Becker's ASC Review

6 ASC MANAGEMENT The biggest physician risks facing ASCs in 2026 By Francesca Mathewes P hysician recruitment and retainment is a key issue for ASCs in the years ahead as the U.S. faces an anticipated shortage of physicians over the next decade. For its "ASC Leader Expectations for 2026" survey, VMG Health asked 97 leaders what their biggest physician- related risks were heading into 2026. Here's a breakdown of responses: 1. Recruiting new surgeons: 61% 2. Divestiture of semi-retired, retiring surgeons: 55% 3. Securing new physician investors: 38% 4. Compensation from hospitals/ health systems: 32% 5. Physicians developing their own centers: 12% 6. Physicians developing in-office procedure suites: 12% 7. Competition with PE and other market entrants: 11% n CMS adds 547 codes to ASC payable list, bumps pay 2.6%: 5 notes By Laura Dyrda CMS will make significant changes to ASC and outpatient surgery reimbursement next year. In the 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Final Rule, published Nov. 21, CMS outlined plans to increase ASC pay and allow for more procedures in surgery centers. "CMS acknowledges in this rule that ASCs can provide safe care to many more beneficiaries for a much wider range of procedures than is currently available," said Bill Prentice, ASCA CEO. "While more work is needed to address structural payment issues that limit surgery centers' ability to perform certain procedures, Medicare beneficiaries will greatly benefit from the finalized policies in this rule." Five things to know: 1. CMS updated the ASC payment rate by 2.6% using the hospital market basket update. Hospital outpatient departments meeting quality reporting requirements will also receive a 2.6% payment increase. CMS plans to use the hospital market basket update for ASCs again next year and monitor the impact. e ASC conversion factor is $56.322 while the HOPD conversion factor is $91.415. 2. CMS finalized plans to phase out the inpatient-only list over three years and will remove 285 primarily musculoskeletal procedures from the list next year. CMS will also add 547 codes to the ASC covered procedure list, many requested by ASCA. e codes include 276 currently paid in HOPDs and 271 coming off the inpatient only list, including: • Cardiovascular codes for electrophysiology studies and ablations: 93650, 93653, 93654 and 93656; and percutaneous coronary intervention: C9602, C9604 and C9607 • Spinal codes for posterior lumbar interbody fusion: 22630; and combined posterior lumbar and posterior lumbar interbody fusion: 22633. • Vascular codes for vascular embolism or occlusion: 37244 e final rule eliminated five general exclusion criteria, which were moved into a new section as "nonbinding physician considerations for patient safety," according to a CMS press release. 3. Next year, CMS plans to align payment rates for select outpatient services between hospital outpatient departments and off-campus facilities to avoid higher copays based on the care location. "We continue to advance Medicare payment reform by advancing policies that help prevent services from unnecessarily being performed in hospitals when they can be safely provided in less intensive settings, streamlining hospital billing systems, and ensuring patients receive transparent, accurate pricing information," said Chris Klomp, CMS deputy administrator and director of the Center for Medicare. 4. e ASC Quality Reporting Program will be a bit different next year. CMS decided not to adopt the following reporting metrics: • Patient Understanding of Key Information Related to Recovery Aer Facility-based Outpatient Procedure or Surgery • Patient Reported Outcome-Based Performance measure CMS decided not to require ASCs to use the Hospital Quality Reporting system for ASC data as proposed. ASCs will not be required to report on COVID-19 vaccines for healthcare providers, health equity measures or social determinants of health next year. "e ASC Quality Reporting Program must remain focused on measures that have been tested for validity in the surgery center setting and are directly related to safety and quality outcomes," Mr. Prentice said. "Additionally, the more information surgery centers are mandated to obtain from patients, the less likely they are to get patients to respond — survey fatigue is real and CMS needs to address our concerns about the length, complexity and high cost of the OAS CAHPS Survey. e newly proposed survey on discharge instructions only added fuel to this fire, so we applaud CMS for pausing on its implementation." 5. CMS noted a calculation error that negatively impacted cardiac surgeries, reporting that instead of cutting reimbursement by 4.7%, the agency will increase it by 3.4% over 2025 rates. n

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