The days of flying free and fast below the regulatory radar appear to be over for the cottage industry that is outpatient surgery, which at the tender age of 20 finds itself square in the political crosshairs with a bull's eye on its back and a bounty on its head.

Outpatient surgery's crime: Too big. Too fast.

Four of every five surgical procedures are done on an outpatient basis today. That's 35 million cases per year.

Outpatient surgery's punishment: Slow death by legislation.

Once healthcare's darling, once a novelty that accounted for one-half of 1 percent of the Medicare program, outpatient surgery is now a runaway train that has shown no sign of slowing down ... until a few overofficious elected officials started pumping the brakes with legislative sanctions.

"What happened to the praise for the ASC industry for being efficient, cost-effective, patient-friendly and profitable?" wonders ASCs, Inc., founder and president Jon Vick. "The ASC industry may be transitioning from a cycle of exceptional growth and prosperity to a cycle of increased scrutiny that requires new strategies for success."

You're holding in your hands a 112-page testament to the regulatory attack ASCs are under. For this issue, we talked to as many attorneys as we did administrators to bring you the latest on:

• The new list of ASC-reimbursable procedures that takes effect July 1 and seems to have been constructed on this premise: If ASCs are profitable, it's because Medicare payments are too high.
• A Senate bill that would annihilate surgical hospitals, which happens to be the subject a new and long-overdue department called Legislative Update that debuts on page 24.
• An Office of Inspector General advisory opinion that concludes that multi-specialty ASCs owned by a group-practice entity that includes such non-utilizers as primary care doctors may be illegal under the federal Anti-Kickback statute.
• And finally, on page 112, a really good rant against all this scrutiny by David Shapiro, MD, the president of the AAASC and senior vice president of medical affairs for Surgis, Inc.