Editor’s note: This response has been lightly edited for clarity and length.
Question: What specific legislative or regulatory barriers have been the most problematic in ASC development?
Dr. Shakeel Ahmed: Certificate-of-need laws, Stark law restrictions and site-neutral payment disparities remain the biggest barriers we face. Certificate-of-need laws are outdated relics that still exist in several states, requiring surgery centers to prove public need before opening — a monumental task that local hospitals successfully block in most cases.
The lack of site-neutral payments means Medicare continues to reimburse hospitals at significantly higher rates than ASCs, currently almost 80% more for the same procedures. In a fair system, this disparity would drive elective cases to outpatient settings, but that shift still hasn’t happened.
Meanwhile, anti-self-referral laws like Stark law and anti-kickback statutes make it difficult — or even risky — for physicians to invest in or directly access ASCs, even when they know they can provide better patient outcomes at a lower cost.