Historically dominated by independent physician-owned models, The ASC industry is shifting towards hybrid ownership structures involving hospitals, private equity firms and corporate healthcare platforms.
Despite growing consolidation, the shift remains gradual. Independently owned ASCs made up 67% of the market in 2024,down slightly from 68% in 2023, according to a report from VMG Health.
Still, many physician-led centers are confronting financial limitations that make independence unsustainable. Many are being “bought out by larger entities because they can’t sustain themselves,” Bill Rhoades, COO of Harrisburg (Pa.) Endoscopy & Surgery, told Becker’s. “Their return on investment is lower than expected.”
Hospitals, private equity firms and national chains see ASCs as prime territory for growth. The drivers include declining physician reimbursements, a payer push toward outpatient care and a press towards economies of scale .
Bonnie Greenblatt, director of ambulatory surgical services at Michigan Institute of Urology, summed up the shift:
“Private equity, hospital and health systems, consolidation and platform alliances, along with the traditional model of physician ownership are all examples of current ownership models,” she told Becker’s. “As more private practices are purchased by private equity groups and more physicians become hospital employees, I think the changes coming our way are more hybridized and joint venture models that will begin to take hold over the traditional physician or practice owned facilities.”
Additionally, she added, as payers push for cases to be performed in outpatient settings, “hospital and health systems will look toward partnering with large private equity owners and larger platform alliances to create mega-ASC platforms.”
Hospitals, eager to protect surgical revenue amid the shift away from inpatient care, are becoming more aggressive in pursuing partial or majority ownership of ASCs. A recent survey of health system executives by VMG Health found that 60% of leaders were considering pursuing outpatient surgery joint ventures in 2024 — the highest area of interest of any potential specialty partnerships.
In June, St. Louis-based Ascension 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.
“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.
Meanwhile, private equity firms continue to fuel consolidation, investing heavily in platforms that aggregate ASCs for scale and returns.
Patrick McEneaney, DPM, owner and CEO of Northern Illinois Foot & Ankle Specialists, said hospitals are aware of payer-driven outpatient migration and don’t want to miss out.
“You are going to see more hospitals look to open ASCs or purchase ASCs, even if it is only a partial interest in them,” he told Becker’s.
ASCs can also benefit from these joint ventures. When designed more justly and collaboratively, however, these partnerships can produce positive long term results for all parties involved.
“We’ve been able to get better reimbursement rates by having a hospital be the majority stakeholder,” Bruce Feldman, administrator of Eastern Orange Ambulatory Surgery Center in Cornwall, N.Y., told Becker’s. “They have a whole contracting department at their disposal. So that was one of the biggest reasons why the hospital became involved here in the first place, and the partners decided to sell their shares to the hospital.”
Other leaders are more wary of collaboration. As new stakeholders flood the market, many physicians are seeing their independence squeezed. While many joint ventures preserve some physician equity, decision-making often shifts to corporate investors and administrative leadership.
“There are several modes of consolidation, and ultimately nearly all of them result in a loss of physician autonomy to varying extents,” Joseph Lamplot, MD, orthopedic surgeon at Endeavor Health Orthopaedic & Spine Institute, told Becker’s. “As such, the desire for autonomy conflicts with physician consolidation.”
Surveys support this. Around 61% of employed physicians said they have moderate or no autonomy to make referrals outside of their practice or ownership system, and 47% said they adjust patients’ treatment options to reduce costs based on practice policies or incentives, according to a survey from NORC at the University of Chicago.
Jane Whinnery, COO of WellBridge Surgical, noted that while physician ownership hasn’t disappeared entirely, the prevalence of wholly independent ASCs is shrinking.
“We see less completely independent surgery centers and more hospital-weighted ownership in the hospital-physician joint venture surgery centers,” she said.
Additionally, some ASC physicians and leaders perceive a growing emphasis on professional autonomy, prompting the emergence of ownership and management models that prioritize independence over traditional acquisition structures.
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