Becker's ASC Review

8 ASC MANAGEMENT care about healing their patients. Too oen, payers encourage cases to move to the ASC setting, only to later deny authorizations or label procedures as experimental or not medically necessary. It may be time for payers and providers to truly work together to create a more balanced system, one that relies on medically sound decision-making, minimizes patient harm, and ensures patients receive high-quality, timely care. Peter Bravos, MD. Chief Medical Officer of Sutter Surgery Center Division (Sacramento, Calif.): One of the biggest challenges ASCs face today is navigating slow and inconsistent authorization processes. Routine procedures oen require prior approvals that can take days or even weeks, creating unnecessary delays. ese inefficiencies don't just frustrate clinicians; they directly affect patients. Delayed care can worsen conditions, increase anxiety, and drive up costs. For patients in rural or underserved areas, these barriers may compound, limiting access and widening disparities. Trina Cole. Administrator of St. Luke's Surgicenter-Lee's Summit (Mo.): In my perspective, the most frustrating part of working with payers today is the challenges with prior authorization. Physicians are required to participate in multiple peer reviews or information sharing just to address their professional decisions on how to take care of their patients. e impact on the patients is the delay, denial or complete cancellation of the procedure. So wasted time of the office and physician on the front side, and the increased possibility of a negative outcome for the patient on the backside. Ashley Hilliard, RN. Administrator of Piedmont Outpatient Surgery Center (Winston-Salem, N.C.): e most frustrating part of working with payers today is the lack of transparency and consistency — particularly around prior authorization, medical necessity determinations and reimbursement methodology. Requirements change frequently; interpretations vary by payer and even by reviewer, and there is oen no clear, timely way to resolve discrepancies. is can lead to delays in patient care, reduced access, administrative burden and financial uncertainty. ese issues can have a negative impact on the patient, as well as the ASC. n The ASC industry's broken data pipeline By Francesca Mathewes I n November, CMS finalized its Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System rule for 2026, which included the addition of 573 codes to the ASC Covered Procedures List. This was a huge win for the Ambulatory Surgery Center Association, which has long advocated for an ASC-CPL expansion. ASC-level data on the safety and effectiveness of outpatient procedures within the Medicare population were essential to ASCA's advocacy efforts, Kara Newbury, ASCA's advocacy chief, told Becker's. "We had a spine surgeon in the ASC space who was able to perform a lot of the lumbar fusion codes during the COVID-19 pandemic when CMS created a Hospital Without Walls Program, as that allowed ASCs to expand upon what they could do," she said. "And that was a great opportunity to showcase how those spine codes could safely be done on the Medicare population." Having Medicare population-specific data is very important, but difficult, Ms. Newbury said. CMS is most concerned about whether procedures can be safely performed on this population specifically, but many ASCs take on a high percentage of patients through private insurance. "While one physician anecdotally talking about their experience is nice, being able to collectively present data from multiple facilities — benchmarking is important, registries are great — having everybody pull together and provide as much data as possible, and being able to say there were 5,000 procedures done safely is probably more impactful than [one facility] being able to speak to their 75 or 100 procedures," she said. Another limiting factor in ASCs' data collection is the stratification of technology use across the industry. According to the ASCA's July 2025 survey, 76% of ASCs now use an EHR, up from 55% in 2021. Yet nearly 1 in 4 ASCs still rely on paper, and two-thirds of those plan to remain paper-based until regulations force a change. For the first time since 2021, ASCA's survey found data collection ranked as the most valuable EHR benefit, cited by 87% of users. Cost is the top barrier, with 49% citing expense as the reason for staying analog. "Although it can be extremely costly and, unlike the hospitals, who, under the [Health Information Technology for Economic and Clinical Health] Act were given allocated funding for them to implement EHRs … [T]hat was just never available to ASCs," she said. "Of course, ASCs are smaller facilities, but [the cost of EHR technologies] can be quite staggering. Cost was cited as a top barrier to switching systems by 49% of ASC leaders in ASCA's 2025 survey. While Ms. Newbury has no doubt that ASCs are collecting outcomes data and are in touch with their facility's operations, "it's really taking that next step and being able to put your data with and up against other facilities providing the same services" that will create a deeper understanding of the industry's impact on care. "Anything that can make it easier for our facilities to collaborate and combine their information so that we can share collectively instead of one-off, anecdotal evidence, is important." she said. n

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