Along with the onset of a new presidential administration, ASCs are paying close attention to healthcare policymaking.
Here are the federal policies ASC leaders are watching most in 2025:
Editor's note: Responses have been lightly edited for clarity and length.
Larry Sobal. CEO of Heart and Vascular Institute of Wisconsin (Appleton): It’s hard to judge what federal policies will or won’t materialize based on the first two weeks of the new administration. That said, the legislation I am paying attention to is site neutrality. As an independent cardiology practice, we are strong supporters of eliminating or reducing the large gap between the PFS and HOPPS. Second, I am concerned about tariffs leading to increased costs of supplies.
Suzi Cunningham. Administrator of Advanced Ambulatory Surgery Center. (Rancho Cucamonga, Calif.): I would like to see the elimination of the inpatient only list and the addition [or] return of more complex spine cases to the Medicare ASC fee schedule. During the last administration, it seemed like we took two steps back, so I’m hopeful that we see some positive movement in that direction. Further, we need increased reimbursement for ASCs. The fact that we are not an HOPD shouldn’t penalize us from equal reimbursement. Surgery centers have proven to be an excellent and safe alternative to having surgery at a hospital and can save our healthcare system substantially. There needs to be greater attention to this by our federal government.
Robert Nelson, PA-C. Former Executive Director of Island Eye Surgicenter (Westbury, N.Y.): As we all know, ASCs are among the most heavily regulated businesses in healthcare. The process of gaining Medicare certification alone is onerous, to say the least. But maintaining Medicare certification and independent accreditation continues to be met with ongoing challenges. One of those areas that provides headaches for ASC administrators is quality reporting. While CMS continues to impose reporting requirements on ASCs, they have not yet repealed any that have been in place and provided data for years. Rather, CMS has actually added three additional quality measures to the CMS Quality Reporting Program beginning in 2025. Each of these new measures will have voluntary reporting in 2025, with mandatory compliance in 2026. More to do for the already busy ASC administrator. Reimbursement is another area that is front of mind for ASC owners and administrators. While under the final 2025 CMS rule ASCs have received another increase, fingers remain crossed as we move forward. In many ways, we are fortunate to have received regular payment increases, and for CMS to have finally (in 2019) changed the reimbursement methodology from the CPI model to now the Hospital Market Basket. But future increases are never a guarantee. We need to continue to support our ASC industry associations so that our interests are properly represented in Washington. Finally, an area that should be an area of particular concern to the ASC industry is office-based surgery. A largely unregulated new service site that should be of concern to the public in general, and CMS and state regulatory agencies in particular.