In a defining move for the ASC landscape, St. Louis-based Ascension has signed a definitive agreement to acquire AmSurg, a major ASC operator with 250 locations across the country.
The transaction will expand Ascension’s ASC footprint from 58 to more than 300 centers in 34 states — a fivefold leap that places it in direct competition with Tenet Healthcare’s ASC giant, United Surgical Partners International.
The deal, reportedly valued at $3.9 billion and expected to close in late 2025 or early 2026, reflects more than a growth strategy. According to industry leaders, it marks a pivotal moment in how health systems engage with outpatient care.
“This transaction reflects a broader recalibration among health systems, which are increasingly recognizing the imperative to pivot more aggressively toward the ambulatory surgical setting — and away from traditional inpatient and HOPD models,” Benjamin Stein, MD, chairman and CEO of Capital Surgical Solutions, told Becker’s.
Dr. Stein believes Ascension is uniquely equipped to turn this acquisition into long-term value.
“For any ASC acquisition strategy — whether through large consolidators like AmSurg or Surgery Partners, or via independent centers — to translate into sustained economic success, the acquiring entity must possess the ability to activate key downstream levers that maintain the active engagement of the physicians who are migrating their patients to these sites of care,” he continued. “Health systems such as Ascension are uniquely positioned to do this.”
Unlike private equity players, health systems bring integrated payer relationships, managed care contracts and value-based infrastructure, all crucial for ASC scalability in today’s payment environment.
AmSurg, based in Nashville, Tenn., is one of the largest players in the outpatient surgery market. Through partnerships with more than 2,000 physicians, the company offers operational support, clinical infrastructure and national scale.
“We have 58 ASCs. This is going to add another 250, so it’s going to give us a good presence in 34 states,” Ascension President Eduardo Conrado told Becker’s. “And AmSurg has a great management team. They’ve got an operational platform that mirrors their areas of focus, which is quality, clinical engagement and patient experience — in a [the ASC market] that’s growing 9% to 12% over the next five years. So, everybody’s very excited about coming up on this next step.”
In a June 17 release, Ascension CEO Joe Impicciche positioned the acquisition as mission-aligned: expanding access to affordable, localized care while enhancing capacity for procedures that are rapidly shifting out of hospitals — such as orthopedics and cardiology.
Within the industry, reaction to Ascension’s move has been cautiously optimistic. Tammy Smittle, RN, CEO of Stonegate Surgery Center — a joint venture with SCA Health and Ascension — told Becker’s she is “happy to have them part of our team.”
Wes Battiste, CEO of Destin (Fla.) Anesthesia and advisor at Avanza, sees the deal as a long-overdue jumpstart to Ascension’s outpatient strategy.
“Ascension, even admittedly so, has had very little success developing their ASC portfolio with productive ventures,” he said. “We are seeing in our advisory work at Avanza, health systems ramping up their ASC strategy. These health systems are realizing the payors, physicians, patients and politics are going to drive the volume and associated revenue to the ambulatory setting. If the health systems are not in front of this, they will surely be left behind.”
Mr. Battiste praised AmSurg’s leadership, particularly COO Keith Hennegan, calling the culture “authentic” and “best-in-class.” He cautioned that the success of the deal depends on how much freedom Ascension allows AmSurg to maintain its identity.
“I look forward to seeing the outcome of this buyout, and just hope Ascension is wise enough to allow AmSurg and its leadership to steer this ASC initiative and not attempt to convert the model into a hospital model,” he said.
The timing of the deal comes as financial pressures mount across the healthcare system. The latest Medicare Trustees report projects earlier-than-expected depletion of trust funds, reinforcing the need to shift surgical volume into lower-cost, outpatient settings.
“Moving cases to lower cost environments is not only strategically important, but it’s also a health policy imperative,” said Scott Kulstad, CEO of St. Paul (Minn.) Eye. “I don’t think we needed more signals to tell us of that truth, but we certainly have one.”
With the AmSurg deal, Ascension is no longer a peripheral player in the ASC space, it’s a top-tier competitor. As Dr. Stein put it, “This is a watershed moment for the ASC industry.”
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