Leaders say the next five years will bring a sharper, smarter ASC industry, one that is more data-driven, integrated and patient-focused.
Six ASC leaders joined Becker’s to discuss how they see the ASC industry evolving over the next five years.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: How do you see the ASC landscape or business model evolving over the next five years, and what changes do you think will have the greatest impact?
Jenny Bono. Administrator of the Joint Replacement Center of Louisiana (Lake Charles): ASCs will continue an accelerated maturation period not only in volume growth but fundamentally how they compete in the healthcare industry. ASCs are maximizing on the ongoing CMS policy shifts and regulatory clarity around site neutrality. While the pressure for payment parity tied to value, an upside is created for ASCs who already focus on patient outcomes and quality initiatives. Another trend that will accelerate will be strategic joint venture partnerships bringing capital, scale and access to negotiated payer contracts.
Peter Bravos, MD. Chief Medical Officer of Sutter Health Surgery Center Division (Sacramento, Calif.): Over the next five years, I believe the ASC landscape will continue evolving toward deeper integration with value-based care, driven by payer incentives and patient demand for high-quality, lower-cost surgical options. Advances in minimally invasive technology, digital health and data analytics will further expand ASC capabilities, enhancing efficiency, safety and patient outcomes.
Gregg Florentin. CEO of Tri-City Cardiology Group (Phoenix): Over the next five years, ASCs will evolve rapidly. We’ll see a shift toward higher-acuity procedures, deeper integration with value-based care models, and greater adoption of technology from AI to robotics. Physician alignment and workforce strategy will be critical, as will navigating increasing regulatory demands. ASCs that embrace innovation and stay agile will lead the next wave of outpatient care.
Jen Parks, RN. Manager of Ambulatory Surgery Services at Muskegon (Mich.) Surgical Associates: Over the next five years, I see ASCs continuing to take on higher acuity procedures and expanding service lines. As payers and patients look for cost-effective care outside hospitals, ASCs are well-positioned to meet that demand. Procedures like total joints and spine surgeries, once limited to hospitals, will become more common in ASCs due to advances in anesthesia, pain management and minimally invasive techniques. From a clinical management perspective, the shift toward value-based care and outcomes tracking will have a major impact. ASCs will need to invest in data analytics, patient engagement tools, and quality reporting to stay competitive and meet regulatory requirements. Staffing models may also evolve to support a broader range of procedures through cross-training and flexibility. Technology will continue to drive change, from supply chain automation to EMR integration and smart scheduling. Still, the core of the ASC model remains the same: delivering safe, efficient, patient-centered care. The challenge will be managing growth while maintaining high standards and a personalized experience.
Michael Powers. Administrator of Children’s West Surgery Center (Knoxville, Tenn.): Over the next five years ASCs will continue to take share from hospital outpatient departments, but the landscape will get more complex: higher-acuity cases will move outpatient, robotics and specialty devices will become common (raising costs and capabilities), consolidation and strategic investment will accelerate (though deal cadence is uneven), and regulatory/payment changes (quality reporting, drug payments, and prior authorization pilots) will restructure economics and access.
Here are specific changes likely to have the greatest impact
1. More complex / higher-acuity procedures shift to ASCs
Minimally invasive techniques and payer pressure to lower cost are driving orthopedic, ENT, ophthalmology, GI and selected soft-tissue procedures into ASCs. That increases revenue potential but also clinical risk and capital needs (OR capability, recovery areas).
2. Robotics and specialty capital equipment become mainstream in ASCs
Smaller, more mobile robotic systems and endoluminal platforms are being adapted for outpatient suites improving case mix and surgeon recruitment but increasing per-case capital and instrument costs and need for specialized training. Expect more centers to buy or partner on robotics.
3. Payment and regulatory changes will reframe margins
CMS updates to ASC payment rules, separate drug payments, and new quality reporting requirements (and ongoing OPPS/ASC rulemaking) will change reimbursements and compliance burdens. For example, CY-2025 updates and ongoing CY-2026 rulemaking show CMS is actively refining ASC payment policies.
4. Prior authorization and utilization controls expand
Demonstrations and pilots expanding prior authorization into Medicare/ASCs are being planned/rolled out; this will affect scheduling, cash flow and administrative load (more front-end checks, possible denials). Expect more payer controls for services seen as vulnerable to misuse.
5. Consolidation, strategic capital and slower but larger deals
Private equity and large consolidators remain influential. Deal volume has softened in 2025 compared to prior years, but larger, strategic transactions and JV models continue driving scale advantages in contracting, supply purchasing and capital access. That consolidates negotiating power with payers and device vendors.
6. Workforce, staffing and perioperative care model changes
Nursing/tech shortages and anesthesia staffing pressure will continue to be a constraint.
7. Technological integration
The adoption of AI, electronic health records and data analytics will streamline operations, reduce waste and improve patient outcomes. These technologies will also facilitate better patient selection, especially for high-risk cases, and enable operations to be more personalized and efficient.
Bernadette Purser, RN. Senior Administrator of Ambulatory Surgery at VCU Health (Henrico): ASCs will continue to grow and integrate with health systems, enhancing their reach and capabilities. Advances in AI will drive improvements in quality, efficiency and patient care. This combination will be key in shaping the ASC landscape.