As the ASC industry matures, transaction activity is evolving, shaped by diverging strategies among private equity, health systems and independent operators. F
Here’s what five leaders have told Becker’s recently about what they’re seeing in today’s transaction landscape.
Shakeel Ahmed, MD, CEO of Atlas Surgical Group: Surgery Partners’ decision to walk away from Bain speaks volumes about where leadership sees long-term value creation. Our industry is still early in its maturity curve. We’re witnessing unprecedented migration of complex surgeries to outpatient settings, bundled payment models gaining traction, and increasing physician alignment. While private equity may see a ceiling, operators like Surgery Partners see a runway. I believe they’re betting that controlling more of this outpatient real estate over the next 5-7 years will yield far greater enterprise value than selling today. I personally refuse to sell shares on my franchise based on the same dogma. The ASC business is far too lucrative to bring in non-surgeon partners at this juncture in time.
Nicholas Aubin. Co-founder and CEO of Commons Clinic (Los Angeles): Over the next five years, I think there are going to be two prevailing M&A strategies in the ASC space: The consolidators like SCA, USPI and multi-market hospital systems are going to continue to pursue large-scale strategic acquisitions to further expand their footprint. 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. This is really the big get — bigger strategy.
The other side of this coin will be recapitalizations and turnarounds. Despite the rapid growth of facilities, there remains a long tail of broken physician syndicates and underperforming surgery centers that will be attractive to physician groups, physician practice management roll-up strategies, and others that bring strong physician alignment and new capabilities (i.e., service lines) to bear.
Across both strategies, I believe everyone will be looking to level up the stickiness/performance of their physician partners, as well as the complexity of care delivered in those sites to drive value for health plans and earnings for partners.
Edward Dixon. Sterile Processing Manager of Surgery Center Mountain View (Calif.): Over the next five years, mergers and acquisitions are poised to significantly reshape the ASC space — marking a clear shift from fragmented, independent operations toward large-scale, integrated systems.
The days of small, standalone ASCs springing up on every corner are dwindling. Instead, we’re witnessing a powerful trend: hospitals and health systems are increasingly forming partnerships with — or outright acquiring — ASCs to expand their outpatient footprint. This move isn’t just strategic; it’s essential in an environment where rising operational costs, complex reimbursement structures, and growing technological demands are squeezing smaller players out of the market.
Large systems benefit from economies of scale, particularly when it comes to supply chain leverage. A health system that manages dozens of ASCs can negotiate more favorable contracts with suppliers, optimize staffing models, and implement system-wide best practices — advantages a single-site or entity ASC simply can’t match. As a result, being part of a larger organization is no longer just an option; it’s becoming a necessity for long-term viability.
Richard Evans, MD. Vice President of Surgical Services and Director Mini Medical College at Bon Secours Charity Health System (Suffern, N.Y.): The greatest threat to ASC success depends on if the ASC is owned and operated by a hospital system or independently owned by practitioners. If an ASC is owned by private practitioners, the status of the ASC is predicated on if the practitioners remain independent or join a hospital system. The trend over the past decade has been for hospital systems to employ surgeons. In this scenario, the surgeons are often obligated to resign their ownership stake in their independently owned ASC and move their cases to the hospital employing them. The decreased volume weakens the financial stability of the ASC until enough of the stake holders resign and leave the independent ASC with insufficient volume to survive. A hospital system-owned ASC has the optimum opportunity for growth and expansion. The hospital system employed physicians must perform their cases in the hospital ASC — contingent only upon the medical status of the patient being conducive to outpatient treatment.
Allyn Wilcock, CRNA. Owner of Advanced Anesthesia Services and Northwest Healing and Wellness (Snoqualmie, Wash.): PE firms such as Bain Capital are betting big on ASCs, seeing the financial potential as surgeries continue to move to outpatient settings. While Optum is a giant corporation, it operates much like a PE firm, buying out more and more independent practices and surgery centers across the country. Independent ASCs can survive this upheaval if they have strict financial and accounting standards and a value proposition to draw patients and surgeons to their facilities. Partnering with an outpatient-focused anesthesia group, focused on quick, outcomes-focused care, can improve both finances and the value proposition independent ASCs bring to the table and set them apart in this world of corporate healthcare.
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