Now that 2026 is well underway, it is an appropriate time to take stock of the many significant developments that shaped ambulatory surgery centers (ASC) last year. In many ways, 2025 was a pivotal period for the industry — bringing notable progress alongside familiar operational and regulatory challenges. Taken together, the year strengthened the ASC landscape and helped lay the groundwork for continued advancement in 2026.
To better understand the forces that defined 2025, we asked several leaders from Surgical Information Systems (SIS) and the broader ASC community to share their insights on the trends, achievements, and issues that mattered most. Note: The responses below are presented in alphabetical order.
New ASCs Open as Demand for Complex Care Grows
Janet Carlson, MSN, BSN, RN, NE-BC, FACHE, CEO and Co-Founder, Vertex Surgical Solutions
"When I look back on 2025, my proudest accomplishment was opening three surgery centers from the ground up. Two were in Indiana, a non-certificate of need (CON) state, which allowed for true multi-specialty services. The third was in Kentucky, one of the strictest CON states, and it is now preparing to go through the survey process. Getting all three centers ready for survey and delivering patient care were major milestones for me, both professionally and personally.
"What made it especially meaningful is that I did this without the backing of a health system or management company. Those organizations usually have entire teams dedicated to development. I did it myself, with the help of the administrators I hired to run each facility. Starting in mid-2023, I found the land, build the centers, and deliver fully operational ASCs with PTANs (provider transaction access number) and payer contracts in place in less than 2.5 years. That is something I am incredibly proud of.
"From an industry perspective, 2025 also felt like a turning point. It was the first year ASCs were required to collect and report patient satisfaction data (OAS CAHPS), further reinforcing the reality that surgery centers are now essentially held to the same standards as small independent hospitals. At the same time, ASCs continued to prove they can safely and confidently handle higher-acuity cases. We saw growing momentum in cardiovascular services, interventional radiology, vascular access, and general surgery moving out of the hospital and into the ambulatory setting. That migration to the correct site of service is a big deal, and it is only increasing demand for ASC solutions."
Advocacy and Collaboration Advance Cardiac Care Expansion
Jeffrey Flynn, CASC, Administrator and COO, Gramercy Surgery Center
"I look back on 2025 with a lot of optimism, particularly in New York State. We made real progress moving cardiac procedures into the ASC setting, and for the first time, the state committed to a phased approach with clearly defined steps. That did not happen by accident. It took years of advocacy, persistence, and making sure we continued to clearly articulate who we are as an industry and why ASCs belong in these conversations.
"One of the challenges we continue to face is the narrative around for-profit surgery centers. That came up repeatedly during discussions around cardiac care, with claims that ASCs are somehow less safe or less appropriate. What often gets overlooked is that many of the voices opposing this shift come from highly compensated hospital executives, while ASCs are being held to strict quality, safety, and reporting standards. We can never afford to stop telling our story, because if we do, someone else will tell it for us.
"What was encouraging in 2025 was the growing recognition that healthcare costs are simply not sustainable. CMS took a meaningful step by expanding the list of procedures that can safely be performed in the ASC setting, acknowledging what many of us already knew: many procedures performed in hospital outpatient departments are already same-day cases. Moving them into ASCs improves access, lowers costs, and maintains quality. We also saw something important happen at the state level. The New York State Health Commissioner (James McDonald, MD, MPH) and Governor Kathy Hochul both visited surgery centers during the year, which sent a clear signal that ASCs are part of the solution, particularly as the state grapples with Medicaid cost pressures.
"Another positive development was collaboration between states. When New York needed data to support cardiac expansion, states like Texas were incredibly open to sharing their experience and outcomes. Illinois, Pennsylvania, and other CON states were also moving in similar directions. That kind of cooperation matters, because no state operates in isolation, and sharing data and best practices accelerates progress for everyone."
Technology Transformation Accelerates Across the ASC Industry
Lindsay Hanrahan, Vice President of Product Management, Surgical Information Systems
"What really stood out to me was the scale of change management we saw across the ASC industry and among our customers. Over the past year, we made significant progress supporting large, enterprise customers as they moved to the cloud and adopted technology in a more unified, system-wide way. While this work is still very much underway, seeing such strong commitment to that transition across so many organizations is exciting.
"With cloud solutions having been on the market for many years, freestanding ASCs using older products are increasingly ready to make the transition. They see that newer technology can provide a real advantage from operational, clinical, and financial perspectives. These capabilities drive patient and provider satisfaction and help centers remain competitive. Conversely, not having current technology can be a major disadvantage in all these areas. Many ASCs also recognize that adopting newer technology makes them more attractive if they are looking to be acquired. They can demonstrate their value with data and metrics and integrate more efficiently into a larger ecosystem.
"We also saw continued momentum around interoperability and smarter automation. As customers began to experience real benefits, such as reduced manual data entry and more streamlined workflows, it created a flywheel effect. Initial adoption built confidence, leading centers to look for additional opportunities to automate thoughtfully. At the same time, there has been a consistent emphasis on maintaining the right balance between automation and the human touch, especially in clinical quality and judgment.
"Another meaningful milestone for the industry in 2025 was navigating the first year of OAS CAHPS. It was challenging, and sometimes frustrating, as ASCs worked through new requirements while balancing everything else on their plates. The fact that so many centers made it through year one is an accomplishment in itself and sets the stage for using the data from those surveys more effectively moving forward. I am very proud that SIS was able to help customers by offering reports that enable CAHPS compliance, as well as integration options to automate the process of preparing and submitting reports on a recurring, timely basis."
Policy Changes Drive Shift to More Complex Care in ASCs
Nate Kiely, Chief Strategy Officer, Surgical Information Systems
"In many ways, 2025 was the year the ASC model truly gained traction. Federal policy continued to support the shift of surgical care away from inpatient settings, reinforcing what ASC leaders have known for years: surgery centers can deliver high-quality care more efficiently and at a lower cost than hospitals. That momentum built steadily and started to translate into real, exciting change across the industry.
"The expansion of the ASC Covered Procedures List (ASC-CPL) and the movement toward phasing out the inpatient-only list were especially important. These changes weren't just about adding procedures. They pushed ASCs to rethink how they operate day to day. Taking on more complex cases isn't only a clinical decision. It brings new expectations in areas such as technology, billing accuracy, and compliance, often at a scale many centers hadn't dealt with before.
"As case mix shifted, the operational and financial impact became harder to ignore. More advanced procedures tend to involve devices, bundled supplies, and tighter payer requirements, which increase both opportunity and risk. At the same time, quality reporting expectations continued to change. The centers that performed best in 2025 were those that understood early on that technology, revenue cycle management, and compliance aren't just back-office concerns. They're core capabilities that directly and substantially support growth and stability."
Integration Fuels Growth and Operational Progress
Jessica Nelson, Senior Vice President of RCM Operations, Surgical Information Systems
"Looking back, what stands out most to me is how much momentum came from bringing SIS and Surgical Notes together (following the SIS acquisition of Surgical Notes in late 2024) and seeing what that unlocked for our teams. The integration created opportunities not just operationally, but professionally, as people stepped into new roles, took on greater responsibility, and found ways to make a bigger impact for themselves and for the clients we serve. That kind of growth is energizing, and it sets the tone for everything else we worked on throughout the year.
"From an RCM (revenue cycle management) perspective, we continued building on the evolution of automation that has been a consistent theme in the industry. While there was nothing flashy or disruptive that suddenly changed everything, we made meaningful progress in areas like appeals and denial management. Those improvements had a real operational impact as the companies came together and volumes increased, allowing us to be more efficient and consistent in supporting our clients.
"Another important development was expanding our reach beyond serving only SIS clients. Through Surgical Notes, we were able to support the ASC industry more broadly, bringing new scale and complexity, while reinforcing the importance of process discipline and operational alignment. Overall, 2025 was less about a single headline achievement and more about steady, foundational progress that positioned us well for what comes next."
Efficiency Gains Paired With a Premium Patient Experience
Colleen Ramirez, RN, CASC, Chief Administration Officer, Bone and Joint Surgery Center of Novi
"With over 18 years in leadership within the ASC industry, I've come to appreciate the critical balance between operational efficiency and fostering a welcoming environment for our clinical staff, surgeons, and patients. In 2025, we made significant strides by streamlining our schedule and collaborating closely with our surgeons to optimize their block utilization. This resulted in less open block time and positively impacted both our efficiency and anesthesia's profitability.
"We've also focused on refining our large joint arthroplasty program, which has led to remarkable patient satisfaction. Patients often express their delight, noting how well our team interacts and how friendly and compassionate everyone is at our center. Our dedicated staff strives to create a 'Disney experience' in healthcare, and it's rewarding to see how this commitment distinguishes us and offers a premium level of healthcare concierge service.
"A transformative aspect of our operations has been the integration of AI to assist with reviewing contracts and analyzing operational data. This technology has been a game changer for us, significantly saving time and allowing our team to focus on more strategic initiatives rather than getting bogged down in data analysis and contract reviews."
New Leadership Role Brings Technology-Enabled Workflow Improvements
Raghu Reddy, Chief Administrative Officer, MiOrtho Surgery Center
"2025 was a busy year for me, both personally and professionally. I joined MiOrtho Surgery Center in July, which meant stepping into a larger, single-specialty facility focused on orthopedics, spine, and pain management. Coming from a multi-specialty environment, that took some adjustment, but in many ways, it also simplified how we operate. Working primarily with one specialty allows for more focused workflows and clearer priorities, and I have really enjoyed that transition.
"From a technology standpoint, the move itself was relatively smooth since both my previous center and MiOrtho use the same EHR (SIS Complete). That continuity allowed us to spend less time on system change and more time on optimization. Over the course of the year, we began migrating from our legacy compliance tools to SIS Comply. We also made a significant push around inventory management and leveraging the ENVI solution through SIS. A major focus has been integrating EDI (electronic data interchange) with most of our vendors and connecting that workflow directly to our financial system, with the goal of automating the supply chain from placing an order through invoice entry and payment. That level of integration takes time and effort, but it has already started to deliver real efficiency gains.
"The reason for focusing on these initiatives became clear pretty quickly. When I arrived, we took a close look at where our bottlenecks were and how staff time was being used. We realized that many tasks requiring manual effort could be streamlined or reassigned through better use of technology. By tightening workflows and using the systems we already had more effectively, we were able to redeploy resources and avoid expanding our staff. That experience really reinforced how critical technology has become to running a sustainable operation."
Mature Platform and Rising Adoption Reflect Changing Market Dynamics
Daren Smith, Vice President of ASC Solutions, Surgical Information Systems
"2025 was an exciting year for SIS, and that excitement definitely translated down to me personally. We're at a point now where the core SIS Complete product is in great shape — incredibly stable — and anything new we add isn't going to be for everybody, but that's a good place to be. It reflects a level of maturity where the platform is proven, and we can focus more on adding targeted capabilities that solve real problems for specific types of centers and specific needs.
"Last year, we had a record number of people choosing SIS, and that's energizing because the more customers we have, the more input we get. It allows us to be more proactive instead of reactive, and that ultimately makes the platform better for everyone.
"One of the most exciting developments for me, especially coming from a nursing background, was bringing SIS Comply into the fold. I spent years surrounded by three-inch binders — logs for this, logs for that — and every year I'd buy a stack of new binders just to keep up. Now, having a single place where logs, credentialing information, employee files, and training all live together is a game changer. It's another piece of the puzzle as we work toward the goal of having everything you need to run a surgery center under one roof.
"I was also really encouraged by the adoption numbers we saw around SIS Complete. More than 90% of customers choosing SIS are now opting for the EHR as well. Five years ago, that number was closer to 20%. That shift says a lot about where the industry is and what centers need as costs rise and staffing becomes more difficult.
"Industry-wide, we also saw some long-awaited movement in 2025. The ASC market had been stagnant for a few years, with just as many centers closing as opening. Last year, that changed, particularly with growth in cardiovascular ASCs. At the same time, we continued to see aggregation — the big players getting bigger and fewer independents — and I'm still a little conflicted about what that means long term."
