ASC investments are entering a new phase, as health systems, payers and physician groups reshape the market through consolidation, integration and renewed pushes for independence.
Here are five new ASC investment and transaction trends to know:
1. Private equity shaping the market
Over the past decade, private equity firms have aggressively expanded into the ASC market, drawn by its fragmentation, profitability and growth potential. ASCs now perform over 60% of outpatient procedures, representing a $30 billion market, according to a report from the Private Equity Stakeholder Project.
Big PE buyouts have followed a familiar playbook: consolidating small centers under large platforms, optimizing for scale and eventually selling to corporate or nonprofit buyers. While these strategies improve efficiency and drive investor returns, they often come with higher debt burdens, pricing pressure and reduced transparency, the report found.
“Part-and-parcel to this strategy will be the current wave of venture and private equity-backed ASC platforms that are going to be looking for a home and liquidity,” Nicholas Aubin, co-founder and CEO of Los Angeles-based Commons Clinic, told Becker’s. “This is really the big get — bigger strategy.”
2. Health systems and payers absorb PE-built networks
A second wave of consolidation is underway as nonprofit and corporate systems — particularly St. Louis-based Ascension and UnitedHealth — acquire ASC platforms originally built by private equity. Ascension’s $3.9 billion purchase of Nashville, Tenn.-based AmSurg will add more than 250 centers to its network, while UnitedHealth’s SCA Health has absorbed PE-built platforms such as PE GI Solutions and U.S. Digestive Health.
According to PESP, these deals can often blur the line between investor- and mission-driven healthcare, creating vertically integrated systems that combine insurance, physician and facility ownership. The report adds that much of this consolidation occurs through smaller “roll-up” deals that evade antitrust thresholds.
However, other ASC leaders say the era of rapid-fire rollups is slowing. Investors are now taking a more targeted approach focused on infrastructure, payer contracting and operational optimization.
“While private equity continues to show interest in ASC rollups, many of these deals are no longer about explosive growth,” Maria Todd, director of business development at Red Rocks Surgery Center, told Becker’s. “They’re pivoting toward infrastructure optimization, market access and payer leverage. The goal is no longer just aggregation — it’s integration.”
Other health systems, like Dallas-based Tenet Healthcare, are reshaping business models to focus on its ASC arm, United Surgical Partners International, the largest ASC company in the country, while divesting hospital assets to boost profitability and streamline operations. Tenet sold 14 hospitals in California, South Carolina and Alabama in 2024 for more than $4.8 billion, sharpening its focus on outpatient care. Today, USPI accounts for a significant portion of Tenet’s financial performance, operating 520 ASCs and 25 surgical hospitals across 37 states.
3. The pendulum swings toward independence
Even as consolidation accelerates, many leaders believe the pendulum is swinging back toward clinician-owned independence, but with smarter alliances.
“I believe the pendulum is beginning to swing back for clinician-owned ASCs. We have seen large, national surgery center companies accumulate centers like we are heads of cattle,” Alejandro Badia, MD, hand surgeon at Miami-based Badia Hand to Shoulder Center, told Becker’s.
According to a survey from consulting firm Bain & Co., nearly 25% of physicians in health system-led organizations are contemplating a change in employers, compared to just 14% in physician-led practices. Of those considering a switch, 37% are looking to move to physician-owned settings.
Physician groups are now forming coalitions that preserve autonomy while achieving scale.
“We are building a national coalition of independent ASCs and physician-owned hospitals that bundle risk, admin and finance,” Dutch Rojas, CEO and founder of Physician Capital, told Becker’s.
ASC innovators such as Sapient Health and Surgical Solutions IPA are developing new models that blend MSO infrastructure with physician-led governance, offering ASCs a middle path between independence and consolidation.
4. A new era of physician alignment
Surgeon-majority-owned groups are redefining what ownership means. Benjamin Stein, MD, orthopedic surgeon and chairman of Capital Surgical Solutions, told Becker’s that a “new era” of ASCs is emerging — one centered on alignment, autonomy and collaboration, not just equity returns.
“There’s always going to be different models of ASCs because it’s so regionally based,” Dr. Stein said. “There’s always a role for independents that are truly surgeon-owned and controlled.”
He emphasized that surgeon engagement is the key to success across all ownership models.
“There has to be alignment so surgeons feel they have real input on controlling elements — whether performing surgery or managing patients,” he said. “They should be part of decisions that affect quality and efficiency.”
Other ASC leaders agree.
“A major shift is occurring in how surgeons are viewed in M&A deals,” Janet Carlson, vice president of ASCs at Commonwealth Pain and Spine, told Becker’s. “Rather than being passive participants, physicians are now seen as essential stakeholders.”
5. Specialty-specific investment takes center stage
ASC growth is increasingly concentrated in high-acuity, high-margin specialties such as orthopedics, spine and cardiology. USPI saw a 19.4% increase in total joint cases in 2024, while Brentwood, Tenn.-based Surgery Partners performed more than 117,000 orthopedic cases, up 11% from 2023, and reported a 50% jump in total joint procedures.
Tenet added nearly 70 centers last year, with CEO Saum Sutaria, MD, noting a shift toward “migrating lower-acuity, higher-volume activities out of the ASCs” to focus on complex, profitable cases.
Gastroenterology remains one of the fastest-growing service lines. According to HST Pathways, GI ASCs saw 19% year-over-year case growth, with block utilization rising to 58% and average revenue per case hitting $1,420, despite mounting claim denials.
Cardiology is another fast-growing ASC specialty. According to Avanza’s 2022 “Key ASC Benchmarks and Industry Figures” report, cardiology procedures saw the highest estimated Medicare payment increases in 2021.
Meanwhile, investors are moving into niche markets like pediatrics. In 2025, Regent Surgical Health partnered with Patches Kids Care to open its first pediatric-focused ASC in Houston. Similarly, Great Hill Partners acquired Blue Cloud Pediatric Surgery Centers, the nation’s largest pediatric ASC operator.