Federal Policy is Shifting; Here’s What ASCs Need to Know
02
May
2025
By Traci Albers, Chief Executive Officer, and Allison Stock, Chief Operating Officer, Surgical Management Professionals
Every year, the federal update at ASCA gives us a peek behind the curtain, where policy meets payment and legislative decisions ripple straight into the day-to-day operations of surgery centers nationwide. This year’s session, led by Kara Newbury from ASCA, didn’t disappoint.
If you run, manage, or support an ASC, here’s what you should be aware of—and what we at SMP are watching closely for our partners.
Medicare Payment: Still Tied to the Hospital Market Basket—for Now
For 2025, ASCs and HOPDs will both see a 2.9% payment increase. That’s good news on the surface. The reason? We’re still tethered to the Hospital Market Basket instead of the CPI-U index, which would result in a much worse update. But this tether only lasts through 2025. Unless something changes, we could lose this advantage.
And then there’s the weight scalar, the policy tweak that reduces ASC payments by an additional 13% across the board. This arbitrary math continues to shrink margins, especially for high-volume codes. And ASCA is pushing to eliminate it entirely through upcoming legislation.
Top Procedures, Volume, and the Reimbursement Gap Most of our industry’s Medicare volume is concentrated in a few procedures. Think cataracts, GI scopes, and epidural injections. Just 10 codes account for nearly 60% of ASC Medicare volume.
The problem? These codes are still significantly underpaid compared to hospitals. Despite delivering the same (if not better) outcomes in a more efficient setting, ASCs are reimbursed at just 50–60% of what HOPDs receive. That gap doesn’t just hurt our revenue—it impacts sustainability.
The ASC Covered Procedures List Needs Fixing CMS introduced a new “pre-proposed rule” nomination process this year. Great in theory. But in practice? Not one of the codes ASCA submitted, including crucial spine and cardiovascular procedures, made it to the final list. That’s frustrating, especially when our industry brought data, outcomes, and real-world examples forward.
ASCA is not backing down. They’re rallying support and lobbying CMS with backing from specialty societies like ACC and the Heart Rhythm Society. These efforts matter—and we’re watching them closely.
Quality Reporting: Getting More Complex, Less Practical This one deserves its own blog. But here’s the short version:
- New measures are here, including equity and social drivers of health.
- The OAS CAHPS survey is now required, and facilities need 200 completed responses.
- ASC-21 (THA/TKA outcomes) is voluntary now, but mandatory in 2028.
What’s missing? Testing. CMS continues to copy-paste hospital metrics into ASC settings without adjusting for our unique workflows. ASCA is pushing for all new quality measures to be tested before implementation—a common-sense ask.
Legislative Watch: Two Big Bills That Matter ASCA is pushing two federal bills we should all care about:
- The Outpatient Surgery Quality & Access Act would stabilize payment updates, improve transparency, and eliminate the ASC weight scalar.
- The Co-Pay Cap Act – would limit ASC patient cost sharing to the same cap hospitals receive (~$1,676), making care more accessible and competitive.
These aren’t just good ideas—they’re necessary if ASCs are going to thrive in the years ahead.
Site-Neutral Payment Sounds Nice—But It’s Dangerous. Site-neutrality is the new buzzword in D.C. But here’s the issue: Current proposals wouldn’t bring ASC rates up to match hospitals. Instead, they’d drop everyone, including ASCs, to the lowest reimbursement rate: the physician office fee schedule.
We’re talking about a race to the bottom. The data used to determine these changes doesn’t reflect quality, safety, or patient outcomes—it’s just volume-based. This is bad policy disguised as cost-cutting, and ASCA is sounding the alarm.
State-Level Threats: Facility Fee Bans Are on the Rise. States like Colorado, Connecticut, and even Texas are floating facility fee restrictions. If these pass, they could gut ASC finances overnight. These aren’t theoretical threats—they’re active bills and bipartisan. We’re tracking them and encourage every center to do the same.
So, What Does All This Mean for SMP Clients? It means we can’t sit on the sidelines.
At SMP, we’re already helping our partners prepare for OAS CAHPS, map out compliance timelines, and forecast reimbursement projections based on the impact of the weight scalar. We’re also staying engaged in advocacy conversations because policy isn’t just paperwork; it’s the fuel (or friction) for every OR we manage.
If your team needs help unpacking how these changes affect your facility or how to prepare, let’s talk.
The landscape is shifting. Let’s be ready.
