CMS’ 2026 Hospital Outpatient Prospective Payment System rule advances a major step toward site-neutral payment, aiming to reduce the long-standing Medicare payment gap between hospitals and physician offices. New site-neutrality reforms are expected to lower hospital payments, rather than boost ASC payments to HOPD levels. CMS—with value-based care, with site neutrality — is really wanting to push that,” he said. The widespread use of ASCs for specialty care has greatly improved access to these services, and site neutrality would continue that expansion, he said. “If they don’t figure[this] out, it’s eventually just going to happen — they’re going to make site neutrality.”