Advocacy Pays Off for ASCs - Scorecard - MDSpire

Advocacy Pays Off for ASCs

At the Outpatient Ophthalmic Surgery Society’s “OOSS Perspective 2026” symposium in Washington, DC, the organization's Washington counsel, Michael Romansky, JD, delivered an update on reimbursement, regulatory developments, and advocacy priorities affecting ophthalmic ambulatory surgery centers (ASCs).

  • By

  • Jennifer Ford, content director

  • Jennifer Ford, content director

  • May 1, 2026

  • 4 min

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Clinical Scorecard: Advocacy Pays Off for ASCs

At a Glance

CategoryDetail
ConditionOphthalmic Ambulatory Surgery Centers (ASCs)
Key MechanismsAdvocacy for reimbursement and regulatory changes impacting ASCs.
Target PopulationPatients undergoing ophthalmic surgeries, particularly cataract and retina procedures.
Care SettingOutpatient surgical centers.

Key Highlights

  • CMS proposed a 4.7% reduction in ASC payments for 2026, which was changed to a 3.4% increase after advocacy.
  • Advocacy efforts resulted in approximately $150 million for ASCs performing cataract surgery.
  • CMS will determine the update factor for ASCs in 2027, with recommendations to retain the Hospital Market Basket.
  • Concerns raised about narrow definitions for non-opioid drug payments and compliance issues with prior authorization.
  • Legislative efforts include the Outpatient Surgery Access Act of 2026 to address reimbursement concerns.

Guideline-Based Recommendations

Diagnosis

  • Monitor compliance with CMS prior authorization requirements.

Management

  • Advocate for broader definitions of eligible non-opioid drugs for separate payment.

Monitoring & Follow-up

  • Stay vigilant regarding payment restrictions for MIGS combination procedures.

Risks

  • Potential penalties for noncompliance with patient satisfaction survey vendor contracts.

Patient & Prescribing Data

Patients undergoing cataract and retinal surgeries.

Increased reimbursement for retina cases is being sought due to rising demand.

Clinical Best Practices

  • Engage in grassroots lobbying to influence policy changes.
  • Utilize OOSS advocacy tools to contact legislators.

References

Original Source(s)

Advocacy Pays Off for ASCs

  • by Jennifer Ford, content director, Jennifer Ford, content director

  • May 1, 2026

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