After examining the milestones and challenges that defined 2025, we invited the same ambulatory surgery center (ASC) leaders to look ahead to what 2026 may hold. The coming year promises continued change across the industry, with evolving regulations, advancing technology, and shifting care patterns shaping how ASCs operate and grow.
Below, leaders from Surgical Information Systems (SIS) and the broader ASC community share their outlook on the trends, opportunities, and risks they believe will define the year ahead. Note: Their responses are presented in alphabetical order.
Janet Carlson, MSN, BSN, RN, NE-BC, FACHE, CEO and Co-Founder, Vertex Surgical Solutions
"I believe 2026 is going to be a banner year for surgeon independence and autonomy. We are seeing physicians at every stage of their careers make the decision to step away from large health systems. This includes younger surgeons just a few years out of fellowship who are saying the big paycheck is not worth the constant call, inefficiency, and lack of control. They want a better quality of life, and they want to practice medicine in a setting that actually works.
"The continued phase out of the IPO (inpatient-only) list gives physicians more flexibility to bring procedures into the ASC setting, where they know the care belongs. Combined with growing frustration around consolidation and the challenges private equity has faced investing in provider organizations, there is a very real grassroots movement toward independence. Physicians want a seat at the table. They want to drive decisions, own their outcomes, and be the masters of their own destiny.
"I also expect to see more like-minded surgeons partnering together, not to give up independence, but to strengthen it. Independent groups and ASCs will collaborate for purchasing power, implant pricing, rebates, and payer contracting, while remaining fiercely independent in ownership and governance. Many do not want their ASC owned by a REIT (real estate investment trust). They want development and management partners who maintain the building and support operations, while still allowing physicians to invest in the real estate and diversify their income.
"At the same time, I think hospitals will continue to struggle. We are going to see more hospital closures, particularly in markets where systems built redundant facilities offering the same services. As more care migrates to ASCs and scrutiny of hospital nonprofit status and site-neutral payments, the opportunity for physicians to reclaim autonomy will only grow. For those willing to plan carefully and invest intentionally, 2026 represents a powerful opportunity to reshape how and where care is delivered."
Jeffrey Flynn, CASC, Administrator and COO, Gramercy Surgery Center
"This year is all about implementation and momentum. The policies are being put in place, but the real work begins now. In New York, we are already seeing hospitals quietly push back, urging legislators to slow or restrict progress. The hope is that state leadership remains willing to be brave and stay focused on access, affordability, and patient outcomes, rather than institutional pressure.
"One of the most important opportunities ahead is Medicaid reform. Today, Medicaid will reimburse for implants when procedures are performed in hospitals, but not when the same procedures are performed in ASCs. That creates a financial barrier that keeps thousands of cases in higher-cost hospital settings, even when they can be done safely in surgery centers. We are working to bring data forward that shows how covering implants in the ASC setting would save the system money overall while dramatically improving access to care, particularly for underserved populations.
"Patient experience continues to be a driving force behind all of this. ASCs consistently deliver care that is more personal, more efficient, and often safer for patients who can recover at home rather than in a hospital. We see it every day at Gramercy. Patients come back to us again and again, not because of a single physician, but because they trust the experience. That kind of confidence does not happen by accident. It comes from well-designed workflows, strong clinical partnerships, and technology that support safety at every step, from documentation to consent to inventory control.
"I am also excited about the opportunity to strengthen collaboration across states in a more structured way. As more states adopt cardiac and other advanced procedures in ASCs, there is a real need to connect leaders, share data, and shorten the learning curve. We should not be reinventing the wheel state by state. By working together, we can expand access faster and more responsibly.
"Ultimately, the next phase for ASCs is about moving forward without losing sight of why we exist in the first place. This is about getting patients the care they need, in the right setting, at the right time. If we stay focused on that, and continue to support one another as an industry, the opportunities ahead are significant."
Lindsay Hanrahan, Vice President of Product Management, Surgical Information Systems
"This year, the focus becomes less about whether organizations adopt enterprise technology models and more about how they move through that transition successfully. Many of our largest customers are still midstream, and that work is significant. Moving to the cloud and standardizing technology across an organization is not something you declare done overnight. It requires sustained commitment, coordination across teams, and a realistic understanding of the time and effort involved.
"Another area that will continue to gain momentum is interoperability. Over the past few years, customers have moved from having limited connectivity between systems to adopting integration and starting to see real benefits from shared data and integrated workflows. That initial success has created a flywheel effect. As organizations experience time savings and operational improvements, they come back looking for additional ways to automate and streamline processes. In 2026, we expect that demand to continue, with a more thoughtful and intentional approach to where automation can be advanced to further maximize value.
"Automation and artificial intelligence (AI) will increasingly be part of that conversation, but in a practical way. The goal is not to replace expertise or remove the human element, especially in clinical and quality-focused workflows. Instead, it is about using technology to better leverage limited resources and reduce unnecessary manual effort. The most successful use cases are the ones that support people in doing their jobs more effectively, while preserving the judgment and oversight that remain essential in healthcare.
"Overall, 2026 is about further advancing what has already been set in motion. The technology is available, the commitment is there, and now the work is in execution. Helping organizations navigate that complexity, adopt at scale, and use their systems in a way that truly supports day-to-day operations will be the defining challenge and opportunity in the year ahead."
Nate Kiely, Chief Strategy Officer, Surgical Information Systems
"With the 2026 CMS (Centers for Medicare & Medicaid Services) rule finalized, it's clear that the pace of change is only accelerating. ASCs have more room than ever to expand the procedures they offer, and that opens the door to growth. But it also raises expectations. This year will test how prepared centers really are to operate in a more complex environment.
"Technology will undoubtedly be a big part of that readiness. As volumes grow and procedures become more advanced, disconnected systems and manual workarounds start to fall apart. ASCs need platforms and partners that provide clear visibility into scheduling, documentation, billing, and reporting, without creating more work for staff.
"Revenue cycle performance will matter even more as higher-value cases move into the ASC setting. There's far less margin for error. Breakdowns in pre-authorization, charge capture, or documentation can quickly lead to meaningful revenue loss. Centers that invest in strong RCM processes and use data to stay ahead of payer behavior will be in a much better position as their case mix continues to change.
"Compliance and quality will also stay front and center in 2026. Even as reporting requirements evolve, expectations around accountability and transparency aren't going away. Having the right tools to track quality, support compliance, and respond quickly when issues arise will be essential, not just for regulators, but for payers and patients as well.
"Overall, 2026 feels like a true inflection point. ASCs are playing a bigger role in healthcare delivery, and the ones that succeed will be those that plan ahead, invest wisely, and make sure their operations are flexible and truly ready to scale."
Jessica Nelson, Senior Vice President of RCM Operations, Surgical Information Systems
"While much of the groundwork started in 2025, 2026 is really the year where scaling becomes the focus. We are looking at our operations from a much bigger, more global perspective, with the goal of supporting continued growth as more facilities view RCM (revenue cycle management) outsourcing not as a commodity, but as a strategic model. That shift in mindset from clients is significant, and it raises the bar for how we think about performance, consistency, and outcomes.
"A major priority this year is moving automation and AI from pilot projects into the core of our operating model. It is no longer optional or supplemental. Technology has to be foundational to how we work if we want to keep pace with demand and maintain quality. We have spent time defining and prioritizing our strategic initiatives, with a clear emphasis on embedding automation directly into workflows rather than layering it on afterward.
"There are some exciting opportunities ahead, particularly around more advanced AI capabilities, including more automated and autonomous appeal writing and continued evolution in coding and denial management. Our focus is especially strong on A/R (accounts receivable) and denial management, where automation can have a meaningful impact on both efficiency and results. As we move through 2026, the goal is to make these tools a seamless part of how we operate every day, setting us up not just for this year, but for sustained growth beyond it."
Colleen Ramirez, RN, CASC, Chief Administration Officer, Bone and Joint Surgery Center of Novi
"Looking ahead, I do have some concerns, particularly about potential challenges related to the ACA (Affordable Care Act) and how these changes will affect case volumes and revenue. Despite the growth of high-acuity programs like total joints, many ASCs are still struggling with rising costs for implants and specialized supplies, which are increasing at a pace that exceeds the Consumer Price Index (CPI) adjustments made by CMS. This situation could mean that high-volume cases might generate lower net profits unless we adopt aggressive supply chain management and case costing strategies.
"While we've shown that shifting cases from hospitals to ASCs can yield cost savings, insurance companies have been hesitant to negotiate higher fee schedules. The process is dragged out for months, even years, only to yield a small bump in the contract. This reluctance poses a threat to the financial health of many ASCs.
"Another hurdle we face is the growing complexity of prior authorizations. Many offices are feeling the strain of extended timelines and the added workload these processes entail, which can delay patient care and disrupt operations in the office and at the ASC. The last thing we want is to reschedule or cancel a case because the authorization never came through in time. This task often necessitates hiring additional staff to manage the increased workload, but such proposals are often hindered by budget constraints and a lack of prioritization, leaving surgical schedulers to manage the additional work of prior authorizations themselves.
"I'm enthusiastic about continuing to cultivate a positive work environment for our staff. One of the key aspects of this is our friendly and approachable management team, which fosters an inclusive atmosphere.
"After spending 2025 focused on growing and cross-training my team, I am excited to watch them shine in their roles. As they gain confidence and expand their skills, it's rewarding to see their happiness and engagement reflected in their work.  We regularly solicit feedback through one-on-one meetings. This not only makes employees feel valued but also helps identify areas for improvement. We also prioritize work-life balance, and while our four-day work week is one of the benefits we offer, it's just part of a broader commitment to flexibility. We also invest in our team's professional growth and knowledge of surgery center regulations and operations. Ultimately, we strive to provide our employees with a fulfilling experience, ensuring they feel engaged and appreciated. A supportive workplace not only enhances staff satisfaction but also translates into better care for our patients."
Raghu Reddy, Chief Administrative Officer, MiOrtho Surgery Center
"This is shaping up to be an important year. At the center level, our focus for 2026 is on continuing to optimize what we already have in place so we are fully prepared for what comes next. That means making sure workflows are streamlined, integrations are complete, and teams are using the technology the way it was designed to be used. Once that foundation is solid, it makes sense to start layering in more advanced capabilities.
"One area I am especially excited about is the practical application of AI. We are already seeing benefits from automation, and I believe AI has the potential to take that a step further, particularly when it comes to efficiency and better use of resources. But AI is not something you simply drop into an environment that is not ready. To be successful, centers need a strong technology foundation first, and that is where much of our focus will be heading into 2026.
"From an industry perspective, there are some real headwinds. Reimbursement rates have not kept pace with inflation, while costs continue to rise across the board. That gap puts pressure on ASC margins and forces administrators to find new ways to operate more efficiently. At the same time, CMS continues to accelerate the migration of cases from hospital outpatient departments into the ambulatory setting. Conversations around site-neutral payments are likely to intensify, and those changes will have meaningful implications, especially in certificate-of-need states where hospitals still dominate the market.
"Quality reporting and data requirements are also increasing. As those measures continue to evolve, technology will be essential for capturing data accurately and qualifying for quality-based incentives. Most new ASCs are already opening with EHRs in place, and I expect that trend to continue. AI will likely follow, becoming more broadly applicable as solutions mature beyond isolated or experimental use cases.
"Finally, I am excited about what lies ahead through ASCA (Ambulatory Surgery Center Association). With my term on the ASCA Board of Directors beginning this year, I am encouraged by the organization's focus on advocacy, benchmarking, and administrator development. These resources are becoming increasingly important as the industry navigates reimbursement pressure, consolidation, and growing complexity. While there are challenges ahead, there is also a tremendous amount of opportunity for ASCs that invest in technology, efficiency, and data-driven decision-making."
Daren Smith, Vice President of ASC Solutions, Surgical Information Systems
"A lot of what we're seeing today comes down to capacity. Construction costs are still massive, and most centers can't just add space anymore. When leaders start looking at their capacity alongside the growing list of procedures that can be done safely in the ASC, something has to give. To maintain throughput, some lower-acuity cases are going to move out to offices, and higher-acuity procedures are going to move in because they can — and because they make sense from both an access and profitability standpoint.
"That shift also changes how ASCs tell their story. It's one thing to market a cataract case with a $100 savings. It's another to tell a patient they can save $5,000 on a total joint by choosing a surgery center. That's a much more compelling message, and I think we'll see more centers lean into that as competition for patients increases and cost transparency becomes more important.
"I'm also excited about AI, with a healthy dose of realism. Right now, we're using it primarily on the internal side — making our support teams and development processes more efficient — and customers will start seeing more AI-powered features soon. I see AI as a smarter form of automation. It's a tool, not a revolution, especially in healthcare. I'm still pretty skeptical about near-term clinical AI. It has a long way to go before it can apply best practices in an EHR (electronic health record) the way experienced clinicians do, and I don't think anyone should view it as replacing clinical judgment.
"Staffing pressures are another trend that isn't going away in 2026. For a long time, we could just throw people at problems. That's not an option anymore. There aren't enough people, and costs are too high. Technology has to pick up that slack. The right systems allow staff to work at the top of their license and reduce the burden of tasks that don't require a human touch. That's where I see the industry continuing to head: using technology thoughtfully to adapt to economic realities while still supporting quality, safety, and better outcomes."