Back when I was the chief nursing officer at an orthopedic and spine specialty hospital, I saw this trend starting firsthand. Doctors weren’t allowed to have ownership in hospitals anymore, so they began pushing for joint replacements and similar procedures to move to ASCs. Suddenly, a lot of those surgeries left the hospital for these outpatient centers, which meant the hospital was left with the more complicated—and expensive—cases. The IPO List used to mean certain surgeries only happened in hospitals, but CMS is rethinking that, since modern medicine has made it possible to do more complex procedures safely outside the hospital setting.
But here’s the question: are today’s ASCs actually built to handle this wave of cases? Some are set up just for one specialty, like orthopedics or GI, while others are more general. Since ASCs typically deal with lower-risk surgeries, they’re designed to be efficient and cost-effective, which is great, but things could get tricky as cases become more complex.
Starting in 2026, CMS wants to move 285 musculoskeletal procedures off the IPO list and add 547 new codes (including heart, spine, and vascular procedures) to the ASC covered list. That’s a lot! What will happen to all those hospital ORs when their volume drops and more cases shift to ASCs? Since surgical services are often what help a hospital stay afloat financially—balancing out losses elsewhere—losing that income could be a big problem for some facilities/systems.
For those of us who advise hospitals and ASCs, it means we need to help them get ready for these changes. Designs for ASCs are going to have to evolve to handle more cases and new types of procedures. I wouldn’t be surprised if the rules and Guidelines for outpatient facilities changed too, to keep up with the shift. Here are a few things to think about when it comes to upgrading ASCs:
Facility Expansion and Redesign
As higher-acuity procedures migrate to ASCs, facilities will need to evolve. Existing centers may require structural upgrades to accommodate more complex surgeries, including enhanced recovery areas, advanced sterilization systems, and expanded pre-op and post-op spaces. Health systems are already investing in ASC capacity through both construction and consolidation, anticipating this shift.
