ASCs deliver lower costs but face uphill payment, regulatory challenges

Editor's Note

Ambulatory surgery centers (ASCs) continue to offer significant cost savings over hospital outpatient departments (HOPDs), but payment inequities, regulatory constraints, and growing competitive pressures are straining operations and growth prospects.

Recent data show wide cost differentials between settings, Becker’s ASC Review June 20 reports. A Blue Health Intelligence analysis found that procedures performed in HOPDs can cost up to 58% more than in ASCs or physician offices. Medicare’s own data show the average cost for cataract surgery at an ASC is $1,711, compared to $2,748 in an HOPD. Colonoscopy costs were consistently higher in hospitals across all 50 states, with private insurers paying 55% more in facility fees to hospitals than ASCs, according to a Johns Hopkins Bloomberg study published in JAMA Health Forum.

Despite these savings, payment policies disproportionately favor HOPDs. From 2001 to 2023, Medicare payments to hospitals rose by 70%, while physician payments grew by only 9%. When adjusted for inflation, physician pay actually fell 26%, the article reports. ASC administrators say these trends leave them at a disadvantage. Kathleen Hickman, RN, of Dutchess Ambulatory Surgical Center, described flat or minimal ASC reimbursement increases amid rising supply and pharmaceutical costs. She noted negotiating contracts with payers has become increasingly difficult, especially for independent centers trying to justify higher rates.

Regulatory and administrative pressures further complicate the landscape. Sean Hayes, president of the American Pain Consortium, pointed out that even when payers offer competitive rates, they are often undercut by complex billing rules, denials, and delayed payments. Alejandro Badia, founder of Badia Hand to Shoulder Center, added that HOPDs are typically subject to more operational restrictions than ASCs, although those same ASCs now face intensifying competition from hospital-affiliated facilities.

Despite these headwinds, the future outlook for ASCs is positive. A national study showed ASCs provided more outpatient cardiac interventions to patients from socially vulnerable communities than HOPDs between 2020 and 2022. And Sg2’s 2024 forecast projects ASC volumes to grow 21% over the next decade, outpacing the 17% growth projected for outpatient services overall.

When: Tuesday, November 18 at 12:00 PM ET

Objectives:

• Understand the risk of bi-directional pathogen transfer.
  • Gain awareness of how pathogens can move through OR table drapes and the potential implications for patient and staff safety.
• Recognize the value of evidence-based practices.
  • Learn why reviewing the latest scientific research on drape performance is critical for informed decision-making in the OR.
• Identify opportunities to strengthen infection prevention strategies.
  • Discover how selecting and using the right OR table drapes can help reduce infection risks and improve surgical outcomes.

Meet the Speaker: 

Robert Garcia, Infection Prevention Consultant

 

 

Oregon Health & Science University (OHSU) transformed its perioperative operations by implementing AI-driven staffing solutions to address critical challenges across 53 operating rooms. This initiative replaced manual, reactive processes with data-driven approaches that revolutionized how perioperative teams are deployed.

OHSU faced significant operational challenges, including time-consuming manual processes, limited visibility into staff experience, and difficulty optimizing team compositions. With innovative staffing technology, OHSU achieved remarkable improvements:

• 25+ hours saved weekly in staffing coordination, redirected to patient care
• 5% improvement in staffed room utilization
• 30% improvement in cross-training opportunities, enhancing care team consistency

Key Takeaways:

• AI-powered solutions transform staffing efficiency and redirect valuable time to patient care
• Data-driven approaches improve team consistency and operational performance
• Predictive analytics enable proactive staffing decisions, reducing last-minute changes
• A single source of truth for staff experience improves assignment accuracy
• Technology supports capacity growth without requiring additional resources

Join us to hear directly from OHSU leadership about their journey, implementation strategies, and the measurable impact on perioperative services. Discover how these solutions can transform your healthcare operations while improving both staff and surgeon satisfaction.

Meet the Speakers:

Dio Sumagaysay, RN, MS, Vice President, Perioperative & Multi-specialty Procedural Services, OHSU

Kristen Lund, RN, Director of OR/MSPU Scheduling & Pre-Operative Medicine Clinic, OHSU

Rayna Tuski, Director of Adult Perioperative Services, OHSU

 

 

 

Shane Stubbs, Senior Manager, Client Success, LeanTaaS

The purpose of this webinar is to show how data can be used for both negotiating with commercial payers and with equipment vendors.  We will have representatives from PayrHealth provide an overview of the reimbursement transparency data reports they have available for providers and how they can be utilized when negotiating with commercial payers.  We will also have staff from the Johnson & Johnson MedTech Sourceview team to showcase their database and how it can be used by providers for negotiating with their MedTech vendors. 

Meet the speakers: 

Eric Walker, Associate Director Health Economics and Market Analysis‬‬, Johnson & Johnson MedTech

 

Scott Dewey, Chief Managed Care Officer, PayrHealth

 

 

Scott Bednarke, Senior Manager, Strategic Account Conversions, Johnson & Johnson

 

 

Jackie Wright, C-Suite Level Leader, Large for-profit National Organization

 

 

Join Phyllis S. Quinlan, PhD, RN, NPD-BC, President/CEO of MFW Consultants to Professionals, as she shares her insights on one of the more pressing challenges for leaders in the 21st Century: managing change in the face of persistent uncertainty. Today’s leaders must adopt an agile, flexible mindset to be prepared to address the ever-changing events in today’s world. Change management is an essential skill for any leader in healthcare. However, how do you support a change-weary staff as they try to respond to the need to adjust their practice and modify systems without creating cynicism and weakening morale? This session will provide a frank discussion and present practical approaches to building staff fortitude in an unpredictable, ever-changing industry.

When: Wednesday, August 27, 12:00pm ET 

Learning Objectives:

• Recognize the importance of understanding the effects of persistent uncertainty and its impact on your staff.
• Explain why today’s leader needs to adopt a Pioneer Spirit.
• Construct an outline that features the elements of effective, sustainable Change Management

Meet the Speaker: 

Dr. Phyllis Quinlan, PhD, RN, NPD-BC is President of MFW Consultants & a successful nurse entrepreneur. She is a healthcare consultant and has practiced as a Legal Nurse Consultant specializing in defense since 2004. During her nursing career, Phyllis has held positions in clinical, education & administrative positions in a variety of practice venues.

She is a Certified Professional Coach by the International Coaching Federation and is a Fellow of the Institute of Coaching. Phyllis uses the tools of emotional intelligence, applied positive psychology, and character strength building when working with her clients.

In 2023, an expert group was established to develop clear guidance on surgical gloving practice from the existing literature. Their goal was to formulate recommendations to improve the safety, protection, and experience of healthcare providers and their patients. The expert panel members were assigned to one of four focus areas: Glove Fit, Double Gloving, Indicator Systems, and Glove Damage and Change Protocol; with each group conducting a systematic review of the evidence.

The 2025 Edition of the AORN Guidelines for Perioperative Practice emphasizes the importance of providing a climate of safety with evidence-based practices. Surgical gloves play a crucial role in ensuring the safety of both patients and practitioners. Efforts continue to establish standardized best gloving practices, supported by evidenced-based recommendations. These standardized guidelines aim to enhance clinical outcomes, improve safety, and support hand health and career longevity.

This program will provide the attendee with an overview of how these two bodies of practice align with current recommendations for practice guidelines on surgical gloving.

Speakers: 

Chad Flora BSN, RN, CNOR, is a Clinical Director for the Surgical Glove Business Area at Mölnlycke Health Care. In addition to leading the U.S. Clinical Specialist Team, his responsibilities include clinical education, program development, and assisting with research and development initiatives.

Leah Goldberg MSN, RN, CNOR is the Clinical Nurse OR, Bone and Joint Institute at Hartford Hospital. She works in the operating room at the Bone and Joint Institute at Hartford Hospital and created Acorn Nurse Consulting, LLC to continue her passion for developing knowledge and resources for perioperative staff. She was honored as an AORN Emerging Leader Under 40 in 2012 and 2024. She received AORN’s Outstanding Achievement in Perioperative Education: Clinical Award in 2025.