain hopeful that the impact of the bill will be gradual, and as such, will allow those that may lose service time to take the necessary steps to meet the new requirements, so they can maintain their coverage," she added. "Bottom line, we will be watching the impact of this bill closely so we can be as prepared as possible." n

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