The ASC market is undergoing a major transformation, fueled by clinical innovation, payer pressures and shifting investment dynamics, according to VMG Health’s 2025 Healthcare M&A Report, released on April 22.
Here are five trends shaping the ASC industry, according to the report:
1. Consolidation is reshaping the market
The historically fragmented ASC sector, with about 68% of facilities operating independently as of 2023, is consolidating rapidly as healthcare giants race to scale their portfolios.
In 2024, UnitedHealth Group (parent of Optum) and private equity firm TPG reportedly pursued acquisitions of Brentwood, Tenn.-based Surgery Partners. In January, Bain Capital — already a 39% shareholder — made a $3.2 billion nonbinding offer to acquire the company outright. VMG Health noted that folding Surgery Partners into Optum, which already owns SCA Health, would strengthen UnitedHealth’s dominance in the outpatient market.
These moves highlight outpatient surgical platforms as a strategic priority for major players. ASC valuation multiples have stabilized around 8x EBITDA, indicating a maturing, increasingly competitive market.
2. Private equity has a new ASC strategy
Private equity firms remain active in the ASC space but are shifting their approach. Instead of building standalone ASC platforms, firms are increasingly integrating ASC investments with physician practice management companies to better control the care continuum and diversify revenue, according to the VMG Health report.
While new platform deals have been scarce, steady transaction activity through mid-2024 signals sustained interest. Minority stakes and add-on acquisitions are the new norm, reflecting a disciplined but aggressive investment strategy.
3. Operators begging big on higher-acuity specialties
ASC growth strategies are now heavily focused on high-acuity, high-margin specialties like orthopedics, spine and gastroenterology.
Tenet Healthcare’s United Surgical Partners International reported a 19.4% year-over-year increase in total joint cases in 2024. Additionally, USPI is exploring opportunities to “migrate certain lower-acuity, higher-volume types of activities out of the ASCs,” Tenet Healthcare CEO Saum Sutaria, MD, said in a recent earnings call.
Additionally, Surgery Partners performed over 117,000 orthopedic cases in 2024, an 11% increase from 2023 and saw a 50% rise in total joint procedures.
Operators are scaling aggressively: Tenet alone added nearly 70 ASCs to its portfolio in 2024 through both acquisitions and de novo development. According to VMG Health, success will increasingly depend on capturing complex surgical cases in lower-cost outpatient settings — and building national networks to support that shift.
4. Outpatient and ASC volumes set for sustained growth
The macro outlook for ASCs remains strong. Sg2’s 2024 Impact of Change Forecast projects a 21% increase in ASC volume over the next decade, compared to a 17% rise for outpatient volumes overall.
Several forces — payer incentives, consumer preferences, clinical advances and competition — are propelling this growth, especially in specialties moving complex procedures out of hospitals. Procedures performed in hospital outpatient departments can cost up to 58% more than those at ASCs or physician offices, according to Blue Health Intelligence.
Health systems are taking notice: a 2024 VMG Health survey found that 60% of system executives were considering outpatient surgery joint ventures, the highest level of interest among all potential specialty partnerships.
5. Small ASCs pose new benefits
New data suggests that smaller ASCs may hold an edge in today’s evolving market. HST Pathways’ latest “State of the Industry Report” found that leaner, more specialized centers are thriving.
HST Pathway’s survey of 590 ASCs found a stark contrast in revenue performance between small and large ASCs. From 2023 to 2024, ASCs operating with just two operating rooms reported a 22% increase in year-over-year revenue. In contrast, facilities with 15 or more ORs saw their revenue decline by 8%.
“This surge may indicate that smaller ASCs are becoming more efficient or are better positioned to adapt to market demand,” the report said. “These trends suggest a shifting dynamic in ASC performance, with smaller centers thriving while larger ones face headwinds.”
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