While consolidation among hospitals, private equity and large health systems has been a steady trend within the ASC and physician group space over the years, some leaders and physicians have seen signs of a renewed push toward independence.
“It feels like some of the glory days of M&A have passed us a little bit,” Whitt Holder, CEO of Amarillo (Texas) Urology Associates, told Becker’s. “We lived through a lot of healthcare systems wanting to buy practices and do joint ventures, but that has slowed down a little bit. And then private equity hit hard around COVID, and there was a lot of PE activity, but I feel like the PE activity slowed down a little bit, too.”
Mr. Holder’s observations align with some recent data. According to VMG Health’s 2025 “Healthcare M&A Report,” private equity was involved in 280 physician medical group transactions in 2024, accounting to 59% of total healthcare deals that year. This marks the lowest share of private equity activity since 2018, reflecting a decline from 80% of total deals in 2018.
Additionally, a number of new ASC companies and management services organizations have developed platforms specifically aimed at supporting physician independence and steering away from the traditional acquisition model that has shaped the industry over the last decade.
Mr. Holder told Becker’s that he has declined offers from private equity groups due to doubts he had about these organizations’ ability to keep patients’ needs and quality care at the forefront of their practices.
“I have my doubts, because in the end, you can squeeze out costs, but if you’re not providing good service and you’re not taking care of the patient, not taking care of the physicians, then over time, someone’s left holding the bag, and I think that’s where we’ll get in trouble,” he said. “If the money is being taken out in the beginning, there’s someone that’s going to have to pay the price in the end.”
Another MSO, ASCend Specialists, based in Gillette, Wyo., was designed to empower rural and independent ASCs through nonequity-based support. ASCend pivots away from corporate consolidation models by offering strategic growth planning, operational support and back-office management without acquiring ASCs or asking for equity stakes.
“We’re here to support and keep ASCs strong and independent,” Nortberto Orellana, CFO of ASCend, told Becker’s. “That’s really our goal. It’s not about absorbing or acquiring.”
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