Of all the specialties, the one that makes up about one-third of Medicare's ASC volume will be hit hardest by the government's new ASC payment system. We're talking about GI, of course. The new payment system will dramatically decrease the profitability of both single-specialty gastroenterology centers and multispecialty centers hosting GI services. In spite of impassioned protests by physicians and the GI societies in response to the proposed cuts, CMS carried out its reductions. Former CMS Administrator Mark McClellan said in October at the FASA conference that CMS "knew gastroenterologists would continue to see Medicare patients in ASCs even with the cuts." So here we are. Patients are still arriving and the cuts aren't going away. What now?