Becker's ASC Review

5 ASC MANAGEMENT The 'rising tide' that will define ASCs in 2026 By Cameron Cortigiano T he increased use of AI agents, advancements in robotic surgery and the rise of orthopedic and spine ASCs are among the most important trends this ASC administrator is following. Nearly 300 CPT codes being transitioned from the Inpatient Only List will provide a boost for ASC volumes and revenues, as well as expanding access to care for patients. David Orskey, an administrator at Raleigh (N.C.) Neurosurgical and Spine Surgery Center, recently connected with Becker's to share the biggest industry developments for 2026. Note: This response was lightly edited for clarity and length. Question: What do you believe will be the defining trends/ themes for the ASC industry in 2026? David Orskey: The use of AI agents in business office operations. AI software that follows your policies and procedures and directs AI agents in denial follow-up, collections, insurance verification, KPI improvement, reduction in FTEs and benefit expense. This is something all my peers are discussing during coffee talk, and AI vendor calls are increasing. Robotic surgery, second-generation spine/orthopedic robotic systems with AI that increase accuracy and overall healthcare spend on these systems. I tend to link the growth of robotic surgery to generational change in surgeons and healthcare leadership. In addition, patients are increasingly asking about robotic surgery and if it will be used in their surgical case. We just need the payers to recognize the value and pay for it. Rising tide lifts all ships, with 276 Medicare CPT's transitioning from inpatient only list to outpatient, orthopedic and spine centric ASCs will see volume and revenue growth. This has been celebrated by our partners, knowing that they will be able to bring additional patients to their center where they are in control of the quality, safety and satisfaction. Patients are extremely happy to have their surgery at a surgery center that provides them with a feel of boutique care. n The next wave of ASC opportunities By Patsy Newitt ASCs are entering a new phase of growth driven by new care pathways, staffing models and site-of-care shis. From partnerships with orthopedic walk-in clinics to CMS coverage for EP ablation, here are six opportunities ASC leaders are watching. 1. Build referral pipelines through partnerships with outpatient entry points One of the biggest growth opportunities may be partnerships with outpatient facilities such as orthopedic urgent care centers and walk-in clinics, said Alejandro Badia, MD, founder and CMO of Miami-based Badia Hand to Shoulder Center. "Once a patient is seen in a hospital emergency room, for example, that patient will likely undergo surgery at that facility, oen whether urgent or not," he told Becker's. "Collaboration between a convenient walk- in facility, for example, an orthopedic urgent care center and an ASC, will drive up musculoskeletal surgical volume, while lowering overall healthcare system costs." ese partnerships can route more musculoskeletal cases to the ASC, oen before a patient enters a hospital system, and reduce reliance on surgeon-driven referrals by creating a steadier, clinic-based pipeline. 2. CRNA-only anesthesia models are gaining traction As states broaden CRNAs' ability to practice independently and anesthesia shortages deepen, more ASCs are moving toward CRNA- only models, leaders say. A Medicus Healthcare Solutions white paper found 75% of CRNAs reported practicing without physician oversight as of 2023, and CRNAs now provide the majority of anesthesia care in rural counties. "Most of the ASCs in my area are also becoming CRNA-only," Jesse Johnson, CRNA at Springdale, Ark.-based Chief Anesthesia Services, told Becker's. "is helps keep costs down for anesthesia services." In Mr. Johnson's market, most ASCs are for-profit and physician-owned, meaning they oen lack additional staff to assist with complex cases. Jeff Tieder, MSN, CRNA, clinical assistant professor in the nurse anesthesia program at the University of Tennessee at Chattanooga, echoed this shi. He said many ASCs are moving away from the traditional physician-supervised model. According to Mr. Tieder, CRNA-only models demand "streamlined workflows, cost-effective care and rapid patient turnover without compromising safety." "ese demands are driving a transition toward CRNA-led and CRNA-only models, which align more closely with the clinical and financial objectives of these facilities," he said. "e growing pressure to contain costs while maintaining safety is elevating the visibility and necessity of CRNAs. With the physician anesthesia shortage looming and reimbursement models shiing, CRNAs will continue to be at the forefront of innovative and sustainable anesthesia delivery." 3. Membership-based surgical facilities offer a new access model In dense urban markets where block time is scarce and buildouts are expensive, membership-based surgical centers are emerging as an alternative to ownership. Plastic surgeons Oren Tepper, MD, and Evan Garfein, MD, opened Greenwich Street Surgical, a 6,000-square-foot facility in New York City with three ORs, private pre- and post-op bays, anesthesia support and concierge-style recovery services. e model aims to give surgeons predictable access, priority scheduling, block time and operational support without the fixed costs and administrative burdens of owning or leasing a surgery center long term. Dr. Garfein described the tradeoff as less ownership in exchange for flexibility and lower risk.

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