With rising healthcare costs and mounting pressure for efficiency, ASCs have become attractive targets for hospitals, health systems and private equity.
Here are five key trends shaping ASC transactions today, based on insights from 26 leaders:
1. Two emerging tracks of M&As
On one side, major players like SCA Health, United Surgical Partners International and large hospital systems are acquiring high-performing centers to scale regionally and nationally. This “platform building” model,often backed by private equity, focuses on geographic expansion, brand strength and payer leverage.
“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.”
At the same time, physician groups and practice management roll-up firms are targeting struggling centers for turnaround plays.
“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,” Mr. Aubin continued.
2. A return to the independent mindset
While consolidation surges, some leaders believe the pendulum may be 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.
Others are embracing coalition-style models that preserve autonomy while building 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 Inc., told Becker’s.
Additional innovators are rethinking how independence can be sustained. Sapient Health, based in New York City and founded by Joseph Romano and Bill Ingram, offers the infrastructure of a large MSO while maintaining a personalized, startup-like feel. Meanwhile, Surgical Solutions IPA, launched by Gregg Gordon in 2024, is one of the country’s first independent practice associations built exclusively for ASCs. Based in New York, the IPA unites independent centers to negotiate better contracts, streamline operations and strengthen their position in a consolidating market.
3. Physician alignment is a new priority
According to Janet Carlson, vice president of ASCs at Commonwealth Pain and Spine, M&A success now relies on surgeon leadership and buy-in.
“A major shift is occurring in how surgeons (the producers) are viewed in M&A deals. Rather than being viewed as passive participants, physicians are now seen as essential stakeholders,” she said.
This emphasis is especially critical in service lines such as orthopedics and anesthesia, where multidisciplinary alignment supports long-term operational success.
4. Private equity becomes more strategic
The era of rapid-fire rollups is fading. Today’s private equity investors are taking a more targeted approach, prioritizing infrastructure, payer contracting and operational optimization, according to Maria Todd, director of business development at Red Rocks Surgery Center.
“While private equity continues to show interest in ASC rollups, many of these deals are no longer about explosive growth,” she said. “Instead, they’re pivoting toward infrastructure optimization, market access and payer leverage. The goal is no longer just aggregation. Instead, it’s integration”
Ms. Todd noted that the most attractive acquisition targets now demonstrate sophisticated systems, including accurate case costing, automated billing and real-time operating room metrics.
“With ongoing CMS and employer pressure to shift volume out of hospitals, ASCs are poised to benefit, but only if they maintain cost transparency, bundle pricing options, and data to prove value,” Ms. Todd continued. “Acquirers view these elements as non-negotiable in their due diligence criteria.”
5. The threat to independent ASCs remains.
Independent centers still face significant headwinds: rising labor costs, lower reimbursement and tech demands, all without much external support. But some leaders are finding creative ways to remain competitive, from joint ventures to direct employer contracting.
“This trend is likely to accelerate due to economies of scale for supply chain and payer reimbursements; staffing efficiencies by sharing teammates with sister facilities in a city, like we do in Austin, Texas; and technology adoption for EHRs and patient engagement platforms,” Tammy Smittle, RN, group CEO of Stonegate Surgery Center and Northwest Hills Surgical Hospital, said. “This does threaten independent facilities by creating increased pressure for these ASCs to either align with larger entities or risk falling behind on payer contracts and compliance issues.”
The post Inside the ASC gold rush: 5 new transaction trends appeared first on Becker’s ASC.
